carpal tunnel diagnosis

 What symptoms of the carpal tunnel syndrome are leading to a doctor?

Usually the disease starts with numbness and „formication“ („tingling“) in the tip of the middle finger. Shortly after a lot of affected persons feel   a tingling or painful miss sensations in the thumb, index finger and middle finger.

median nerv compression: clinical signs
paraesthesia in median nerv compression

The area of numbness differing from patient to patient.

The illustration shows a typical case. The hatched areas of the hand are descibed by the patient as „numb an  painful“.

The discomforts also appear during day time. Pain and numbness are mostly triggered by an unbalanced position of the wrist during calls, cycling, etc..

Often patient reports that the whole hand is swollen.  Pain occurs often in the whole hand and forearm, sometimes in the whole arm. This pain mostly occurs during night.

What progression of the disease can be expected?

Pain and unpleasant sensations occur more often not only during night, but also during daytime. Affected persons often report the hand to be clumsy and weak. Housewifes for example, report not to be able to sew anymore, or being unable to open aq button…

In advanced cases the skins sensivity reduces for the thumb, index finger, middlefinger and the ring finger.

thenar muscle atrophia
diminished muscle of thumbs ball

At very late stage of the disease, the thumb’s ball is losing it’s musculature. The illustration is showing such an advanced symptoms.

Absolute loss of skin sensivity in a Hand is fortunately very rare today.

How can the carpal tunnel syndrome be suspected?

Initially it’s very important that the doctor is carefully listening to the patients description of discomforts. Questions about accompanying diseases like diabetes mellitus, thyroid failure or fractures around the wrist are important indications.

What additional options to estabish diagnosis of a cts are available for the doctor?

Check the area of the hand. Below you will find an easy to perform test:

phalens sign for cts
phalens test to estabished cts

Hold hands in above and below position for about 1 minute (Phales test)

phalens signs for carpal tunnel diagnosis
Phalen’s test is completed after postitioning both hands in a maximum flexed position for a minute

With carpal tunnel syndrome, unpleasant sensations and numb fingers will occur during this time. The phales test is of particular significance, if unpleasant sensations occur  espacially in thumb, index finger and middle finger. During the simple phalen test pain is radiating to thumb, index finger and middle finger.

tinels sign nerv compression
tinels sign in carpal tunnel syndrom

Another finding in a carpal tunnel syndrome is the Tinel’s sign. If pressure is applied to median nerv  (Illustration) near the wrist, more pain is felt. The pain is radiating to thumb, index finger and middle finger.

The test can be executed by finger pressure or by light tapping onto the course of median nerv.

How can be distinguished between a nerve compression (entrapment) in the carpal tunnel and a nerve disorder in the area of the cervical spine?

A compression of the median nerv in the hand can be diagnosed with high propability with measuring the „nerve flows“  in an ENG/EMG.

Determining the nerve conduction is the recognised diagnostical standard for the diagnosis, as well as for follow-up checks for the carpal tunnel syndrome. Hereby it’s possible to exactly determine at what point the nerve compression is located.

Information: A simultaneous pressure damage of a nerce in hand, shoulder or neck is  quite possible. (multiple crush Syndrom)

Is a X-Ray examination of the wrist helpful for the diagnosis?

Even though an X-ray examination can not diagnose a carpal tunnel syndrome, it’s reasonable to perform this examination. Often, other diseases are found together with the carpal tunnel syndrome. (e.g. arthrosis of the thumb saddle joint)

Is a magnetic resonance tomography (MRT) useful with respect to the carpal tunnel syndrome?

This examination is not necessary in most of the cases. Only if the doctor has  a specific  indication for example suspecting a tumour. In that case, such a complex examination is useful. In picture below, a rare situation of a tumour in the carpal tunnel is illustrated.

tumor as a cause of carpal tunnel syndrom
rare case: tumor in carpal tunnel

In the shown example, the tumour in the carpal tunnel is so big in size, that it’s visible from outside.


Next   (non operative therapy of carpal tunnel syndrom)