Carpal Tunnel Syndrome - Diagnosis

Diagnosis

Carpal tunnel syndrome is most accurately diagnosed using a medical history, the patient's descriptions of symptoms, a physical examination, and electrodiagnostic tests that measure nerve conduction through the hand.

Diagnosing CTS, however, is not straightforward. Only a small fraction of patients exhibit all three factors necessary for a clear diagnosis:

• Classic CTS symptoms
• Specific physical findings
• Abnormal electrodiagnostic test results

Many people have abnormal electrodiagnostic test results without classic symptoms or any symptoms at all. Furthermore, about 15% of the population has symptoms that are consistent with CTS, but in most of these people, test results do not indicate the disorder.

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MRI, CT scans, and other imaging tests are not useful for diagnosing carpal tunnel syndrome.

Symptom Description and Severity

Many cases of CTS result from a medical problem that is worsened by repetitive stress factors at work. The patient should give the doctor a detailed history and description of any complaints, in any part of the body. The patient should report in detail any daily activities that require repetitive hand or wrist actions, abnormal postures, or other regular situations that could affect the nerves in the neck, shoulders, and hands. The patient should also report whether the symptoms are more likely to appear at night, or after particular tasks.

Questionnaires. The use of specific questionnaires that score results can accurately assess the severity of the condition.

Hand Diagram. A diagram of the hand and wrist, usually divided into six regions, is a very useful diagnostic tool. Patients are asked to indicate where their symptoms are, including pain, numbness, or tingling, by locating the affected areas on the diagram. They may also be asked to rate the severity of their symptoms. A diagnosis is probable if at least two of fingers 1, 2, or 3 have these symptoms, and if there is pain in or near the wrist. CTS is possible if at least one of these fingers has symptoms. It is unlikely if there are no symptoms in these fingers, the palm, or the wrist.