Carpal Tunnel Syndrome - Diagnosis & Treatment

How is carpal tunnel syndrome diagnosed?

• Physical examination. During a physical examination, your doctor will ask about your symptoms and look for signs of nerve pressure. This includes checking for tenderness, swelling, and deformities. To help your doctor evaluate sensation in your fingers and muscle strength in your hand, some simple tests may be conducted:

  • Tinel's Sign. A reflex hammer is tapped on the median nerve in your wrist. A positive test will result in tingling in your fingers or a sensation like a small electric shock.
  • Phalen's Maneuver. Also known as a wrist flexion test, this involves you pressing the backs of your hands together, with your fingers pointed down, for 1 or 2 minutes. If you feel tingling or numbness, this is an indication of carpal tunnel syndrome.

• Nerve conduction studies. These measure the speed and function of the median nerve. A small electrode is placed on the skin near the elbow to send a small electrical current down the median nerve. As healthy nerves transmit electrical signals quickly, the amount of time taken for the current to travel to your fingers will indicate the amount of nerve damage you are experiencing.

• Electromyogram. In this diagnostic test, a small needle is inserted into the muscles in your hand to send electrical impulses that measure the muscle function around the median nerve while you squeeze and relax your hands several times.

• Imaging tests. Imaging tests such as an ultrasound, X-ray or magnetic resonance imaging (MRI) may be performed to rule out any other possible causes of wrist pain such as arthritis.

How is carpal tunnel syndrome treated?

Treatment for carpal tunnel syndrome usually depends on the severity of its symptoms, ranging from lifestyle changes and medication to surgery or a combination of these.

Lifestyle changes

You can reduce your risk for developing this painful condition with some lifestyle adjustments:

• Take short breaks to stretch and bend your hands and wrists.
• Change activities regularly, or alternate the hand you use to give your wrists some relief. This is especially important if you are using equipment that vibrates or using your hands to exert a lot of pressure.
• Avoid using unnecessary force while writing, typing or gripping.
• Avoid excessive or extreme bending of your wrists. Try to keep to a relaxed, middle position. If your work set-up is contributing to your symptoms, consider making adjustments to your physical space or the way you perform your tasks. Place your keyboard at elbow height or slightly lower and use a computer mouse that allows comfortable wrist movement.
• Practise good form and posture to avoid straining neck and shoulder muscles, which can compress the nerves in your neck.
• Keep your hands and wrists warm, as hand pain and stiffness is more common in people who work in a cold environment.

Wrist splint or brace

Putting your wrist in a brace or splint to restrict its movement can allow a period of rest to relieve the symptoms of carpal tunnel syndrome. It may also help to wear one while sleeping.

Physiotherapy

Physiotherapy can help you to adjust the way you use your hands and wrist in your daily routine, to reduce pressure and therefore pain. You can also learn different ways to stretch and relieve strain on your wrists, and exercises to strengthen your hand and wrist muscles.

Medication

Your doctor may prescribe pain relievers or medication to help reduce swelling, but these should be taken sparingly and only under medical supervision.

Carpal tunnel release surgery

For severe and persistent symptoms, carpal tunnel release surgery may be recommended. The procedure involves cutting the carpal ligament to reduce pressure on the median nerve.

Microsurgical neurolysis

In cases where carpal tunnel release surgery is unsuccessful, microsurgical neurolysis may be advised. This procedure releases tight scar tissue around the median nerve to relieve pressure. In some cases, soft tissue will then be transferred to the bare median nerve to prevent scarring from happening again, which would cause the symptoms to return.

See your doctor or a hand surgeon if you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Early diagnosis and treatment offer the best chances for effective relief and prevents the symptoms from getting worse.