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Medical Health Encyclopedia
Carpal Tunnel Syndrome - Diagnosis
(Page 2)
Ruling out Underlying Medical Disorders
One of the most important first steps in diagnosing CTS is to evaluate any underlying medical disorders that may be contributing to the condition. Experts emphasize the need to fully examine patients with symptoms of CTS. Relying only on CTS symptoms and personal or work histories may fail to detect (and thus properly treat) underlying medical conditions that could be serious. If the doctor suspects that an underlying medical condition may be exacerbating the symptoms of CTS, laboratory tests will be performed. Tests for thyroid disease and rheumatoid arthritis may be helpful. The doctor may take an x-ray, for example, to check for arthritis or fractured bones.
Arthritic Conditions. Arthritic conditions, including rheumatoid arthritis, gout, and osteoarthritis, can all cause pain in the hands and fingers that may mimic carpal tunnel syndrome.
Muscle and Nerve Diseases. Any disease or abnormality that affects the muscles and nerves, including those in the spine, may produce symptoms in the hand that mimic carpal tunnel syndrome.
Ruling Out Other Cumulative Trauma Disorders
About 25% of patients with suspected work-related cumulative trauma or repetitive stress disorders have evidence of other conditions that resemble, but are not carpal tunnel syndrome. A definitive diagnosis is often difficult. Most of these disorders require treatments similar to those used for CTS: rest, immobilization, steroid injections, and surgery if conservative treatment is unsuccessful.
Other Cumulative Trauma Disorders
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Location
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Description
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The Median Nerve in Other Locations
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Repetitive work can cause pressure on the median nerve in locations other than the wrist and can also affect other nerves in the arm and hand. The branch of the median nerve that runs through the palm of the hand can be damaged directly by repeated pounding or by the use of certain tools that are gripped with the palm, such as needle-nosed pliers. The median nerve can also be pinched in the forearm.
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Guyon Canal Syndrome (Commonly called ulnar tunnel syndrome)
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The ulnar nerve can, like the median nerve, be trapped as a result of repetitive stress. When this nerve is trapped, the condition is sometimes referred to as ulnar tunnel syndrome. It is more correctly known as Guyon canal syndrome, however, because this is the name of the passage through which the ulnar nerve passes.
General symptoms are similar to those of carpal tunnel syndrome, but patients experience a loss of sensation in the ring and little finger and in the outer half of the palm. Guyon canal syndrome can be a separate problem, although it commonly occurs with CTS. In such cases, release surgery for CTS usually also relieves the ulnar nerve entrapment.
The ulnar nerve can also be affected at the elbow.
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De Quervain's Tenosynovitis
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Tenosynovitis is swelling of the slippery covering of the tendons that move the thumb. When it causes pain on the side of the wrist and forearm right below the base of the thumb, it is known as De Quervain's tenosynovitis. (Finklestein's Test may help identify this. Make a fist that encloses the thumb, and bend the wrist sideways and down away from the thumb. If it causes pain, it is likely to be De Quervain's tenosynovitis.) It may be treated with splints or corticosteroid injections. In severe cases release surgery is effective.
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Digital Flexor Tenosynovitis (Trigger or Snapping Finger)
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Digital flexor tenosynovitis, commonly called trigger or snapping finger, is brought on when a tendon thickens, leaving the finger or thumb in a bent position. This disorder usually occurs when the tendons form a knot. It may be a problem in people with hypothyroidism, diabetes, gout, rheumatoid arthritis, or connective tissue disorders. Digital flexor tenosynovitis can cause pain and a clicking sound when the trigger finger or thumb is bent and straightened. It can be effectively treated with corticosteroid injections.
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Thoracic Outlet Syndrome
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Thoracic outlet syndrome is caused by the compression of nerves or blood vessels running down the neck into the arm. The compression occurs at the first rib in the front of the shoulder. This may happen after an accident or simply from repeatedly slouching. It can produce symptoms very similar to those of CTS. Other symptoms may include Raynaud's phenomenon (changes in sensation and temperature in the hand). A doctor may be able to diagnose the condition by detecting reduced blood flow in the arm as the patient raises the affected hand and turns his or her head toward the opposite side. Although the condition is uncommon, a correct diagnosis is important to differentiate it from CTS, since treatments differ. Surgery may be required to relieve pressure on the nerves and blood vessels.
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