When symptoms of carpal tunnel syndrome persist and progress, it's time to seek out medical care. The first line of defense is often having a conversation with your primary care doctor about your symptoms. If it's likely that carpal tunnel syndrome is the cause, the next appropriate step is to see a hand specialist. A hand surgeon will be better able to confirm that carpal tunnel syndrome is the source of your symptoms, and will be able to outline appropriate treatment steps for you.
If you think you have carpal tunnel syndrome, it may be tempting to diagnose yourself. We often do that with a cold or a stomachache. Carpal tunnel syndrome is not typically diagnosed by the patient. However, there are ways to tell if the symptoms that you're having may in fact be the result of carpal tunnel syndrome. The distribution of that initial numbness and tingling in the thumb index middle finger and this half of the ring finger are a strong suggestion that your symptoms may in fact be carpal tunnel syndrome. Thinking about when the symptoms occur and what makes them happen is also a pretty strong clue that this may be carpal tunnel syndrome. If you're waking up at night with numbness in both hands in that distribution and shaking your hands out makes them go away. That's probably carpal tunnel syndrome. If reproducing that position by curling your wrists like this for 15 or 20 seconds starts to give you numbness and tingling and those specific fingers. That's also probably carpal tunnel syndrome. So patients can have a good sense based on that initial symptom development and evaluation that in fact their problem is carpal tunnel syndrome, and that should lead them to talk to their doctor about it and get an appropriate referral to a hand specialist.
Sometimes people wait too long to see the doctor for their carpal tunnel. You definitely should not wait until your hand is weak. You should not wait until the muscle mass (particularly in the thumb) is going away. If it's keeping you up at night, don't be afraid. See your physician and at least get started on the medical treatment with the roller blade wrist guards (the so-called carpal tunnel cockup splits.)
Testing for carpal tunnel syndrome involves clinical testing and diagnosis as well as specific physiologic tests that are performed by a neurologist. At its core, Carpal tunnel syndrome is a clinical diagnosis. That means that the testing to confirm that carpal tunnel syndrome is responsible are based on history, what the patient tells us about their symptoms, and a physical examination confirming that carpal tunnel syndrome is likely to be the cause. The physiologic tests are done by a neurologist and they are actually tests that can measure the function of the nerves in the upper extremity. That will tell us if the nerve traveling through the carpal tunnel which is called the median nerve is the only nerve affected and if it's affected in the carpal tunnel. That helps to confirm that in fact, carpal tunnel syndrome is the cause of a patient's symptoms. The clinical tests for carpal tunnel syndrome involve examining the nerve and its surrounding environment to see if the nerve is behaving in an irritable fashion. A normal healthy nerve is not easily stimulated externally. If you tap on a nerve over its course through the wrist, nothing should happen. If you tap on a nerve that's irritated by compression, which is what happens in carpal tunnel syndrome, that nerve will be stimulated more easily and patients will experience numbness and tingling in their fingertips. That numbness and tingling is in the distribution of that nerve. So in the carpal tunnel, which is the median nerve tapping on the wrist forcefully such as this will cause numbness and tingling in the thumb through ring fingers. That's called a tunnel sign and it's one of the things we use to confirm that patients have carpal tunnel syndrome. The other way we can test for carpal tunnel syndrome externally is by reproducing that position that increases pressure in the carpal tunnel with the wrist flexed for any length of time. We ask the patient to flex the wrist and then we add a little external compression with our thumb over the carpal tunnel and in patients whose nerve is irritated from carpal tunnel syndrome, that will start to produce numbness and tingling in the thumb through ring fingers, the distribution of the median nerve. That's called a Phalen's test, and it's another test that we use to confirm carpal tunnel syndrome.
Because carpal tunnel syndrome is a well recognized medical condition with identifiable causes and treatment, this is something that insurance companies typically cover. They cover not only the diagnosis and the testing, but they also cover treatment, both surgical and nonsurgical treatment options. So you should be assured if you're experiencing carpal tunnel syndrome, that medical care is indicated and that it should be covered by your insurance plan.
Carpal tunnel is most common in diabetics and women. It's more common in pregnancy. It's also more common in patients with thyroid disease.
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