Diagnosis of Carpal Tunnel Syndrome
Diagnosis of carpal tunnel syndrome involves a combination of physical examination, symptom review, and specialised tests to assess nerve function. A clear diagnosis of carpal tunnel syndrome is important for guiding treatment and ruling out other conditions with similar symptoms.
Medical History
The doctor begins by asking about the nature, frequency, and timing of symptoms. Questions focus on when discomfort occurs (especially at night), the fingers affected, and any occupational or lifestyle habits that involve repetitive wrist use.
Physical Examination
Several clinical tests are used:
- Tinel’s sign: Tapping the median nerve at the wrist may cause tingling in the fingers.
- Phalen’s manoeuvre: Flexing the wrists for 60 seconds may trigger symptoms.
- Grip strength and thumb opposition tests assess muscle function.
Nerve Conduction Studies (NCS)
This test measures the speed at which electrical impulses travel through the median nerve. Slowed conduction suggests compression.
Electromyography (EMG)
Used alongside NCS, EMG evaluates the electrical activity of muscles to detect nerve damage or muscle wasting.
Ultrasound or MRI
Imaging may be used to visualise the median nerve and surrounding structures, particularly if a mass or anatomical abnormality is suspected.
Diagnosis of Carpal Tunnel Syndrome
In some cases, blood tests are ordered to rule out diabetes, thyroid dysfunction, or autoimmune diseases contributing to symptoms.
A prompt and accurate diagnosis of carpal tunnel syndrome ensures the most effective treatment approach — whether conservative or surgical — and helps prevent long-term nerve damage.
How Is Carpal Tunnel Syndrome Diagnosed?
Diagnosing carpal tunnel syndrome involves a detailed review of symptoms, physical examination, and specialised nerve tests. A healthcare provider will start by asking about symptom patterns — particularly numbness, tingling, or pain in the thumb, index, and middle fingers, especially at night. The doctor may also ask about work or daily habits that involve repetitive wrist movements. Doctors often use physical tests like Tinel’s sign (tapping over the median nerve at the wrist) and Phalen’s manoeuvre (holding the wrists in a flexed position) to provoke symptoms and support a clinical diagnosis of carpal tunnel syndrome.
Confirming the Diagnosis with Tests
Doctors use tests like nerve conduction studies (NCS) to assess nerve function and confirm the diagnosis. These tests measure how quickly electrical signals travel through the median nerve. Slowed conduction in the median nerve supports a diagnosis of carpal tunnel syndrome, indicating compression or damage within the carpal tunnel. Electromyography (EMG) helps evaluate muscle activity and can detect signs of nerve damage, offering additional confirmation of carpal tunnel syndrome and ruling out other neuromuscular conditions. In certain cases, imaging such as ultrasound or MRI helps visualise the median nerve or rule out other causes. Doctors may also order blood tests to check for underlying conditions such as diabetes or thyroid disorders, which can contribute to or worsen carpal tunnel syndrome. Accurate diagnosis allows for effective treatment and helps prevent long-term complications.
[Next: Treatment of Carpal Tunnel Syndrome →]
