Carpal tunnel or tendonitis? How the two differ
Quick answer: Carpal tunnel syndrome is a nerve problem. It causes numbness, tingling and pain in the thumb and the next fingers, often at night. Tendonitis is a tendon problem. It causes pain that gets worse when you move the tendon, sometimes with swelling or a grating feeling. They can feel alike, and only an exam can tell them apart. This page is not a self-diagnosis tool.
Health note: This page is general information, not medical advice. If you have numbness, weakness, night pain or symptoms after an injury, see a doctor first. When to see a doctor
Is this a self-diagnosis tool?
No. Different problems overlap, and more than one can happen at once. Use this page to learn the words and to describe your symptoms well. Then ask a doctor or therapist. If you have numbness, weakness or a swollen, hot hand, do not wait. Sudden, severe pain with a pop or snap can mean a ruptured tendon. The NHS says to call 111 for that.
How do carpal tunnel and tendonitis compare?
| Carpal tunnel syndrome | Tendonitis or tendon sheath inflammation | |
|---|---|---|
| What is affected | The median nerve at the wrist | A tendon, or the sheath around it |
| Where it hurts | Thumb, index, middle and ring fingers, sometimes up the forearm | At the inflamed tendon, often at the wrist, thumb or a finger |
| Typical feeling | Numbness, tingling, burning, shock-like pain. Often worse at night. Shaking the hand often helps | Pain that worsens with movement, swelling, sometimes a grating or crackling feeling |
| Weakness | Weak grip or thumb, dropping things | Movement can be painful and limited |
| Typical tests | History and exam. Nerve conduction study, ultrasound or MRI if unsure | History and exam. Imaging only if another cause is suspected |
| Typical first steps | Night splint, less wrist bending, nerve gliding exercises. Painkillers may ease pain for a while but have little evidence of treating the cause | Rest for 2 to 3 days, then gentle movement, ice, a snug support, painkillers |
Sources: AAOS and NHS for carpal tunnel (AAOS, NHS); NHS for tendonitis (NHS); IQWiG for the German Sehnenscheidenentzündung (gesundheitsinformation.de).
Symptoms overlap, so read the table as vocabulary, not as a verdict.
Is carpal tunnel the same as RSI?
No. RSI is a loose term. The NHS describes it as pain caused by repeated movement of a body part, and notes that repetitive or strenuous work does not always cause it (NHS). Carpal tunnel syndrome is one specific problem that RSI-type pain can turn out to be. So can tendonitis. An RSI label alone does not tell you which structure is irritated, and that decides the treatment. For carpal tunnel specifically, IQWiG notes that reviews suggest computer work has only a small effect on the risk (gesundheitsinformation.de).
"The studies so far, however, point to a rather small influence of computer work." (translated from German) — IQWiG (German Institute for Quality and Efficiency in Health Care), Karpaltunnelsyndrom, gesundheitsinformation.de, December 2024
That is about carpal tunnel syndrome only, not about tendon problems, and it does not say computer work is harmless. Some hand surgeons think strain at work can occasionally play a part. SPIEGEL reports that other doctors are not yet convinced.
"In rare cases there is also an overload-related carpal tunnel syndrome" (translated from German), believes Jörg van Schoonhoven, secretary general of the German Society for Hand Surgery, Karpaltunnelsyndrom: Einschlafende Hände sind ein Warnsignal, DER SPIEGEL, May 2017
What are De Quervain's, trigger finger, tennis elbow and cubital tunnel?
These are other common causes of hand and arm pain. Each has its own pattern.
| Condition | Where it hurts | Typical clues | Typical tests | Typical first steps |
|---|---|---|---|---|
| De Quervain's tendinosis | Thumb side of the wrist | Pain and tenderness there, worse with gripping or twisting, sometimes a catching feeling | Exam with the Finkelstein test. X-ray and ultrasound usually not needed | Avoid aggravating activity, thumb splint, ice, anti-inflammatory medicine, injection |
| Trigger finger | Palm, at the base of a finger or thumb | A tender lump, catching or locking, worse in the morning | Exam only. X-ray typically not needed | Rest from repetitive gripping, night splint, anti-inflammatory medicine, injection |
| Tennis elbow (lateral epicondylitis) | Outer side of the elbow | Pain or burning, weak grip, worse with forearm activity such as gripping or turning | Exam. X-ray or MRI only to rule out other causes | Rest from the aggravating activity, pain relief, therapy, a forearm strap or brace |
AAOS describes De Quervain's and trigger finger (AAOS De Quervain's, AAOS trigger finger). The NHS lists typing and mouse use among the activities that can cause tennis elbow (NHS), and AAOS covers its exam and treatment (AAOS tennis elbow). The NHS says to see a GP if elbow pain lasts after two weeks of self-care.
Cubital tunnel syndrome is a nerve problem at the elbow. We do not describe it in detail here. A doctor can tell it apart from carpal tunnel with an exam.
How strong is the evidence for first treatments?
The labels below summarize how the sources describe each option. They are not a guideline grade.
| Treatment | For | Evidence |
|---|---|---|
| Night wrist splint | Carpal tunnel | Some evidence. Advised first by the NHS, AAOS and IQWiG for mild to moderate cases |
| Steroid injection | Carpal tunnel | Some evidence for short-term relief. NHS and AAOS say it can come back |
| Platelet-rich plasma injection | Carpal tunnel | Mixed evidence. AAOS says benefit is temporary and long-term benefit is unlikely |
| Oral anti-inflammatory medicine | Carpal tunnel | Mixed evidence. AAOS lists it. NHS says there is little evidence they treat the cause, and IQWiG says studies suggest they do not relieve pain adequately |
| Acupuncture, therapeutic ultrasound, laser | Carpal tunnel | Little research. IQWiG says there is no proof they help |
| Rest, ice, snug support | Tendonitis | Little research cited. The NHS advises it as a short first step for 2 to 3 days |
| Platelet-rich plasma, shock wave | Tennis elbow | Mixed evidence. AAOS calls results inconclusive or the therapy experimental to many doctors |
What can I do while waiting to be seen?
Cut the load, but do not stop moving. The NHS says resting for more than a few days can cause weakness and stiffness. Take breaks, avoid forceful gripping and bent wrists, and write down what sets symptoms off.
Typing less can help. Dictop is a dictation app for Mac, iPhone and iPad with on-device models, a 30-day free trial, then US $6.99 once with no subscription. It does not treat any condition. It lets you rest your hands and keep working while you recover. See Dictop for Mac or iPhone and iPad.
Where to go next
By Dictop · Reviewed