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What are the signs and symptoms of carpal tunnel syndrome?
Numbness - The first symptom is usually numbness or tingling
in the thumb, index finger, long finger, and ring finger. Everyday
activities that bend (flex) the wrist can make the numbness worse. Some
examples of everyday activities that can cause problems are driving,
writing, holding a book or newspaper, combing hair, or sleeping in an
awkward position. Initially, the numbness may come and go. As the
condition worsens, the numbness becomes more constant.
Weakness/ Muscle Loss - Patients may notice their grip
weakening as the pressure on the median nerve increases. Over time, the
muscles of the thumb will become smaller (atrophy).
Dropping Objects - Because of a weakened grip, patients
frequently complain about dropping objects. This weakening, plus the
loss of feeling in the thumb and fingers, does not allow the patient to
notice the object slipping from the hand.
Pain - Pain is a less common symptom. The constant numbness
can feel painful. A persistent ache, particularly in the thumb, may
spread up to the shoulder, the neck, or both. In severe cases, there may
be a constant burning pain in the wrist and hand.
How is carpal tunnel syndrome diagnosed?
History -The doctor often suspects CTS from the patient's history
and symptoms. If the patient complains of numbness and tingling in the
thumb and fingers (supplied by the median nerve) the doctor suspects
CTS. If symptoms worsen with the typically suspected activities (such as
driving, writing, reading, or combing hair) or the patient's work and
activity patterns involve repetitive motions, the doctor will suspect
CTS.
Examination - The doctor will determine if there is decreased
feeling in the thumb, index finger, long finger, and ring finger. In
severe cases, the doctor may find that the muscles of the thumb have
atrophied (become smaller).
Testing - The doctor may do some manual tests to confirm the
diagnosis of CTS.
Phalen's Maneuver - The patient holds the wrist in a
bent position for one minute. If CTS is present, the added pressure on
the nerve will make the numbness worse.
Tinel's Sign - The doctor will gently tap on the wrist
where the median nerve travels through the tunnel. Patients with CTS
experience a feeling of electricity or tingling, similar to the
sensation that occurs when the "funny bone" is bumped.
Electrodiagnostic Studies - Physicians who specialize in
nerve function often use more objective techniques to confirm CTS and
evaluate the severity of nerve damage. These tests are not essential to
make a diagnosis of carpal tunnel syndrome, but they are very helpful in
ruling out other problems like pinched nerves in the neck or arm.
A nerve conduction study is performed by applying a
very mild electrical current along the path of the nerve. The speed the
current travels along the nerve indicates how well the nerve is working.
Electromyography measures the electrical activity of
muscles. Extremely small, threadlike needles are placed in certain
muscles. Any deviation from normal muscle activity indicates a problem
with the nerve supply to that muscle.
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