STEP #1:
Relating your medical and work history to your doctors is the first step
in diagnosing Carpal Tunnel Syndrome ("CTS"). Your doctor will ask you
to describe your symptoms. The commonly associated symptoms
include:
-
Tingling, pain or numbness in the area
of the hand served by the median nerve. Often these sensations first
occur while you are sleeping. Many people mistakenly believe this
phenomenon occurs because they are sleeping on their hands. Though not
everyone with "CTS" has the experience of waking up at night with
their hands "on fire," it is probably the best early indicator of a
problem even though research has not found a clear explanation for why
this symptoms is common.
-
Some people
report tingling, pain or numbness that is not limited to the median
nerve area but may feel as if it has spread to the entire lower arm
from the elbow down. This should indicate simultaneous compression of
one or both of the other nerves that provide sensation to the arm and
hand (see ulnar nerve entrapment at the elbow, ulnar nerve entrapment
at the wrist and thoracic outlet syndrome). When left untreated, the
tingling, pain, or numbness can develop into excruciating pain.
-
Loss
of sensation can progress rapidly as
the median nerve is damaged. Two common effects of this are that you
become increasingly clumsy as your ability to feel things in your
hands deteriorates and you may have the sensation that your grip has
lost strength. This symptom also can occur as decreased sensitivity to
hot and cold
-
Loss
of muscle tone and strength at the base
of the thumb is a sign of advance "CTS". This condition is noticeable
when the fleshy area at the base of your thumb atrophied (reduced at
size).
STEP # 2:
Your doctor will review your medical history to determine if you had, in
the past or have presently, any of the non-occupational factors
associated with "CTS", including arthritis, diabetes, gout,
hypothyroidism, menopause, pregnancy, wrist fractures and dislocations.
Your doctor will ask you a series of questions
regarding your work history. Most questions will focus on your present
job. For example, does your job involve repetitive motions, high levels
of force, vibrations, etc? How often do you take rest brakes? Is your
job stressful, etc? Your medical and work history are important factors
in accurately diagnosing "CTS".
Unfortunately, many doctors are not aware of the
prevalence of Repetitive Stress Injuries and their association with job
related risk factors. Others are hesitant to indicate that your Carpal
Tunnel Syndrome is related to your work activities, simply because they
do not want to get involved with Workers' Compensation insurance
companies.
IMPORTANT NOTE: The initial visit to
your doctor with symptoms "consistent with CTS" is legally significant
for three reasons:
-
Even though
you may have a non-occupational "CTS" factor (i.e. diabetes),
you are, nevertheless, entitled to receive Workers' Compensation
benefits if your work responsibilities aggravated or accelerated such
pre-existing conditions.
-
Your
doctor's records indicating your symptoms, work activities and your
doctor's opinion that your "CTS" is related to your work, is
significant legal evidence to establish your right to receive Workers'
Compensation benefits.
-
The date
that you are informed by a doctor that you have developed work-related
"CTS" is the "official" date of accident in Repetitive Stress Injury
Workers' Compensation claims. This date is significant to the filing
and notice requirements of the Workers' Compensation Act.
STEP #3:
During your physical exam, your doctor will use two basic diagnostic
tests to screen for "CTS":
-
Phalen's maneuver- Requires you to put
the backs of your hands together with your wrists flexed and your
fingers pointing toward the ground. Because this forces compression of
the median nerve, you will reproduce your symptoms of "CTS" after one
minute in this position if you have this disorder.
-
Tinel's sign- A simple test in which
you rest your hand, palm side up, and tap on your wrist where the
median nerve passes through. If you experience tingling or numbness in
the parts of the hand that receive sensations via the median nerve,
you have reason to suspect that you have "CTS".
STEP # 4:
Doctors currently rely primarily on two different methods of
electrodiagnostic testing-nerve conduction velocity (NCV),
electromyography (EMG) to diagnose Carpal Tunnel Syndrome and other
nerve related Repetitive Stress Injuries such ulnar nerve entrapment and
thoracic outlet syndrome:
(1)Nerve
Conduction Velocity Testing- Your nerves conduct electrical
signals. NCV testing measures the speed at which the signal travels. A
damaged nerve transmits the signal at a slower than normal speed.
If the result
of your NCV test indicate nerve damage, it is likely that you have a
relatively severe case that requires immediate attention and treatment.
If your test does not indicate nerve damage, however, this does not put
you in the clear.
NCV tests have
a high threshold-that is, they usually detect nerve damage only when it
has progressed significantly. Because NCV tests can cost anywhere from
$150 to $500 depending on where you live and the extent of the tests,
and because they are of limited use, at best, for detecting nerve damage
at early stages, they are used with restraint. Often, self-reporting of
symptoms and simple so called provocative tests such as Phalen's test
and Tinel's sign are more sensitive, far less expensive and therefore,
more practical.
(2)
Electromyography- EMGs measure the response of muscles to
electrical stimuli, just as electrocardiogram (EKG's) measure the
responses of heart muscles.
You have two
kinds of nerves-those that carry sensory signals (allowing you to feel
sensations) and those that carry motor signals (that move your muscles.)
EMGs are used to test the latter.
Even more than
NCV tests, EMGs detect only advance nerve damage. They are not generally
useful in testing for RSI involving tissue damage.
Magnetic Resonance Imaging (MRI), while
effective in diagnosing Carpal Tunnel Syndrome, are rarely used due to
their considerable expense.
IMPORTANT NOTE: As a result of
recent advances in digital imaging, high frequency sonography is gaining
acceptance as a cost-effective test for diagnosing "CTS". Unlike MRIs,
sonography is an examination which can be performed with the wrist
placed in different positions.
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