DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of Carpal Tunnel Syndrome. |
Alternative NamesRepetitive Stress Injuries; Thoracic Outlet Syndrome |
DiagnosisCarpal tunnel syndrome (CTS) is most accurately diagnosed using the patients' descriptions of symptoms plus electrodiagnostic tests that measure nerve conduction through the hand. If electrodiagnostic testing is not available, then symptom descriptions and a series of physical tests are useful. Diagnosing CTS, however, is not straightforward. Only a small fraction of patients exhibit all three factors necessary for a clear diagnosis:
Many people have abnormal electrodiagnostic test results but have no classic symptoms or even no symptoms at all. Furthermore, about 15% of the population has symptoms consistent with CTS, but most do not show test results indicating the disorder. In fact, in a 2001 study, some patients who had symptoms but whose nerve and physical tests are normal still experienced relief after CTS surgery. |
Symptom Description and Severity
Many cases of CTS are a combination of a medical problem exacerbated by repetitive stress factors at work. The patient should give the physician a detailed history and description of any complaints, in any part of the body. The patient should report in detail any daily activities that require repetitive hand or wrist actions, abnormal postures, or other chronic situations that could affect the nerves in the neck, shoulders, and hands. The patient should report whether the symptoms especially appear at night or after particular tasks.
Questionnaires. The use of specific questionnaires that score results are quite accurate in assessing the severity of the condition.
Hand Diagram. A diagram of the hand and wrist, usually divided into six regions, is a very useful diagnostic tool. Patients are asked to indicate where their symptoms, including pain, numbness, or tingling are by locating the affected areas on the diagram. They may also be asked to rate the severity of their symptoms. A diagnosis is probable if at least two of fingers 1, 2, or 3 have these symptoms and if there is pain in or near the wrist. CTS is possible if at least one of these fingers has symptoms. It is unlikely if there are no symptoms in these fingers, the palm, or the wrist.
Ruling Out Underlying Medical Disorders
One of the most important first steps in diagnosing CTS is to rule out any underlying medical disorders that may be contributing to the condition. Experts emphasize the need to fully examine patients presenting with symptoms of CTS. Relying only on CTS symptoms and personal or work histories may result in the failure to detect (and thus properly treat) underlying medical conditions that could be serious. If the doctor suspects that an underlying medical condition may be exacerbating the symptoms, laboratory tests will be performed. The doctor may take an x-ray, for example, to check for arthritis or fractured bones.
Raynaud's Phenomenon. Raynaud's phenomenon produces symptoms of numbness and tingling or pain in the fingers of one or both hands. It is usually brought on by cold or stress and is treated with warmth or, in severe cases, medications that may open blood vessels. People with this disorder, in fact, appear to be at higher risk for carpal tunnel syndrome and there may be some associations between the two conditions.
Arthritic Conditions. Arthritic conditions, including rheumatoid arthritis, gout, and osteoarthritis, can all cause pain in the hands and fingers that may mimic but not actually be treatable as carpal tunnel disease.
Muscle and Nerve Diseases. Any disease or abnormality that affects the muscles and nerves, including those in the spine, may produce symptoms in the hand that mimic carpal tunnel.
Ruling Out Other Cumulative Trauma Disorders
About 25% of patients with suspected work-related cumulative trauma or repetitive stress disorders have evidence of other conditions that resemble, but are not, carpal tunnel syndrome. A definitive diagnosis is often difficult. Most require treatments similar to those used for CTS: rest, immobilization, steroid injections, and even surgery if conservative management is unsuccessful.
