Carpal Tunnel Diagnosis

While there are three factors considered in the diagnosis of carpal tunnel syndrome, only a small majority of individuals who suffer from this condition show the signs of all three. These factors include "classic CTS symptoms", "specific physical findings", and "abnormal electrodiagnostic test results".

In some individuals the electrodiagnostic test will produce an abnormal result indicating carpal tunnel; however, they will not have the "classic CTS symptoms" or sometimes no symptoms at all. Carpal tunnel syndrome is typically diagnosed through the patient's description of their symptoms and physical testing as well as electrodiagnostic testing. 

Eliminating Underlying Conditions and Physical Tests 

One of the first steps taken in the diagnosis of carpal tunnel syndrome is the ruling out of any other medical conditions which may mimic CTS. Underlying conditions such as osteoarthritis, rheumatoid arthritis, and gout, can cause symptoms which are similar to carpal tunnel as well as other diseases of the nerves and muscles. Physical testing and the patient's history of symptoms also are a factor in making the diagnosis of carpal tunnel. 

A detailed history of the patient's symptoms will also be examined including situations such as work and daily activities where the hand and wrist are required to perform in a repetitive fashion. What times the symptoms are appearing most frequently - such as after performing a particular task or during the night - will also is analyzed. The patient may be asked to look at a diagram of the hand and wrist and point out the areas where they feel symptoms of tingling and numbness.

If there is pain in the area of the wrist or in the wrist and at least two of the three fingers known to be affected by carpal tunnel are experiencing numbness or tingling, then this indicates the probability of carpal tunnel syndrome.   

Physical Criteria and Confirming the Diagnosis of Carpal Tunnel Syndrome 

Carpal tunnel syndrome will likely be diagnosed if physical testing confirms weakness of thumb, decreased sensitivity in the fingers where the median nerve passes through and - in the later stages of carpal tunnel - there may be the inability to distinguish differences in one or two sharp points at the tips of the fingers.

Another factor in diagnosing carpal tunnel is determined by the "flick test" which is simply asking the patient how they respond to their symptoms. If they indicate that they use a "flicking" motion or shake their hand in a rapid manner similar to shaking a thermometer, then this is also a very strong indication of carpal tunnel syndrome.

There are other common tests performed in which the results will be used in determining a diagnosis of carpal tunnel syndrome. These tests are provocation tests which include the "Phalen's test" and "Tinel's test". These tests include having the patient position their hand in such a way as to recreate the motion that produces the symptoms of carpal tunnel.

Other provocation tests include applying pressure to the median nerve or over the carpal tunnel to produce small shocks or tingling. If the symptoms of numbness and tingling are experienced within less than a minute, this is strongly indicative of carpal tunnel syndrome.

In order to confirm a carpal tunnel diagnosis, the physician may order electrodiagnostic tests. The two most common forms of these tests are the "nerve conduction test" or "electromyography".

These tests basically consist of sending tiny electrical shocks through the nerves of the wrist, forearm and fingers to determine the rate of speed at which these signals travel through the nerves that control sensation and movement. In the majority of cases, these tests can definitively diagnose or rule out the condition of carpal tunnel syndrome.