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  • Q&A with Australian Health Practitioners

    How is carpal tunnel syndrome diagnosed?

    Related Topics
    Carpal Tunnel Syndrome Neurology
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    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    In the case of numbness, pain or tingling into the wrist and hand we will conduct a physical examination of the hands, arms, shoulders, and neck to help determine if the patient's complaints are related to daily activities or to an underlying disorder. As carpal tunnel syndrome can be idential to other symptoms, a good examination can rule out other painful conditions that may mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger is tested for sensation, and the muscles at the base of the hand are examined for strength and signs of atrophy. Your specialist or GP may undertake routine laboratory tests and X-rays that can rule out reveal diabetes, arthritis, and fractures.We use specific tests in order to reproduce the symptoms. The most common tests we use are the Tinel test and the Phalen test. In the Tinel test, we tap on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant electric shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Sometimes you may notice some specific movements or actions that cause the symptoms. It is important to tell and show us of those movements. If we are unsure that it's a true carpal tunnel syndrome we will confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. Sometimes you may also be referred for ultrasound imaging which can show impaired movement of the median nerve. 

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    Dr Jillian Tomlinson

    Hand Surgeon, Plastic Surgeon

    Dr Jill Tomlinson is a fully qualified plastic, reconstructive and hand surgeon. After graduating dux in her year at University High School, Jill completed medical … View Profile

    In many instances the condition can be diagnosed on the basis of classic symptoms and signs (see below). Sometimes the diagnosis is unclear, in which case your doctor will recommend that you have nerve conduction studies to see if your symptoms are from carpal tunnel syndrome or if your symptoms are due to something else. Nerve conduction studies are very reliable in diagnosing carpal tunnel syndrome.

    The most common symptoms of carpal tunnel syndrome are pain and numbness or tingling of the fingers and hand. People often complain that their affected hand feels clumsy and you may have trouble picking up small objects. You may wake at night with pain in the hands, wrist or up the arm. You may wake up with pain and shake your hands to try to get rid of the pain. The symptoms may also be exacerbated by activities where the wrist is flexed, such as driving. In severe, longstanding cases there may be wasting (shrinkage) of the muscles at the base of the thumb.

    There are two clinical tests described for carpal tunnel syndrome. “Phalen's” test involves asking you to flex your wrist for a minute and seeing if your symptoms worsen. “Tinel's” sign involves tapping at the site of the carpal tunnel and seeing if this produces symptoms of shooting nerve pain or abnormal nerve sensations. These tests are considered as part of an overall assessment of your clinical symptoms and signs.

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