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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome: How Is The Diagnosis Made?

Tuesday, March 20, 2012 - 17:55

Contributing Author: Guy Slowik FRCS

A doctor will take a careful medical history, asking about:

  • The symptoms and what brings them on
  • How long you've had them
  • What makes them worse or better
  • Your general medical background

The doctor will examine your hands, wrists, elbows, shoulders, and neck to check for nerve compression or other problems, and may perform a more detailed examination to look for medical conditions.

Examination will include:

  • Tapping your wrist over the median nerve to see if this reproduces your symptoms (the Tinel test)
  • Gently holding your wrist bent forward for 30 to 60 seconds to see if this reproduces your symptoms (the Phalen test)
  • Gently using pinpricks and light stroking motions with a pin to see if any part of the hand has lost sensitivity (a sign of nerve damage)

Need To Know:

Q: What type of specialist should I consult if I think I have CTS?

A: There is simply no substitute for an accurate diagnosis. Besides a family practitioner or internist, sufferers may consult an orthopedistneurologist, hand surgeon, rheumatologistphysiatrist, or a specialist inoccupational medicine or sports injuries. If ultimately surgery is required, it will be done by an orthopedic surgeon or a hand surgeon.

Specialized Tests

Sometimes, it is not clear whether the symptoms are due a problem with median nerve at the wrist or higher up in the arm. They could be caused by a problem with other nerves to the hand, particularly the ulnar nerve, or even from affected nerves in the neck, causing the pain and tingling to radiate into the hand.

Specialized tests will resolve this dilemma:

  • Nerve conduction tests. This test determines if the transmission along the nerve has slowed down due to damage to the nerve. A doctor or certified technician will place electrodes on the hand and wrist. Small electric shocks are applied to the nerves in the fingers, wrist, and forearm to determine if the nerve messages are being conducted properly.
  • Electromyography. In more serious cases, the muscles supplied by the nerve will show abnormal electrical activity. A doctor or certified technician will insert a very fine, sterile wire briefly into a muscle in the affected area, and the electrical activity will be displayed on a monitor.
  • X-rays of the wrist and neck. These may be taken to rule out arthritis or previous fractures. (X-rays alone cannot reveal the presence of CTS.)
  • Magnetic resonance imaging (MRI). This test can determine if structural abnormalities at the wrist are contributing to CTS.

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