Getting an accurate diagnosis of your hand pain and tingling can ensure that you get the proper treatment for your specific condition. So how is carpal tunnel syndrome diagnosed, and how do you know that the diagnosis you get is the right one?
Self-Checks/At-Home Testing
The symptoms of CTS are caused when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. This area, called the carpal tunnel, contains several tendons and vascular structures along with the median nerve. (Carpals are wrist bones, and they form the roof of the tunnel.)
Carpal tunnel syndrome is considered a repetitive stress injury. That means that it is caused by some motion or motions that are repeated over and over again. For this reason, symptoms tend to come on gradually and with no specific injury. Symptoms are usually worsened by excessive computer work that involves using the mouse and typing. Other repetitive tasks like writing may cause CTS.
Pain in your wrist and forearmPain in your thumb, index finger, and middle fingerTingling in your thumb, index, and middle fingerWeakness in your hand
Clinical Tests
If you suspect you have CTS, checking in with your healthcare provider is a good idea. After listening to your history and recording your symptoms, he or she may perform specific clinical tests to confirm (or rule out) carpal tunnel syndrome.
Measuring Range of Motion
Your healthcare provider may measure hand and wrist range of motion. Many people with CTS exhibit decreased motion in their wrist. This is due to the swelling of the nerve and tendons that course through the carpal tunnel. This swelling prevents the normal motion from occurring, and a loss of wrist flexion and extension motion may be present.
Tinel’s Sign
Tinel’s sign involves gently tapping on a nerve to elicit symptoms. Tinel’s sign for CTS is done by having your healthcare provider tap over your median nerve near your wrist just above your palm. If this tapping causes pain or tingling in your thumb or fingers, carpal tunnel syndrome may be suspected.
Phalen’s Test
Phalen’s test involves placing the back of your hands together in front of you with your wrists in extreme positions of flexion. This flexion compresses the carpal tunnel and may cause your symptoms to occur.
Grip Strength
Sometimes, CTS causes loss of strength in your hand or fingers. Your healthcare provider may use a special instrument called a grip dynamometer to measure your strength.
EMG
Electromyographical (EMG) testing involves inserting small needles into your arm along the course of your median nerve. These needles may run from your neck and upper arm and into your hand. Once the needles are placed, a small electrical shock will be sent down your arm and into your hand. Specialized instruments will measure the velocity of this electricity. If there is compression of your median nerve, the electrical signal will be slowed as it crosses your wrist, indicating carpal tunnel syndrome.
Getting Your Diagnosis
Sometimes performing these special tests and measures is enough to confirm a diagnosis of carpal tunnel syndrome. Your healthcare provider may then prescribe treatments to help decrease your symptoms and improve your overall function. This may include a referral to physical therapy or occupational therapy.
Imaging
Carpal tunnel syndrome is largely diagnosed by examination of your wrist and hand and by the description of your clinical symptoms. Sometimes, more advanced imaging is used to completely diagnose your condition. These images may include:
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X-Ray
An x-ray can show your healthcare provider the bones in your forearm, wrist, and hand, and a fracture here may cause some of your symptoms. (Keep in mind a wrist fracture is typically caused by a traumatic event, and CTS usually comes on gradually.)
MRI
Magnetic resonance imaging (MRI) allows your healthcare provider to visualize the soft tissue structures of your wrist and hand. This includes a detailed image of your median nerve, tendons in your wrist, and the ligaments that support your wrist and hand.
CT Scan
A computed tomography (CT) scan is a three-dimensional image of the bones of your wrist and hand and it may be obtained by your healthcare provider to rule out arthritis or a fracture.
Differential Diagnosis
There are other conditions that may present with similar symptoms to CTS. These may include:
Cervical Radiculopathy
Cervical radiculopathy occurs when a nerve in your neck is compressed by a herniated disc, arthritis, or facet joint problems. This condition may cause pain to travel from your neck and into your arm and hand, mimicking some symptoms of carpal tunnel syndrome.
Ulnar Nerve Compression
Your ulnar nerve travels down your arm and into your hand on the pinky side. (If you have ever banged your elbow on your funny bone, this is really your ulnar nerve.) Your ulnar nerve can be compressed in your elbow and cause tingling and numbness in your hand and ring and pinky fingers. While these symptoms are slightly different from median nerve compression in the wrist, they may be confused with CTS.
Thumb Arthritis
Arthritis may affect your carpometacarpal (CMC) joint of your thumb. This may cause weakness and pain in your thumb and hand, leading you to believe you have CTS.
Wrist Arthritis
Arthritis of your wrist may also cause hand, thumb, and finger pain, which may be confused with CTS.
If you suspect you have carpal tunnel syndrome, it is important that you see your healthcare provider. He or she can perform a thorough clinical examination and order the correct tests to ensure a proper diagnosis. By getting an accurate diagnosis, you can get started on the best treatment for your specific condition.
Reoccurring numbness or pain in your thumb, index finger, and middle fingerA sensation of swelling in those fingers (even though they don’t look swollen)Tingling in the fingers during the nightAwakening with a need to shake out your hands or wrists in order to relieve pain or tingling—known as the “flick sign”
Pronator syndrome, or AIN neuropraxia (damage to the anterior interosseous nerve)Raynaud syndromeUlnar compression neuropathyVibration white finger (tingling, numbness, and blanching of the fingertips caused by prolonged use of tools that vibrate)Wrist arthritis
