Helping Hands Heal since 2005
From Dr. Z - Carpal tunnel syndrome specialist
The test for carpal tunnel syndrome occurs in two phases. The first test is a simple set of manual exams you can do on yourself. It's technically called a "provocative test" because you try to provoke the symptoms.
The manual provocative test is actually the same set of exams doctors use in their office. Below are step-by-step instructions on how to perform them. They consist of the Phalen, Tinel, and Durkan exams.
If your provocative test results are positive, then see your doctor for the next test for carpal tunnel syndrome. These are electrodiagnostic exams. They consist of the nerve conduction exam and electromyography (or EMG) exam.
If you're also positive for carpal tunnel using the electrodiagnostic exams, the doctor will discuss the many treatment options available. These options are also discussed below.
You will likely try nonsurgical treatments first because they work well in most patients. If those nonsurgical remedies don't help, then surgery may be your only other choice.
Before we get into a specific test for carpal tunnel syndrome, you should know a few key facts about this condition.
First, carpal tunnel is a neurological disorder. That's because the median nerve deep inside your wrist joint is damaged. This is a major nerve of the hand, so any damage causes unwanted sensations like pain and numbness.
So what causes the nerve damage? Irritated tendons!
The hand's flexor tendons are responsible for performing motions like the grasping action of the fingers. When we type fast, for example, the flexor tendons pull the fingers rapidly downward and with force to strike the keys.
As a result of performing that action over and over again, those tendons become irritated due to prolonged mechanical strain. This is called repetitive stress of the hand.
With enough stress, the tendons continue to be irritated. Then they subsequently inflame and swell. And as they swell, they push outward and against the adjacent median nerve. In time, they push so much that eventually the median nerve is crushed.
So fundamentally, carpal tunnel syndrome is nerve damage caused by overworked and irritated adjacent tendons.
Another fact about carpal tunnel syndrome is that it's genetic. If a close family relative has or had it, then your chances of getting carpal tunnel increase dramatically.
Even if you're not genetically prone to getting carpal tunnel syndrome, you could be at risk simply because of how you use your hands.
For instance, professionals who repetitively stress their hands a great deal are infamous for getting carpal tunnel syndrome. Examples of these professions include:
Finally, carpal tunnel syndrome is not curable. Sure, you can manage the symptoms so they don't bother you any more. But that's not a cure. Even carpal tunnel surgery isn't a cure but merely a treatment to manage symptoms.
So if you have carpal tunnel syndrome, you have it for life. But most people manage symptoms so effectively they never come back again.
Before you test for carpal tunnel syndrome, you want to pay attention to the specific signs and symptoms of this disorder. The usually are located in the palm of the hand and fingers, but not the little finger. The image above illustrates their location. The primary symptoms are:
In the initial stages, carpal tunnel syndrome symptoms happen only when your hand is at rest. You usually feel numbness or pain when you're trying to sleep. Patients often feel the need to wake up and "shake out" the numbness.
Hand clumsiness is also an initial sign. You might have difficulty picking up keys or coins. Buttoning a shirt may feel clumsy. Opening a jar is almost impossible. And you begin to drop things.
As carpal tunnel advances, symptoms begin to appear during the day. This is severe stage carpal tunnel syndrome. The pain or numbness intensifies to the point of being called "cruel" or "crushing". Most patients begin to lose the feeling of hot or cold in their fingertips. Weakness and loss of dexterity becomes progressively worse.
In 80% of patients these symptoms happen on both hands within 6 months. Doctors call it bilateral carpal tunnel syndrome.
The first test for carpal tunnel syndrome can be performed on yourself. Note that it's best to have a partner help you. Doing so increases the accuracy of the results.
These are manual tests and are divided into 3 separate exams: Phalen, Tinel, and Durkan exams. Usually if only one of these exams are positive, then you likely have carpal tunnel syndrome. If more than one is positive, it's nearly certain you have carpal tunnel syndrome.
These manual exams are described below.
The Phalen exam is performed as shown in the photo. Hold you hand (or have a partner do it) at a right angle to your forearm. Push hard to make sure you get a maximum bend. Hold this position for 30 seconds.
If the symptoms in your palm or fingers appear or get worse, then the exam is positive for carpal tunnel syndrome.
The Tinel exam is performed as shown in the photo. Hold your hand out straight. Then, using your opposite forefinger (or that of a partner) rapidly tap the area just below your palm repeatedly and with force. Tap multiple times, and go left to right and back and forth. Tap for 30 seconds.
The tapping may cause the symptoms in your palm or fingers to appear or get worse. It may also cause electric shock-like feelings. If so, then the exam is positive for carpal tunnel syndrome.
The Durkan exam is performed as shown in the photo. Hold your hand out straight. Then, using your opposite thumb (or that of a partner) press hard into the area between the bumps in your palm (at the spot shown). Push hard for 30 seconds.
If pushing hard makes the symptoms in your palm or fingers appear or get worse, then the exam is positive for carpal tunnel syndrome.
The electrodiagnostic test for carpal tunnel syndrome is composed of the nerve conduction exam and electromyography exam (EMG). Both tests are usually performed together. They must be conducted in the doctor's office because special equipment is required.
Note that most doctors do not rely heavily on electrodiagnostics for carpal tunnel syndrome. That's because they are
not more accurate than the provocative exams. Therefore, since they don't add value to the diagnosis, doctors generally use electrodiagnostics to
confirm
their provocative exam results.
The nerve conduction exam determines the health of your median nerve. A healthy nerve transmits electrical signals rapidly. An unhealthy nerve does not.
For this exam, electrodes are taped to the skin around your palm. Then a stimulator touches your skin at various locations around your wrist. The stimulator fires electrical signals. Then their speed is recorded by the tape electrodes.
The entire process may feel like faint static electric shocks on your skin.
The electromyogram (EMG) exam determines how healthy the connection is between your median nerve and the muscles in your hand. An unhealthy connection is when the conduction of electrical signals is delayed.
The electromyogram exam starts by inserting thin needles into your thumb muscles. Other electrodes are taped to the skin at different locations along your arm. The exam sends electrical signals between the electrodes and needles. This determines the speed of the signal's transmission along the nerve.
The procedure is somewhat uncomfortable. But it's also a short procedure.
Do you have positive results in your test for carpal tunnel syndrome? If so, your next step is therapy.
The American Academy of Orthopedic Surgeons (who regulate hand doctors) recommend you try all nonsurgical therapies first, before discussing surgery with your doctor. The reason is four-fold.
Therefore, you have everything to gain by trying nonsurgical options first. The most successful nonsurgical options are:
Rest is nature's way of healing the body. Damaged tendons can heal and inflammation can lessen with simple rest.
Rest also can mean avoiding the activity that damaged your flexor tendons to start with. So, for instance, don't engage in marathon typing or knitting sessions. And try to avoid lifting heavy objects all day long.
If you cannot rest long or avoid the stressful activity, then try taking short rest beaks for your hands. Each time you engage in a stressful hand activity, take a short one-minute break for your hands. During this time, do stretching exercises (described below). This will help relieve symptoms tremendously.
Nocturnal wrist bracing is a form of rest for you hand. At night, we all unconsciously bend our wrists backward. Sometimes we do so with great force. This is very bad if your tendons are already inflamed and swollen. The bending exerts even more pressure on your median nerve.
When you sleep, be sure to wear a certified carpal tunnel night brace. That means it's specifically designed to treat carpal tunnel syndrome, and nothing else (like sprains, arthritis, etc.). Such braces will not have a palmar spine, which is harmful if you already have carpal tunnel syndrome.
Also, never wear a wrist brace during the daytime as you work. Wearing a brace further stresses your tendons as they fight the brace in addition to doing their regular work. So let you hands move freely, even though they may hurt a bit. A brace will only make the situation worse.
Stretching exercises designed for carpal tunnel patients are highly effective in reliving symptoms. Stretching elongates flexor tendons and strips them of adhesions and restrictions. This eliminates the inflammation and subsequent swelling. When that's eliminated, so is the pressure on the median nerve and thus, the symptoms of carpal tunnel syndrome.
The most effective carpal tunnel stretching exercises are actually quick and simple to do. In fact, they take less than a minute to complete. This is is huge advantage because not only are they effective, but they can also be done often and without negatively impacting your work schedule.
You should do these exercises as often as possible. And the more severe your symptoms, the more often you should do them. Most doctors recommend a minute of stretching exercisers for every hour of work.
For carpal tunnel symptoms that are mild or moderate, rest, night bracing, and stretches might be enough to resolve symptoms. But for more severe symptoms, you'll need additional help. That means using myofascial release massage.
Therapists use this treatment for more severe carpal tunnel patients whose symptoms have advanced. The massage treatment requires two thumbs to dig into the forearm and rhythmically knead the tissues below the skin.
This action mechanically breaks apart the adhesions and restrictions on the tendons below. The action also drains excess fluid that has built up inside the wrist joint. This fluid adds to the pressure on the median nerve.
As a result of daily myofascial release massage therapy, even severe carpal tunnel symptoms usually resolve within 4-6 weeks.
A test for carpal tunnel syndrome usually is performed in 2 phases. These are the provocative exams and the electrodiagnostic exams. You can preform the provocative exams on yourself. But the electrodiagnostic exams (including EMG) must be performed in your doctor's office.
If your results are positive, you should begin treatment immediately so carpal tunnel symptoms don't worsen. Start with an array of nonsurgical treatment options including rest, night bracing, stretching exercises, and myofascial release massage. They're highly effective in most carpal tunnel patients, even if symptoms are severe.
