Diagnosing Carpal Tunnel Syndrome

A combination of a physician’s findings from a clinical exam — especially an individual’s reporting of symptoms — plus abnormalities discovered through electrodiagnostic testing, will determine an accurate diagnosis of carpal tunnel syndrome.  Early diagnosis and treatment are essential in avoiding permanent damage to the median nerve.

Diagnosis will begin with a doctor learning an individual’s medical history, finding out a person’s symptoms, checking reflexes, pulses, circulation, and evaluating the feeling, strength, and appearance of the wrist, fingers, hands, arms, shoulders, and neck.

Some of the doctor’s neurological or musculoskeletal assessments are to rule out certain disorders that can mimic the symptoms of CTS. Not all hand pain is related to carpal tunnel syndrome, but may be the result of nerve entrapment at the elbow, for example, or a pinched nerve in the neck.

A person with carpal tunnel syndrome will have symptoms that match the distribution of the median nerve (CTS symptoms normally do not, for instance, involve the little finger).

Tests for Carpal Tunnel Syndrome

• An X-ray can show a fracture or identify an abnormality of the wrist or hand.
• An ultrasound of the wrist or an MRI of the wrist may be ordered if a cyst, lesion, or other structural abnormality that is impacting the nerve is suspected.
• Routine lab tests can reveal other conditions that are linked to carpal tunnel syndrome, such as arthritis, diabetes, and hypothyroid.
• Electromyogram and nerve conduction studies (EMG/NCS) are the best tests to diagnose carpal tunnel syndrome. A nerve conduction velocity test can measure the speed of electrical impulses as they travel down the median nerve through the carpal passageway. A result that indicates the electrical impulses slow down as they pass through the carpal tunnel is an indication of CTS.