Physical exam for carpal tunnel syndrome

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Exam Overview

As part of the physical exam for carpal tunnel symptoms, your health professional will:

• Examine your neck, arms, wrists, and hands, comparing the strength and appearance of both sides.
• Check your thumb for strength and movement by watching you grip or pinch an object.
• Examine other parts of your arm, to check for problems with another nerve in your arm. If your health professional suspects neck-related problems, he or she will also check your neck for possible nerve compression.

One or more of the following tests are commonly used to diagnose carpal tunnel syndrome:

Tinel's sign test

Your health professional taps on the inside of your wrist over the median nerve. If you feel tingling, numbness, "pins and needles," or a mild "electrical shock" sensation in your hand when tapped on the wrist, you may have carpal tunnel syndrome.

Phalen's sign test

You rest your elbows on a flat surface such as a desk, with your elbows bent and your forearms up. You then flex your wrists, letting your hands hang down for about 60 seconds. If you feel tingling, numbness, or pain in the fingers within 60 seconds, you may have carpal tunnel syndrome.

Two-point discrimination test

This test is used when severe carpal tunnel syndrome is suspected. It is not very accurate for mild carpal tunnel syndrome. To do the test, your health professional has you close your eyes and then uses small instruments, such as the tips of two opened paper clips, to touch two points (fairly close together) on your hand or finger. Typically, you would feel separate touches if the two points are at least apart. In severe carpal tunnel syndrome, you may not be able to tell the difference between the two touches, so it may feel as though only one place is being touched.

Why It Is Done

A physical exam with a focus on your neck, arms, wrists, and hands is done if there is tingling, numbness, weakness, or pain of the fingers, thumb, or hand. The examination is to help determine whether your symptoms are caused by compression of the median nerve as it passes through the carpal tunnel in the wrist (carpal tunnel syndrome).

Results

Normal

There appears to be no sign of altered or loss of feeling or strength, or pain in the hand, wrist, arm, or neck during the physical exam.

Abnormal

Tinel's sign and Phalen's tests produce mild to severe signs of tingling, numbness, loss of feeling or strength, or pain in the hand.

What To Think About

If you have mild symptoms of tingling, numbness, loss of feeling or strength, or pain in a wrist or hand, you can start nonsurgical (conservative) treatment right away. Nonsurgical treatment includes rest, stopping activities that may be causing the symptoms, and the use of a wrist splint at night. Although studies have not shown nonsteroidal anti-inflammatory drugs (NSAIDs) to be effective for carpal tunnel syndrome, they may help you to relieve symptoms.

If it is not clear that the symptoms are caused by carpal tunnel syndrome, or if the condition is not improving with home treatment, your health professional may recommend nerve testing, X-rays, MRI, ultrasound, and/or blood tests. These test results should help to clarify your diagnosis.

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Credits

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Last updated:	November 03, 2006
Author:	Monica Rhodes
Reviewed By:	William M. Green, MD - Emergency Medicine, David Pichora, MD, FRCSC - Orthopedic Surgery
Editors:	Kathleen M. Ariss, MS, Pat Truman