Diagnosis of Carpel Tunnel Syndrome

By  , Expert Content
Jun 29, 2012

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Carpal tunnel syndrome (CTS) is diagnosed based on your description of symptoms, findings of physical examination, and electrodiagnostic tests that measure nerve conduction through the hand. If the health care facility does not have electrodiagnostic testing, the doctor will diagnose the condition based on symptom descriptions and a series of physical tests.

The three factors necessary for a clear diagnosis of CTS are:

  • classic CTS symptoms
  • specific physical findings
  • abnormal electrodiagnostic test results.

However, diagnosing CTS may not be straightforward in many cases as they may not exhibit the three factors necessary for a clear diagnosis. For example, some people may have abnormal electrodiagnostic test results without classic symptoms or any symptoms at all, or some may have symptoms consistent with CTS, but most do not show test results indicating the disorder.

History and physical examination: If you have signs and symptoms such as:

  • tingling or numbness in fingers or hand especially thumb and index, middle or ring fingers;
  • pain radiating or extending from your wrist up your arm to your shoulder, or
  • down into your palm or fingers, it may make the doctor suspect CTS.

Timing of the symptoms may also offer clue to the diagnosis. Typically, a person with CTS may experience symptoms which include shivering while holding a phone or a newspaper, gripping a steering wheel, or waking up during the night. On physical examination, strength of the muscles in your hand may be affected by carpal tunnel syndrome.

Lab tests

If your symptoms and physical examination are suggestive of CTS the doctor may do one or more of the following tests to decide whether you have carpal tunnel syndrome.

  • X-ray: X-ray of the wrist may be done to exclude other causes of wrist pain, such as arthritis or a fracture.
  • Electromyogram: In this test the tiny electrical discharges produced in muscles are measured. The electrical activity in the muscle at rest and on contraction is measured and recorded by an instrument. It can help to determine whether muscle damage has occurred.
  • Nerve conduction study: In this test the tiny electrical discharges produced in the nerve are measured. If CTS is suspected, a small shock is passed through the median nerve to see if electrical impulses are slowed.

The two tests, electromyogram and nerve conduction study, can help to rule out other conditions that might mimic carpal tunnel syndrome, such as a pinched nerve in your neck. If the cause of your symptoms cannot be diagnosed, you may be referred to rheumatologist, neurologist, hand surgeon or neurosurgeon to determine if your signs or symptoms indicate other medical disorders, or a need for specialised treatment.


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