The tests that we use frequently in the office to exhibit patience for Carpal Tunnel Syndrome include inspection of the hand - just to look at the hand. Sometimes when carpal tunnel syndrome is severe enough, patients actually have atrophy in their hand. It's called Thenar Atrophy, meaning in the palm, in the thenar region (which is the thumb region) right here *Demonstrates* patients can have wasting of the muscles because these muscles are innervated by the median nerve and if the median nerve is compressed to severely enough, that can lead to atrophy these muscles. So that's a very good indicator of severe carpal tunnel syndrome - if a patient comes in with numbness and tingling in their hands and wasting of those muscles. Inspection is important. Also, we use a couple classic tests including the Tinel's test. The Tinel's test is where we actually tap on the palm right here in the region of the carpal tunnel *Demonstrates* and by tapping there (and you can try this at home) - If you tap there and your fingers begin to tingle in the thumb, index, middle, and ring finger, then that is a sign that you may have carpal tunnel syndrome. Another test that we commonly use is called the Phalen's test. What the Phalen's test is, is that we actually have the patient bend their wrist, flex the wrist and hold it for 30-60 seconds and see if the patients develop numbness and tingling in the thumb, index, middle, and ring fingers. That also is a very good diagnostic test for assessing for carpal tunnel syndrome. A third test I use to assess for carpal tunnel syndrome is what's called the compression test. What that is (and again, you can try this at home) is you just put your thumb right here, right in the palm *Demonstrates* and just hold pressure. With application of pressure, oftentimes patients with carpal tunnel syndrome will develop numbness and tingling in the thumb index, middle, and specifically the radial half of the ring finger. This half of the ring finger is innervated by the median nerve. The outer portion is actually innovated, gets sensation from the ulnar nerve, so there's a distinction. The ring finger, is helpful as a distinguisher between the two nerves. A general practitioner/primary care doctor should be able to diagnose carpal tunnel syndrome, but most likely they would end up referring you to a hand specialist.
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