Diagnosis of carpal tunnel syndrome (CTS) is made by a health professional. He prescribes you different examinations according to your signs and symptoms.
Several tests described below can prepare you to these examinations and encourage you to consult your doctor. These steps in the diagnosis of carpal tunnel syndrome allow you to begin a treatment that is adapted to the stage of development of your condition.
Pre-diagnosis of carpal tunnel syndrome
In order to prepare your consultation as well as possible, identify your sensations or symptoms and their intensity. Do you have tingling, numbness, pain or loss of sensitivity? Which part of your hand is affected? Are these sensations mild, moderate or severe? Do they occur at night, during the day or both? How long do your symptoms last: a few minutes, hours, continuously? Do they wake you up at night?
Do you sometimes drop an object? Do you feel a loss of grip strength or less precision (difficulty to hold a pen, a phone, to bear weight or to open a bottle, etc.)?
This kind of information is useful for your doctor to establish the diagnosis after assessing the daily discomfort and the type of movements you consider as impossible or difficult to do.
Clinical examination with your doctor: diagnosis of carpal tunnel syndrome
Clinical examination enables the doctor to assess sensitivity in your fingers and to test muscle strength of your hands. He also evaluates your discomfort during specific movements such as wrist flexions. You’ll probably be asked to do some provocation tests in order to identify painful postures and assess the severity of the disease. Among these tests, the Tinel’s sign, Phalen’s test and Durkan’s test are often proposed.
The Tinel’s sign is used for assessing the neurological functioning. It consists in slightly hitting the median nerve in the carpal tunnel . If it causes electric shocks, paraesthesia (tingling) or pain, the patient can be suffering from carpal tunnel syndrome .
This test was invented by George Phalen in 1966 but since then, it has progressed. Its goal is to reproduce the symptoms felt by the patients in the fingers. To do so, hold your hands together, back to back with fingers pointing down. This position forces you to flex the wrist at 90°. Keep this position during one minute: its aim is to compress the median nerve. If you feel a loss of sensitivity, it can be linked with carpal tunnel syndrome . The more severe is CTS, the more the test is reliable. The reverse Phalen’s test is another manoeuvre that consists in holding the hands together, palm to palm with fingers extended. Keep this position during one minute. This time, the nerve is not compressed but stretched. Here again, if you feel tingling, it may be CTS.
Durkan’s test also aims to reproduce the symptoms of CTS. Slightly apply pressure with your thumb on the median nerve in the carpal tunnel during 30 seconds. It is sufficient to compress the median nerve and to observe the effects.
The clinical examination and provocation tests can be sufficient for the health professional to propose an appropriate treatment. However, complementary examinations are often necessary to confirm and precise the diagnosis. Indeed, certain diseases include symptoms that are close to those of CTS, such as tendinitis or rheumatism.
Medical imaging to diagnose CTS
Hand or wrist X-ray can identify a bone-related cause to carpal tunnel syndrome . This can be associated with sequelae of an old fracture or in case of wrist osteoarthritis . These two examples can cause narrowing of the carpal tunnel and compress the median nerve.
Ultrasound can also identify other causes that could be responsible for narrowing of the tunnel, and consequently CTS.
Electromyogram or EMG
Sometimes, clinical signs are misleading or insufficient to establish the diagnosis. In this case, electromyogram can be necessary to measure electrical activity of the median nerve. Electrodes, placed along the nerve, record the transmission of electrical waves to reveal potential lesions. Slackening of electrical pulses in the carpal tunnel confirms CTS.
Both hands are examined because the condition can affect them at the same time.
EMG defines the severity of the condition and can exclude some causes of similar symptoms like compression in the neck.
All these examinations contribute to reliable diagnosis and appropriate treatment. Your doctor can prescribe you a rigid brace for resting periods* or a flexible brace for activity periods*. Surgical intervention is also possible according to the degree of the condition.
*These products are medical devices that bear the CE marking under this regulation. Carefully read the instructions before use. Manufacturer: MILLET Innovation. 09/2021