How Is Carpal Tunnel Syndrome Diagnosed
Doctors can diagnose carpal tunnel syndrome using a combination of your history, a physical examination, and tests called nerve conduction studies.
A physical examination includes a detailed evaluation of your hand, wrist, shoulder, and neck to check for any other causes of nerve pressure. Your doctor will look at your wrists for signs of tenderness, swelling, and any deformities. They will check sensation to the fingers and strength of the muscles in your hand.
Nerve conduction studies are diagnostic tests that can measure the conduction speed of your nerve impulses. If the nerve impulse is slower than normal as the nerve passes into the hand, you may have carpal tunnel syndrome.
What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. ;The NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world.
Scientists supported by the NINDS are studying the factors that lead to long-lasting neuropathies, and how the affected nerves are related to symptoms of pain, numbness, and functional loss. Researchers also are examining biomechanical stresses that contribute to the nerve damage responsible for symptoms of carpal tunnel syndrome in order to better understand, treat, and prevent this ailment. By quantifying the distinct biomechanical pressures from fluid and anatomical structures, researchers are finding ways to limit or prevent CTS in the workplace and decrease other costly and disabling occupational illnesses.
Scientists funded through NIHs National Center for Complementary and Integrative Health are investigating the effects of acupuncture on pain, loss of median nerve function, and changes in the brain associated with CTS. In addition, a randomized clinical trial designed to evaluate the effectiveness of osteopathic manipulative treatment in conjunction with standard medical care is underway. Evaluations of these therapies and other therapies will help to tailor individual treatment programs.
Why It Is Done
A physical exam with a focus on your neck, arms, wrists, and hands is done if there is tingling, numbness, weakness, or pain of the fingers, thumb, or hand. The exam is to help find out whether your symptoms are caused by compression of the median nerve as it passes through the carpal tunnel in the wrist .
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Treating Carpal Tunnel Syndrome
For mild cases of carpal tunnel syndrome, resting your hand and wearing a splint at night might be all it takes to relieve symptoms. Symptoms of carpal tunnel syndrome often occur at night, causing people to wake up and shake or move their hand around until the numbness resolves and it feels better, says Dr. Rozental. Medications, such as aspirin and ibuprofen aren’t a cure, but can help relieve pain. Your doctor may also want to try giving you steroid injections to help relieve symptoms.
If these carpal tunnel treatments aren’t effective, however, it may be time to consider surgery to release the ligament that is placing pressure on the median nerve.
What Are The Symptoms
The main symptoms of carpal tunnel syndrome, in order of appearance, are:
- Pain or burning sensation in the hand, fingers or forearm.;
- Numbness and tingling in the hand, especially in the thumb, index and middle fingers.
- Symptoms get worse at night.; Night awakenings. Need to shake hands.
- Worsening of symptoms with manual activity or driving.
- Swollen feeling in the fingers and hand.
- Weakness, clumsiness and loss of dexterity.
Numbness and tingling in the palm of the hand or in the fingers are usually the first signs of the disorder. These symptoms occur especially at night, or early in the morning, and often cause insomnia or nocturnal awakenings. Itching or burning pain is sometimes felt. Patients often have to shake the affected hand to remove numbness.
During the day, symptoms can be triggered by activities such as driving, prolonged phone use, or reading the newspaper.
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Physical Examination For Carpal Tunnel Syndrome
Before the diagnosis, your doc would consider your general health and medical history for a better evaluation.
Next, several physical tests help in careful examination of your wrists and hand.
Some of these tests include:
- Tapping the median nerve to check if its the possible cause of numbness
- Holding your arm in a flexed position to check for numbness in your hands
- Test for checking sensitivity in hands with the help of a particular instrument
- Weakness examined near the base of your thumb
- Examination of any signs of muscular atrophy in the base of the thumb
After this physical examination, there are tests conducted to check the functioning of the median nerve.
Numbness And Tingling Sensation
The initial symptoms of the syndrome start with a tingling sensation in the thumb, index finger, and middle fingers.
Though, in most cases, not all areas start showing the sign at the same time. They usually appear gradually, but in rare cases, there might be numbness all at once.
In mild cases, these symptoms might be transient like they might appear in the day and disappear at night.
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Diagnosis Of Carpal Tunnel Syndrome
An early condition of CTS can be transient, and just shaking your hands can relieve the symptoms irrespective of the causes of carpal tunnel syndrome.
But, with time, the numbness might not go away and cause irritation.
It might lead to less grip strength as gradually your muscles start shrinking with more pain and cramps.
Hence, its always better to get help in the early stages of CTS itself.
Diagnosis can be done in two ways:
- Physical examination
Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
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What To Think About
If you have mild symptoms of tingling, numbness, loss of feeling or strength, or pain in a wrist or hand, you can start nonsurgical treatment right away. Nonsurgical treatment includes rest, stopping activities that may be causing the symptoms, and the use of a wrist splint at night. Studies have not shown nonsteroidal anti-inflammatory drugs to be effective for carpal tunnel syndrome. But they may help relieve symptoms.
If it is not clear that the symptoms are caused by carpal tunnel syndrome, or if the condition is not improving with home treatment, your doctor may recommend nerve testing, X-rays, MRI, ultrasound, and/or blood tests. These test results should help to clarify your diagnosis.
Complete the medical test information form to help you prepare for this test.
When To Get Surgery
“The mistake that people often make is waiting too long to get surgery,” says Dr. Rozental. “I see a lot of people who say that their numbness was gradually worsening and now their hand is completely numb and has been for a year.” If the nerve is compressed long enough, the muscle atrophies and the nerve damage becomes permanent, she says.
So, if your carpal tunnel symptoms aren’t responding to other treatments, take action quickly.
The surgery takes 10 minutes under a local anesthetic. Unless you do a job that involves manual labor, you can typically go right back to normal activities, says Dr. Rozental.
“I tell my patients all the time that a carpal tunnel release done at the right time for the correct diagnosis is very successful,” she says.
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How Often Is Hand Pain Caused By Carpal Tunnel Syndrome
While carpal tunnel syndrome is a common condition, it has a different set of symptoms from many other sources of hand pain. There are actually several similar conditions that cause hand pain. These include:
- De Quervains tendinosis: A condition where swelling affects the wrist and base of the thumb. In this condition, you will feel pain when you make a fist and simulate shaking someones hand.
- Trigger finger: This condition causes soreness at the base of the finger or thumb. Trigger finger also causes pain, locking and stiffness when bending the fingers and thumb.
- Arthritis: This is a general term for many conditions that cause stiffness and swelling in your joints. Arthritis can impact many joints in your body and ranges from causing small amounts of discomfort to breaking down the joint over time .
How Is Carpal Tunnel Syndrome Treated
Treatment of carpal tunnel syndrome depends on how severe your pain and symptoms are and if there is weakness. In 2008, the Academy of Orthopaedic Surgeons released guidelines for the effective treatment of carpal tunnel. The recommendation was to try to manage carpal tunnel pain without surgery, if possible.
Nonsurgical options include:
Surgery may be necessary if theres severe damage to your median nerve. Surgery for carpal tunnel syndrome involves cutting the band of tissue in the wrist that crosses the median nerve so as to lessen the pressure on your nerve. Factors that determine success or failure are age of the patient, duration of symptoms, diabetes mellitus, and if there is weakness . The outcome is usually good.
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Does Carpal Tunnel Syndrome Have A Long Recovery
Surgery to repair carpal tunnel syndrome does not have a particularly long recovery. The bandage that covers the stitches after surgery can be removed in a few days. The hand can then be used for light activities. Making a fist is encouraged. Full range of finger motion and early symptom relief is usually seen within two weeks after the stitches have been removed. You can usually return to most activities by six weeks. Your return to work depends on factors such as type of work, how much control you have over your work and workplace equipment.
Treating Carpal Tunnel Without Surgery
#1. Splinting
You can try wearing a brace or splint at night to prevent bending your wrist while sleeping.
This helps reduce the pressure exerted on the median nerve and reduces the symptoms.
Wearing the splint in the daytime can also help in doing activities that could otherwise have aggravated your symptoms.
#2. Non-Steroidal Anti-Inflammatory Drugs
There is a medication that can help to reduce the pain by reducing the inflammation of the nerve.
However, only take these medicines when prescribed by your doctor.
#3. Nerve Gliding Exercises for Carpal Tunnel Syndrome
Many exercises can help relieve the discomfort caused by CTS. But before you start with the exercises, remember that if any of the following exercises cause pain, take a break immediately.
Take the exercise slow and steady. Also, consult your doctor before starting with these:
- Bend your elbow and form a fist that faces you.
- Extend your fingers straight pointing up with your arm neutral and thumb tucked in.
- Now, bend your wrist in a position that your fingers point away from you.
- Extend your thumb in the outward direction and hold the position while turning the forearm away from you.
- Use the other hand to pull your thumb down for a more deep stretch.
- Repeat these three to five times.
#4. Steroid Injection
Anti-inflammatory injections are prescribed by doctors to help relieve the symptoms. But their effects are only temporary, and they are usually not for longer use.
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How To Diagnose Carpal Tunnel Syndrome
This article was co-authored by Joshua Grahlman, PT, DPT, FAFS. Dr. Joshua Grahlman, PT, DPT, FAFS, is the Founder and Chief Athlete Mechanic of Clutch PT + Performance, a private physical therapy clinic specializing in sports and orthopedics in New York City. With more than a decade of experience, Dr. Grahlman specializes in treating acute and chronic pain and injuries, sports performance optimization and post-operative rehabilitation. Dr. Grahlman earned his Doctorate of Physical Therapy from Columbia University College of Physicians and Surgeons. He is one of just a few DPTs in New York City recognized as a Fellow in Applied Functional Science through the Gray Institute for Functional Transformation . He is certified in Active Release Technique and Spinal Manipulation and is a TRX Suspension Training Specialist. Dr. Grahlman has spent his career treating athletes of all levels, from Ironman Champions and Olympians to marathoner moms. He consults for Triathlete, Mens Health, My Fitness Pal and CBS News.There are 11 references cited in this article, which can be found at the bottom of the page. This article has been viewed 79,386 times.
Pengobatan Carpal Tunnel Syndrome
Pada beberapa kasus, Gejala CTS tidak membutuhkan pengobatan khusus dan dapat pulih dengan sendirinya. Terutama bagi wanita hamil CTS dapat membaik setelah tiga bulan paska melahirkan.
Pada gejala CTS yang ringan dan sedang dapat ditangani dengan membalut pergelangan tangan dengan papan kecil disertai suntikan kortikosteroid. Jika hal ini tidak berhasil, dokter bisa melakukan prosedur operasi. Operasi penting dilakukan jika dicurigai terdapat kerusakan saraf permanen.
Namun, pemulihan paska operasi akibat CTS mungkin butuh waktu lama jika kasus CTS yang terjadi sudah cukup parah. Bahkan, ada kemungkinan tidak ada perkembangan dari penanganan yang sudah dilakukan.
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Carpal Tunnel Syndrome Risk Factors
You might have a higher risk of getting carpal tunnel syndrome if you:
- Are a woman. Women are three times more likely than men to get it. This might be because they tend to have smaller carpal tunnels.
- Have a family member with small carpal tunnels
- Have a job in which you make the same motions with your arm, hand, or wrist over and over, such as an assembly line worker, sewer or knitter, baker, cashier, hairstylist, or musician
- Fracture or dislocate your wrist
Diagnosis Carpal Tunnel Syndrome
Diagnosis carpal tunnel; syndrome ditegakkan terutama dengan menggabungkan hasil antara anamnesis dan pemeriksaan fisik yang dibantu oleh pemeriksaan elektrodiagnostik yaitu penilaian konduksi saraf dan elektromiografi.;Umumnya pasien akan mengeluhkan nyeri, mati rasa, kesemutan, dan nyeri terutama pada malam hari pada jempol, jari telunjuk, jari tengah dan setengah sisi radial jari kelingking. Keluhan ini akan berkurang bila pasien mengibas-ngibaskan pergelangan tangannya flick sign.
Anamnesis
Anamnesis dilakukan untuk menggali gejala klinis berdasarkan derajat, antara lain:
Derajat Ringan:
Pasien sering terbangun di malam hari dengan sensasi tangan bengkak, kebas; gejala berlanjut menjadi nyeri yang memberat yang menjalar dari pergelangan tangan ke bahu dan rasa seperti tersetrum yang mengganggu pada tangan dan jari-jari . Gejala berkurang dengan menggoncang-goncangkan tangan . Pada pagi hari biasanya sendi tangan kaku.
Derajat Sedang
Gejala tetap ada pada siang hari, kebanyakan ketika pasien berada pada posisi yang sama dalam jangka waktu lama atau melakukan gerakan berulang pada tangan dan pergelangan tangan. Ketika defisit motorik muncul, pasien melaporkan sering menjatuhkan benda saat sedang menggenggam.
Derajat Berat:
CTS derajat berat merupakan tahap final, hipo/atrofi tenar. Pada fase ini gejala sensorik menghilang.
Riwayat penyakit berfokus pada:
- Gerakan yang dapat memperingan gejala
- Adanya faktor predisposisi .
Pemeriksaan Fisik
Inspeksi
Palpasi
| Tes Provokasi |
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Diagnosing Carpal Tunnel Syndrome
Fortunately, there are several diagnostic tests that can help physicians determine if someone has carpal tunnel syndrome when they are experiencing hand and wrist pain and other neurological symptoms. Health care providers will want to rule out other conditions that can cause similar symptoms, such as arthritis or De Quervain’s tenosynovitis .
What Tests Are Used To Diagnose Carpal Tunnel Syndrome
If your doctor suspects you might have carpal tunnel syndrome, they will perform a physical exam that includes specific tests to evaluate the sensitivity of your median nerve, the strength of your grip, and other indicators. If this exam doesn’t provide a definitive diagnosis, imaging tests are performed. Magnetic resonance imaging allows a view of the median nerve, tendons, and ligaments in the wrist as well as the bones and can reveal if there’s compression on the nerve.
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Carpal Tunnel Syndrome Diagnosis And Tests
Your doctor may tap the palm side of your wrist, a test called Tinel sign, or fully flex your wrist with your arms extended. They might also do tests including:
- Imaging tests. X-rays, ultrasounds, or MRI exams can let your doctor look at your bones and tissues.
- Electromyogram. Your doctor puts a thin electrode into a muscle to measure its electrical activity.
- Nerve conduction studies. Your doctor tapes electrodes to your skin to measure the signals in the nerves of your hand and arm.
Can I Diagnose Carpal Tunnel Syndrome Myself At Home
Only a doctor can reliably diagnose carpal tunnel syndrome, especially when an office exam isn’t sufficient and imaging tests are required. The common signs and symptoms of carpal tunnel syndrome should be enough to alert you to the possibility you have this condition, however, so you know to seek a definitive diagnosis.
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How Do I Know If I Have Carpal Tunnel Syndrome
Your doctor may use a handful of tests to diagnose carpal tunnel syndrome and rule out other causes of hand and wrist pain.
Theyâll probably start with questions about your medical history. Then theyâll examine your hands, arms, shoulders, and neck to figure out if your pain results from another condition, like an injury or arthritis. Theyâll also make sure your daily activities arenât to blame.
The doctor may focus on your wrist to see if the area is tender, swollen, warm, or discolored. Theyâll probably test each finger to see if youâve lost any feeling. And theyâll check the strength of the muscles in your hand.
After that, they may do tests focusing on the median nerve, which runs through your forearm into your hand. When that nerve gets pressed or squeezed through the carpal tunnel, it causes carpal tunnel syndrome.
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