Carpal tunnel: signs, symptoms & treatment | BMI Healthcare
Carpal Tunnel Syndrome Symptoms and Diagnosis
Hand pain or tingling that’s worse at night is a common complaint with carpal tunnel syndrome.
Carpal tunnel syndrome is a common hand condition that can happen when the median nerve — which runs from the upper arm to the fingers — gets pinched at the wrist. ()
This pinching can occur when a passageway through the wrist — called the carpal tunnel — becomes narrowed or when the tissues around the tendons passing through the carpal tunnel become swollen. It may lead to pain, weakness, numbness, or tingling in the hands and fingers.
Carpal Tunnel Syndrome: Signs and Symptoms
At first, symptoms of carpal tunnel syndrome tend to be subtle. Pain and other sensations begin gradually and worsen over time, typically. While some people experience an injury, such as a wrist sprain or break, which could lead to symptoms, most of the time carpal tunnel symptoms start without any obvious injury. (1)
Common symptoms of carpal tunnel syndrome include: (1)
- Numbness or Tingling One of the hallmark symptoms of carpal tunnel syndrome is numbness or tingling in the fingers and hand. This typically takes place in the thumb, index, middle, and ring fingers. Some people may also feel numbness and tingling in the wrist and forearm.
- Pain In addition to numbness or tingling, you may also feel painful shock-like sensations. Pain might stay just the wrist, or pain may radiate to the fingers. Pain may also feel like a dull ache.
- Weakness or Clumsiness Less commonly, people with carpal tunnel syndrome experience weakness or clumsiness when using their hands. This can cause problems holding objects, turning doorknobs, buttoning clothes, or opening jar lids.
Carpal tunnel syndrome symptoms often occur while doing an activity that causes you to hold your wrist in the same position for an extended period of time. These activities includes actions such as holding a steering wheel, phone, or newspaper. ()
Timing of Carpal Tunnel Syndrome Symptoms
Nighttime complaints are common with carpal tunnel syndrome. Carpal tunnel syndrome symptoms typically worsen at night. That’s because many people sleep with their wrists bent. Many report being awoken by their symptoms. ()
The symptoms of carpal tunnel syndrome typically begin gradually and worsen over time. (2)
Some people find that shaking or wringing their hands or placing them under warm running water helps to alleviate symptoms. (3)
See your doctor if you think you have symptoms of carpal tunnel syndrome. Early treatment is important for carpal tunnel syndrome. Without treatment, permanent nerve damage can occur. (2)
Carpal Tunnel Syndrome Diagnosis and Testing
Your doctor will use a physical exam, medical history, and imaging diagnostic tests to tell if you have carpal tunnel syndrome.
Medical History Your doctor will ask you about your symptoms and your general health or medical history. This can help to rule out related conditions or other medical problems that could be causing wrist and hand pain. (
Physical Exam Your doctor will examine the hands, wrists, arms, shoulders, and neck. The exam will include a number of physical tests to look for any signs of nerve damage.
Physical tests for carpal tunnel syndrome may include: (4)
- Tapping on the inside of your wrist over the median nerve to see if it causes any numbness or tingling. This is called a Tinel’s test.
- Bending your wrist and pushing the back surfaces of both hands together for 30 to 60 seconds. This is called Phalen’s maneuver. Numbness or tingling in this position could signal carpal tunnel syndrome.
- Raising your hands above your head for one minute to see if symptoms of carpal tunnel syndrome occur.
- Lacing pressure on the inside of your wrist for 30 seconds to see if it causes, pain, numbness, or tingling. This is called a manual carpal compression test.
Diagnostic imaging tests for carpal tunnel syndrome may include:
Electrodiagnostic Tests These tests assess nerve function. They can help your doctor confirm a carpal tunnel syndrome diagnosis and rule out other nerve conditions. Electrodiagnostic tests can include: (1)
- Nerve Conduction StudiesSmall electrodes are taped to the skin. They send a small shock through the median nerve to measure its electrical activity. The doctor will look to see whether the electrical impulse slows at the carpal tunnel — a sign that the nerve is pinched.
- Electromyogram This test measures tiny electrical impulses in the hand muscles. It can show whether there is any nerve or muscle damage.
X-Rays X-rays will show your doctor abnormalities in bone structure. An X-ray can help to rule out other causes of wrist pain, such as a bone fracture or arthritis. (5)
Ultrasound Ultrasound uses high-frequency sound waves to create a picture of the nerves, muscles, and bones of the wrist. An ultrasound can show abnormalities in the median nerve. (1)
Magnetic Resonance Imaging (MRI) MRI can be used to detect abnormalities of the median nerve and the ligaments and tendons of the wrist. But it may not be the best test for diagnosing carpal tunnel syndrome. It’s usually used only to rule out a mass or lesion. (3)
Conditions Related to Carpal Tunnel Syndrome
A few related disorders can cause carpal tunnel-like symptoms. These typically involve a pinched nerve elsewhere in the arm or neck.
Some related conditions include:
- Cervical radiculopathy This happens when a nerve in the neck gets pinched or irritated by the cervical vertebrae. The cervical vertebrae are the bones immediately below the skull that make up the neck. Cervical radiculopathy can cause tingling or loss of sensation in the hand and fingers and weakness in the arm. (6)
- Thoracic Outlet SyndromeIn this condition, a nerve or blood vessel gets pinched in the area where the neck meeds the collarbone. It can cause feelings of “pins and needles” or numbness and tingling in the upper arm, forearm, or hand. (7)
- Pronator Teres SyndromeThe median nerve becomes pinched further up the arm, near the elbow. Pronator teres syndrome shares many symptoms with carpal tunnel syndrome. But in pronator teres syndrome, there’s usually some pain or tenderness when pressing on the under side of the forearm near the elbow.
Video: Quick Carpal Tunnel Test - Nerve Conduction
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