Diagnosing Carpal Tunnel Syndrome
No single test can tell for sure if you have carpal tunnel syndrome. Instead, your doctor reviews your medical history and does a physical exam, then may arrange for you to have one or more tests.
During a physical exam for suspected carpal tunnel syndrome, your doctor examines your hands, arms, shoulders and neck. Your doctor may also
- Show you a hand diagram and ask you to mark those places where you experience numbness and tingling. One clue that it might be carpal tunnel syndrome is if you dont have symptoms in your little finger. Thats because the median nerve doesnt provide sensation to it. Hand diagrams are one of the most helpful diagnostic tools doctors use.
- Examine muscles at the base of your thumb for signs of shrinking .
- Check to see how sensitive to touch your index finger is compared with your little finger.
- Check your ability to feel vibrations or mildly painful sensations on your fingers. Diminished ability to feel these sensations may suggest that you have carpal tunnel syndrome.
How Carpal Tunnel Syndrome Happens
Today we understand a lot more about carpal tunnel syndrome than we did a decade ago. It happens due to malfunctions in the chemistry of the wristsflexor tendons. These tendons are the ropy structures running from the hand to the forearm, on the palm side.
The flexor tendons are responsible for moving your fingers and producing grasping actions. Normally, the tendons glide effortlessly next to each other. But when they malfunction, they no longer provide smooth movement.The key to ALL carpal tunnel pain relief is to make tendons glide smoothly again.
The following are the 3 primary steps that produce carpal tunnel syndrome.
Helpful Life Hacks For Carpal Tunnel Pain
When you have the wrist or hand pain and tingling of carpal tunnel syndrome, it may seem like surgery is the only answer. But there are measures you can take to either avoid or postpone surgery and still have good quality of life.
See Causes and Risk Factors for Carpal Tunnel Syndrome
2.Use a wrist braceBracing the wrist is one of the most reliable ways to stabilize the wrist and ease carpal tunnel pain. When selecting a brace, choose a structured, firm option that will immobilize the wrist, as opposed a flexible one made of neoprene or elastic.
See Treatment Options for Carpal Tunnel Syndrome
3.Elevate hands, especially during sleepElevating the hands and wrists can help ease inflammation, particularly at night. This can be done by sleeping on your back and propping your wrists up on pillows. Since keeping your arms straight can also help, try wrapping a towel or ace bandage around your elbows.
5.Ask about job rotationIf your job involves activities such as repetitive assembly line work, talk with your employer about the possibility of rotating tasks to give your wrists and hands a rest.
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How Is It Diagnosed
Physical therapists work together with other health care providers to accurately diagnose and treat CTS. Symptoms of CTS are typical. It is often possible to diagnose it without extensive testing. Your physical therapist will conduct a thorough evaluation to determine all the factors that may be contributing to your condition.
They will begin by asking you questions to gather information about your health history and condition. The interview will become more specific to the symptoms of CTS. They may be helped by forms you fill out before your first session. Your physical therapist may ask you:
- Did you experience an injury to the area?
- If so, how did your injury occur?
- Do you perform repeated tasks for your work, or for sport?
- How have you taken care of the condition, such as seeing other health care providers? Have you had imaging or other tests, and received their results?
- What are your current symptoms, and how have they changed your activities?
- Do you have pain. If so, where and how intense is your pain? Does pain vary during the day?
- Do you have trouble doing any activities? What activities are you unable to do?
This information lets the physical therapist better understand what you are experiencing and helps to determine the course of your physical exam.
Several tests may be used to help diagnose or rule out CTS, including:
In some cases, your physical therapist may refer you to a doctor or other health care provider for additional testing or treatment.
When Its Time To See The Doctor
If these home treatments dont ease your pain in one or two weeks, it might be time to see an orthopaedic physician, who specializes in treatment of bones, joints and muscles.
Your doctor may recommend surgery if theres severe damage to your median nerve or to prevent permanent sensory or functional loss, Dr. Seitz says.
The surgery involves cutting the band of tissue in the wrist that crosses the median nerve to lessen the pressure.
Over time, surgery may be the best route to permanent relief, Dr. Seitz says.
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Test : Electrodiagnostic Test For Carpal Tunnel Syndrome
The electrodiagnostic test for carpal tunnel syndrome is composed of thenerve conduction examandelectromyography exam. Both tests are usually performed together. They must be conducted in thedoctor’s officebecause special equipment is required.
Note that most doctors do not rely heavily on electrodiagnostics for carpal tunnel syndrome. That’s because they arenot more accuratethan the provocative exams. Therefore, since they don’t add value to the diagnosis, doctors generally use electrodiagnostics toconfirmtheir provocative exam results.
Reduce Or Quit Tobacco Use
Nicotine is an addictive chemical in tobacco products. It also constricts arteries and reduces blood flow in the body. If the blood flow in the hand is reduced, the nerves can be more sensitive to injury. Stopping tobacco use may reduce the risk of CTS symptoms and is good for your overall health. Consider talking to your primary care physician about quitting.
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Carpal Tunnel Syndrome Exercises
The right exercises are useful compliments to another CTS treatment. Exercises along with the right treatment, proper activity modification and wrist splinting can hasten the recovery process.
Here is a generic exercise that you can do anytime, anywhere. This exercise is developed by Dr. Housang Seradge at the University of Oklahoma Orthopaedic & Reconstructive Research Foundation.
- Extend and stretch both wrists and fingers acutely as if they are in a hand-stand position. Hold for a count of 5.
- Straighten both wrists and relax fingers.
- Make a tight fist with both hands.
- Then bend both wrists down while keeping the fist. Hold for a count of 5.
- Straighten both wrists and relax fingers, for a count of 5.
- The exercise should be repeated 10 times. Then let your arms hang loosely at the side and shake them for a few seconds.
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Heres another set of exercises from University of Maryland Medical Center for carpal tunnel syndrome. These exercises work to strengthen the wrist, hands, arms and shoulders to help cure and avoid carpal tunnel syndrome.
Core Wrist Exercises
Exercise 2
- Hold one hand straight up shoulder-high with your fingers together and palm facing outward.
- With the other hand, bend the hand you are exercising backward with the fingers still held together and hold for 5 seconds.
- Spread your fingers and thumb open while your hand is still bent back and hold for 5 seconds. Repeat five times with each hand.
Exercise 3
Ignoring Symptoms Of This Carpal Tunnel Syndrome Can Lead To Permanent Nerve Damage
First, you may notice tingling or numbness in your fingers that comes and goes. Over time, the sensations may get worse, lasting longer or even waking you up at night. Eventually the pain and numbness might even make it hard to grip things like a fork, a pen, or other objects.
If you’re having these symptoms, it could be carpal tunnel syndrome, which occurs when the median nerve which runs down your arm and into your hand is compressed by a ligament that crosses over it as it passes through a narrow space in the wrist known as the carpal tunnel.
“Carpal tunnel syndrome has classic symptoms, which include numbness and tingling in the thumb, index finger, middle finger, and half of the ring finger,” says Dr. Tamara Rozental, professor of orthopedic surgery at Harvard Medical School and chief of hand and upper extremity surgery at Beth Israel Deaconess Medical Center. Your little finger is typically not affected because a different nerve serves it.
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Physical Therapy Guide To Carpal Tunnel Syndrome
Read Time:
Carpal tunnel syndrome is a common condition that causes pain, numbness, and weakness in the wrist and hand. CTS can affect the use of the entire arm. It is caused by pressure on the nerve at the base of the palm . Because of the constant demands people place on their hands and wrists, surgery may be needed when symptoms are severe. For many people with CTS, however, physical therapy treatment can relieve pain and numbness. It often can help restore normal hand, wrist, and arm use without the need for surgery.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
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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Causes Of Carpal Tunnel Syndrome
- Arthritis various types of arthritis, especially rheumatoid arthritis, can cause inflammation and swelling
- Pregnancy the hormones associated with pregnancy cause general fluid retention, which can compress the nerve. Carpal tunnel syndrome triggered by pregnancy usually goes away soon after birth
- Wrist fractures bone fragments can irritate the tenosynovium or reduce the amount of space in the carpal tunnel
- Congenital factors some people have a smaller carpal tunnel than others
- Overuse injury the tendons in the carpal tunnel can become irritated and inflamed by awkward postures or repetitive hand movements.
Talk To A Doctor About Surgery
Typically, surgery will involve severing a ligament around your wrist to help reduce median nerve pressure. Surgery is generally performed under regional involving some sedation or local anesthesia and doesnt require an overnight stay at the hospital. Many individuals need surgery on both hands.
Although carpal tunnel surgery involves the surgeon relieving nerve pressure by cutting the ligament, they can use two different methods to accomplish this:
- Open Release Surgery: Open release surgery is the standard surgery used for correcting carpal tunnel syndrome. The surgeon makes a two-inch incision in your wrist and cuts the carpal ligament so they can enlarge the carpal tunnel. Usually, patients require local anesthesia for this surgery, and its performed on an outpatient basis.
- Endoscopic Surgery: Endoscopic surgery may allow for less post-operative discomfort and quicker functional recovery than the standard open release surgery. There could, however, be more complications, and you may require additional surgery. The surgeon will make an incision or two of around a half an inch in your palm and wrist. Then, theyll insert a camera which is attached to a tube so they can observe the ligament, nerve and tendons while cutting the carpal ligament.
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Who Gets Carpal Tunnel Syndrome
Another fact about carpal tunnel syndrome is that it’sgenetic. 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 isnot 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.
Drug Treatment And Surgery
In addition to wearing splints and other comfort measures, prescription medications or injections are available.
Oral corticosteroid medication may decrease inflammation and swelling, which might help to reduce pressure on the median nerve. Corticosteroid medication is also available as an injection into the wrist. Injections seem to be more effective than oral corticosteroids for CTS.
No significant evidence supports the use of non-steroidal anti-inflammatory drugs to treat CTS.
Conventional treatments for CTS should take place under the guidance of a doctor.
If CTS relates to an underlying condition, such as diabetes, arthritis, or hypothyroidism, try to control the condition and symptoms should reduce.
For people who develop CTS during pregnancy, symptoms usually resolve 6 to 12 weeks after giving birth. Some specialists recommend putting a splint on the wrist while sleeping.
Sometimes, if severe compression is occurring on the median nerve, it may be causing nerve damage or muscle wasting that requires further treatment.
The treating doctor may recommend surgery if CTS is severe and if non-surgical treatments do not help. Surgical treatment of CTS does appear to have the best outcome. Studies have shown that 6 to 12 months after surgery, CTS improves more than it would with just a splint or some other non-surgical treatment.
The two types of surgery available for CTS are:
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Traditional Treatments For Carpal Tunnel Syndrome
More serious cases of carpal tunnel syndrome may require your doctors help.
Your doctor may recommend corticosteroids to lessen your pain and inflammation. These drugs reduce the amount of swelling and pressure placed on the median nerve. Injections are more effective than oral steroids. This therapy may be particularly effective if your CTS is caused by inflammatory conditions, such as rheumatoid arthritis.
Your doctor may also recommend surgery to relieve pressure on the nerve. This typically involves making one or two incisions in the area affected and cutting the ligament involved. This will release the nerve and increase the space around the nerve.
The ligament will eventually grow back, allowing more space for your nerve than there was before. If your CTS is severe, surgery may not clear up your symptoms completely, but it should help you feel better and help prevent any further damage to the nerve.
Treatment Options For Carpal Tunnel And Wrist Pain
Home / News / Treatment Options for Carpal Tunnel and Wrist Pain
Are you noticing a numb, weak, pins-and-needles or falling asleep sensation in your hand and wrist? What about pain in your wrist? Perhaps, all of these sensations are occurring for no apparent reason. If youre having these symptoms, chances are you could be experiencing carpal tunnel syndrome.
Its best not to delay carpal tunnel treatment or wrist pain treatment, as ignoring the symptoms of this common condition could lead to permanent nerve damage. If you suspect you have carpal tunnel syndrome , visit us at the Orthopedic Institute of Pennsylvania to receive an official diagnosis and begin treatment.
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What Causes Carpal Tunnel Syndrome
The majority of people who suffer from carpal tunnel syndrome often have a combination of the following factors:
- Pregnancy is generally accompanied by fluid retention, which can compress the nerve
- Wrist fractures can reduce the amount of space in the carpal tunnel
- Congenital factors that cause some people to be born with smaller carpal tunnel than others
- Overuse injury from awkward postures or repetitive hand movements.
Basically anything that causes inflammation or swelling can lead to carpal tunnel syndrome.
How Is Carpal Tunnel Syndrome Treated
Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Underlying causes such as diabetes or arthritis should be treated first.
Non-surgical treatments
- Splinting. Initial treatment is usually a splint worn at night.
- Avoiding daytime activities that may provoke symptoms. Some people with slight discomfort may wish to take frequent breaks from tasks, to rest the hand. If the wrist is red, warm and swollen, applying cool packs can help.
- Over-the-counter drugs. In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs , such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide some short-term relief from discomfort but havent been shown to treat CTS.
- Prescription medicines. Corticosteroids or the drug lidocaine can be injected directly into the wrist or taken by mouth to relieve pressure on the median nerve in people with mild or intermittent symptoms.
- Alternative therapies. Acupuncture and chiropractic care have benefited some individuals but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among those with CTS.
Surgery
Recurrence of carpal tunnel syndrome following treatment is rare. Less than half of individuals report their hand feeling completely normal following surgery. Some residual numbness or weakness is common..
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