Diagnosis of Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition wherein the patient feels pain, tingling, and numbness in the arm and hand. This condition is caused when the median never in the wrist is squeezed and fails to send signals to the brain for normal functioning of the arm and hand. In severe cases, carpal tunnel syndrome can shrink the muscles in the hand and the patient would find it much difficult to make a fist or hold something in the hand. 

To diagnose carpal tunnel syndrome, your doctor would first check your medical history and analyze the symptoms you are experiencing. He/she might also perform a physical examination of your arms, hands, shoulders, and neck to see if any other condition is causing the pain and tingling sensation. If the doctor finds your wrists to be swollen, warm, tender, or discolored, he/she would recommend a few tests to diagnose carpal tunnel syndrome. Below are some of the tests recommended by doctors at community healthcare centers to diagnose the disorder.

Tinel’s Sign

In this test, the doctor would gently tap or press on your median nerve using a reflex hammer. If you get an electric-shock-like feeling during the process or if you feel tingling in the fingers, you may have carpal tunnel syndrome.

Phalen’s Maneuver

In this test, the doctor would ask you to press the back area of your hands and fingers while keeping your wrists flexed and the fingers pointed downward. You would need to stay in the position for a couple of minutes. If you feel numbness in the fingers or get a tingling sensation, you may have carpal tunnel syndrome.

Two-Point Discrimination Test

In this test, the doctor would use a small and flat device known as 2-point disk-criminatory to check your median nerve function and the extent of compression. The doctor would use the device to touch on two points on your skin keeping the distance a few centimeters apart. He/she would then slowly reduce the distance until you feel only one point of pressure.

Nerve Conduction Velocity Test

In this test, the doctor would place a small electrode near your elbow and send mild electric signals down through your median nerve. Analyzing the time taken for the current to reach your fingers would help the doctor to determine the extent of damage to your median nerve. This is the most reliable test to diagnose carpal tunnel syndrome.

Electromyogram

In this test, the doctor would place a small needle-like electrode on your arm and hand to see how the median nerve receives electric signals sent through the muscles. You might be asked to flex and relax your hand a few times during the process so that the median nerve can receive the signals normally. This test would help the doctor to figure out if your median nerve is being squeezed or is damaged.

Your doctor might also recommend an X-ray, ultrasound, or MRI to rule out the possibilities of other conditions that have similar symptoms. While an X-ray would help to identify problems like arthritis or broken bones, ultrasound and MRI would help to see if the median nerve is compressed or swollen. Sometimes, a few blood tests are also advised to check if any other diseases like diabetes are causing nerve damage.

Treatment Options for Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that progresses very slowly but can get really worse if left untreated for long. Early diagnosis of the disorder as well as determining the extent of nerve damage or compression would help your doctor to derive the best treatment plan for your condition.

Your doctor might recommend ice therapy to ease the pain you are experiencing. Similarly, you can also soak your hand in warm water to relieve the stiffness and numb feeling. You would also be advised to rest your wrists and hands as much as possible, and take enough breaks when working with your hands. At times, over-the-counter medications like aspirin, ibuprofen, and naproxen are also prescribed to ease the pain and swelling in the wrists.

Using wrist braces is a great way to rest your hand and alleviate the pain, and it is usually recommended to patients who have mild to moderate carpal tunnel syndrome. However, they might not work for severe cases, which might need surgery to treat the condition.

Note that surgery is often recommended as the last resort when your condition does not get better by following any other treatment method. There are mainly two types of carpal tunnel release surgeries – open surgery and endoscopic surgery. In both the procedures, the doctor would cut the ligament on the top of the carpal tunnel to release the pressure off the median nerve. The ligament would come back together post-surgery but would ensure that there is more space for the median nerve to pass through.