Helping Hands Heal since 2005
From Dr. Z - Carpal tunnel syndrome specialist
This article explains how carpal tunnel is diagnosed. If you have carpal tunnel syndrome, a proper diagnosis is the very first step in treating this condition.
Usually, a doctor will perform the diagnosis. You can also perform an accurate diagnosis on yourself using some of the same methods the doctor uses - and described here.
There are two kinds of diagnostic tests for carpal tunnel syndrome. They are:
The provocative tests are simple-to-do physical exams -- and this article will teach you how. Carpal tunnel is diagnosed regularly using these tests. In fact, you can perform them on yourself. By pushing and tapping in the correct areas of the arm, you can "provoke" symptoms to appear. Only patients with carpal tunnel syndrome will show a positive response.
To verify the provocative tests, doctors use electrodiagnostic tests. They are are composed of the EMG (electromyographic) test and the nerve conduction test. But you cannot do thee tests on yourself. A doctor must perform them in their office because they require specialized equipment and training.
This two-step testing process insures you get the proper diagnosis. After all, you don't want to treat carpal tunnel syndrome if you actually have another condition!
In this article, you'll learn how the tests are performed. You'll also learn what you might expect during testing and the meaning of your results.
Before understanding how carpal tunnel is diagnosed, it's necessary to establish whether you have the symptoms or not. the signs and symptoms of carpal tunnel syndrome are different for everybody. But they follow a general pattern.
Carpal tunnel syndrome will usually give you the following sensations in your hand and fingers. The diagram below shows you the location of these sensations.
In the beginning, carpal tunnel syndrome usually only appears when your hand is resting. In fact, most patients only feel symptoms when they're trying to sleep. It will wake them, with the need to rub out the pain or shake out the numbness.
This is what distinguishes early carpal tunnel symptoms from those of tendonitis. Tendonitis pain or numbness occurs only when the hand is working, not at rest.
Early signs of carpal tunnel can also appear as a clumsy hand. It might feel awkward to button a shirt, tie a shoelace, or open a car door. You have to concentrate more while picking up coins or keys.
Tightly gripping an object (like a coffee mug) may cause shooting electric shocks. Raising your hand at or above your head (like holding a phone to your ear) may cause numbness or tingling in your fingertips.
As carpal tunnel syndrome advances, so do the symptoms. Usually, the condition is largely ignored up to this stage. Most often, it's only when symptoms become annoying or painful that carpal tunnel is diagnosed. Unfortunately, these are also the more advanced stages, when effective treatment is more challenging.
In essence, the symptoms are the same as those listed above. But more advanced carpal tunnel means they are more severe. Using your hand becomes more and more difficult. This means writing with a pen, holding a steering wheel, or cooking requires extra care and vigilance.
Your hand's grip strength is usually compromised. That means constantly dropping things. Some people lose the ability to pick up grocery bags or infants.
As carpal tunnel syndrome advances further, most patients lose the ability to sense hot or cold at their fingertips. This makes cooking dangerous because holding a knife safely is compromised, and so is sensing a hot stove.
These are characteristics of severe stage carpal tunnel syndrome. Patents use terms for the pain or numbness as cruel, punishing or crushing. They often say they feel like cutting off their hand to end the misery.
About 80% of patients will begin to see signs of carpal tunnel syndrome on the other hand within 6 months. This is known as bilateral carpal tunnel syndrome.
Finally, without treatment the hand enters the "end stage" of carpal tunnel syndrome. It's when the median nerve has degenerated irreversibly. Basically, the median nerve is dead and this causes the thumb muscles to die as well.
You can visibly see the thumb muscle flattened out as it wastes away. Gripping function is lost. In most patients, the hand eventually forms a "claw" due to the loss of muscle control.
There are certain risk factors for acquiring carpal tunnel syndrome. They are
According to the CDC and OSHA, the professions listed below are well-known to have a higher incidence of workers with carpal tunnel syndrome.
Carpal tunnel syndrome is one of the most frequently misdiagnosed disorders. In fact, some studies show that over 70% of patients receive an incorrect diagnosis.
That means these patients are told they have carpal tunnel syndrome when they actually have a different disorder. The result? Over 70% of patients who have carpal tunnel surgery never needed it!
For this reason, exactly how carpal tunnel is diagnosed is often debated. Doctors struggle with using only the provocative tests versus the provocative tests PLUS the electrodiagnostic tests.
Performing this "double pronged" diagnosis can eliminate disorders that have similar symptoms. These are the disorders many patients actually have, instead of carpal tunnel syndrome. They include:
As a first step, carpal tunnel is diagnosed using the Durkan, Phalen, and Tinel tests. These provocative tests are designed to determine if your symptoms can be "provoked". Provoking them means you are positive for carpal tunnel syndrome.
This is the very first exam a doctor will give you in their office. If they show you're positive, the provocative tests are normally followed by the electrodiagnostic tests.
To perform these tests on yourself, see
specific instructions here. It's best to have a partner help you. The partner can perform each test so you can relax and concentrate on the symptoms. This insures accuracy.
DURKAN TEST
Hold your arm out in front you, palm side up. Identify the 2 large fleshy bumps in your lower palm. They are located just above the crease in your wrist.
With your opposite thumb, press in between those bumps. You must press hard, and hold the pressure for 30 seconds.
A positive sign for carpal tunnel syndrome is when the pressure causes numbness, pain or tingling in your hand or fingers.
PHALEN TEST
Bend your hand into an "L" position, with fingers extended. Use your opposite hand to push down on the bent hand. (You can also push down against a wall.)
Push as hard as you can tolerate. Hold this position for 30 seconds.
A positive sign for carpal tunnel syndrome is when you feel numbness, pain or tingling in your hand or fingers.
TINEL TEST
Hold your arm out in front of you. Using your opposite forefinger, firmly tap around the crease of your wrist.
Be sure to tap repeatedly and rapidly. Move your tapping finger from left to right, then up and down an inch or so. Keep tapping for a total of 30 seconds.
A positive sign for carpal tunnel syndrome is if you feel numbness, pain, tingling or shooting electric shocks in your hand or fingers.
When your provocative tests are positive for carpal tunnel syndrome, you doctor will order electrodiagnostic tests. They are used to confirm the results of the provocative tests.
If they are used alone for a diagnosis (without the provocative tests results) they result in a high number of "false positive" results. Also, by themselves, the electrodiagnostic tests are not more accurate than the provocative tests.
Exactly how carpal tunnel is diagnosed with electrodiagnostic tests is a complex process. The tests are performed under the supervision of your carpal tunnel doctor. They require specialized electronic equipment and special training for the technologist.
The electrodiagnostics tests are usually performed in 2 parts. They are the:
NERVE CONDUCTION TEST
This test can tell if your median nerve is not functioning properly. The speed of electrical signals travelling down the median nerve is recorded. A malfunctioning median nerve produces slower signals. This is the basis of having carpal tunnel syndrome.
The technologist applies several tape electrodes to your palm. Then they use an electrical stimulator (like a large pen) to send signals down the median nerve. The electrodes in your palm can pick up the signals and send the data to the analyzer.
These tests are not painful. However, some patients say they feel faint shocks on their skin surface (which are similar to static electricity).
ELECTROMYOGRAPHY (EMG) TEST
This is similar to the nerve conduction test. It determines the health of your median nerve and thumb muscles. Any delay in the signal from the nerve to the muscle means you might have carpal tunnel syndrome.
This test requires needles inserted into your thumb muscles. Other electrodes are applied to the skin along your arm. The needles are electrodes which detect the electrical signals travelling down the median nerve from the surface electrodes. Any delay in the signal means you might have carpal tunnel syndrome.
The EMG test is somewhat painful because of the needles in your hand. Most patients feel electric shocks or burning. But they don’t last long.
Now that you have a confirmed diagnosis of carpal tunnel syndrome, what do you do?
The American Academy of Orthopedic Surgeons maintains a policy about carpal tunnel surgery. They advise carpal tunnel doctors to resort to surgery only after all nonsurgical options have been exhausted. The reason?
Because many nonsurgical options are safe and effective. In fact, nonsurgical remedies are successful in over 90% of patients. In comparison, by the second year, carpal tunnel surgery has about 50% success rate.
The key nonsurgical treatments usually recommended are Bracing, Rest, Exercises, and Massage (B.R.E.M.):
BRACE YOUR WRIST AT NIGHT
Bracing your hand and wrist during the night allows your hand to rest. When we sleep, we bend our hands (usually backward) unconsciously and sometimes for hours at a time.
Such bending is damaging to the median nerve if you already have carpal tunnel syndrome. That’s because a bent wrist amplifies the pressure inside the joint, further pressurizing the median nerve. And that makes symptoms much worse.
When using a brace, your hand is held in a neutral position (i.e., relatively straight). This minimizes pressure on the median nerve, allowing it to heal gently while you sleep.
It’s important to note that most wrist braces sold in drug stores are not designed for this purpose. That’s because they contain a metal spine on the palmar surface. These are not certified carpal tunnel braces -- so avoid them.
Also, never wear any brace during the daytime. Doing so forces your tendons to overcome the brace while also doing their regular job. And this further stresses the tendons. So let you wrist move freely during the day.
REST YOUR HAND
Good, old fashioned rest is how the body heals. And when it comes to treating carpal tunnel syndrome, rest is also a game-changer.
When working with your hands, take breaks from the activity. This un-stresses your hand, even if only for a few minutes. But that crucial rest period makes a big difference.
Better yet, give you hand a rest from the stressful activity by avoiding or minimizing the activity altogether. Figure out ways to lessen that stress. Wearing gloves or adjusting your posture usually helps.
During these rest periods, try to incorporate stretching exercises (see below). Rest and stretching is a two-for-one remedy that only helps your hand.
EXERCISE YOUR FINGERS & HAND
One of the most overlooked remedies for carpal tunnel syndrome is regular stretching exercises. Even severe stage carpal tunnel syndrome can be reversed with a proper regimen of exercises.
When performing exercises, make sure you use specific carpal tunnel stretching exercises. They’re designed to maximize tendon lubrication and remove restrictions. ThIs reduces inflammation on tendons and allows them to heal quickly.
The best carpal tunnel stretches should never take more than a minute to do. And you should also do them multiple times per day for best results.
MASSAGE YOUR WRIST AREA
Some patients have more advanced or severe carpal tunnel symptoms. In that case, they require more aggressive therapy in addition to bracing, rest, and exercises.
Specifically, they require a type of massage known as myofascial release. It’s a special technique which breaks up adhesions and restrictions on tendons. This reduces inflammation around the tendons and allows them to glide smoothly.
Moreover, myofascial release massage also drains the fluid which causes pressure on the median nerve. At the same time it increases blood flow to the area.
As a result of removing adhesions, draining excess fluid, and increasing blood circulation, the massage creates a perfect environment for healing carpal tunnel syndrome.
Unfortunately, you cannot perform myofascial release massage on yourself. You also need it daily and for several weeks in order to be effective. So a willing partner or a professional therapist is normally required.
Knowing how carpal tunnel is diagnosed means understanding the 2 types of tests doctors use. They are:
Each one of these tests attempts to provoke symptoms (or make them worse). If symptoms like pain, numbness, electric shocks or tingling are felt, then it's a positive sign of carpal tunnel syndrome.
When the provocative tests are positive, the doctor will usually order follow-up electrodiagnostic tests. There are two types: nerve conduction studies and electromyography or EMG. Both of them test the health of your median nerve using electrical impulses.
Today, carpal tunnel is diagnosed using this two-pronged approach. While the provocative tests alone are usually sufficient evidence of carpal tunnel syndrome, electrodiagnostic tests confirm the findings.
With a diagnosis of carpal tunnel syndrome, patients are normally advised to use nonsurgical remedies first. The most useful ones are night bracing, rest, stretching exercises, and myofascial release massage. They are effective in relieving symptoms in most patients within 8 weeks.
