Carpal Tunnel Syndrome (cont.)
How does a patient with carpal tunnel syndrome
feel?
Patients with carpal tunnel syndrome initially feel
numbness and tingling of the hand in the distribution of the median nerve (the
thumb, index, middle, and part of the fourth fingers). These sensations are
often more pronounced at night and can awaken patients from sleep. The reason symptoms are worse at night may
be related to the flexed-wrist sleeping position and/or fluid
accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.
As the disease progresses, patients can develop a
burning sensation, cramping and weakness of the hand. Decreased
grip strength can lead to frequent dropping of objects from the
hand. Occasionally, sharp shooting pains can be felt in the forearm.
Chronic carpal tunnel syndrome can also lead to wasting (atrophy)
of the hand muscles, particularly those near the base of the thumb in the palm of the hand.
How is carpal tunnel syndrome diagnosed?
The diagnosis of carpal tunnel syndrome is suspected
based on the symptoms and the distribution of the hand numbness.
Examination
of the neck, shoulder, elbow, pulses, and reflexes can be performed
to exclude other conditions that can mimic carpal tunnel syndrome.
The wrist can be examined for swelling, warmth, tenderness, deformity,
and discoloration. Sometimes tapping the front of the wrist can
reproduce tingling of the hand, and is referred to as Tinel's
sign of carpal tunnel syndrome. Symptoms can also at times be
reproduced by the examiner by bending the wrist forward (referred to as
Phalen's maneuver).
The diagnosis is strongly suggested when a nerve
conduction velocity test is abnormal. This test involves measuring the
rate of speed of electrical impulses as they travel down a nerve.
In carpal tunnel syndrome, the impulse slows as it crosses through
the carpal tunnel. A test of muscles of the extremity, electromyogram (EMG), is sometimes performed to exclude or detect other conditions that might mimic carpal tunnel syndrome.
Blood tests may be performed to identify medical
conditions associated with carpal tunnel syndrome. These tests
include thyroid hormone levels, complete blood counts, and blood
sugar and protein analysis. X-ray tests of the wrist and hand
might also be helpful.
Next: How is carpal tunnel syndrome treated? »
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