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How is carpal tunnel syndrome diagnosed?

Dr. Rachel Rohde, MD
Orthopedic Surgeon

Diagnosis is made by history and examination by your doctor. If there is a history of injury, X-rays can determine if there are any bony reasons for the symptoms. A nerve conduction study (NCV) and/or electromyogram (EMG) is not always needed might be performed to confirm the diagnosis and to check for other nerve problems.

Dr. Vonda Wright, MD
Orthopedic Surgeon

Carpal tunnel syndrome involves compression of a nerve, called the median nerve, as it travels through the wrist. Diagnosis is based on a combination of patient history, physical exam and nerve testing. Typical symptoms include numbness and tingling in the thumb, index and middle fingers. More severe forms include weakness in certain hand muscles. Your physician can do certain special physical exam tests that may reproduce some of your symptoms. Your physician may also send you to get nerve conduction testing which can calculate the severity of nerve injury.

Debra Fulghum Bruce PhD
Healthcare Specialist

Your doctor can diagnose carpal tunnel syndrome after a complete physical examination and review of your medical history. Your doctor will notice the type of pain you have and the specific places on your hand. Tests including an electrical nerve conduction test may be helpful in obtaining an accurate diagnosis. With carpal tunnel syndrome, x‑rays and blood tests are usually normal. Depending on the exact cause, treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs), along with a splint for your wrist, a local injection of cortisone to reduce the swelling around the nerve or possibly a minor outpatient surgical procedure.

First, a doctor will usually evaluate your reported symptoms and examine your hand and wrist. One clue to diagnosis is that the median nerve—the nerve that causes carpal tunnel syndrome—does not affect the little finger, so pain or numbness in that finger can indicate another condition. If your doctor suspects carpal tunnel syndrome based on your symptoms, a nerve test may be recommended. Usually, tests for carpal tunnel syndrome will include measuring the electrical activity in your hand muscles.

Dr. Prosper A. Benhaim, MD
Orthopedic Surgeon

Carpal tunnel syndrome is diagnosed by taking into account a number of factors, including the symptoms, physical examination findings and diagnostic testing. The history of symptoms provided by the person is very important in helping a doctor to determine whether or not the symptoms are typical for carpal tunnel syndrome. Physical examination findings include a number of specific examination maneuvers that the doctor will perform to elicit evidence of nerve compression or nerve irritability. 

Dr. Michael E. Raemisch, MD
Orthopedic Surgeon

Most often, carpal tunnel syndrome can be diagnosed by history (the description of the pains the patient is experiencing), and physical exam (what the doctor finds looking at your hand during your visit). Stereotypical symptoms include numbness and tingling in the thumb, index and middle fingers, and occasionally the ring finger. This numbness is usually associated with a "pain" in the hand that can be very difficult for patients to describe. While carpal tunnel syndrome is a nerve problem, some patients describe it as their hand "doesn't get enough blood flow". Many people with carpal tunnel will shake their hand to "get the blood flow back". At times, the pain may be severe enough to keep a person up at night.

Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis and fractures.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within one minute. Doctors may also ask patients to try to make a movement that brings on the symptoms.

Often, it is necessary to confirm the diagnosis by using electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which the nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; the viewing of electrical activity on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

Early diagnosis and treatment of carpal tunnel syndrome are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis and fractures.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within one minute. Doctors may also ask patients to try to make a movement that brings on the symptoms.

Often, it is necessary to confirm the diagnosis by using electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which the nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; the viewing of electrical activity on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

This answer is based on source information from the National Institute of Neurological Disorders and Stroke.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.