Carpal Tunnel Syndrome Symptoms and Diagnosis
You may experience symptoms even at night when you are at rest.
Symptoms of carpal tunnel syndrome usually come on slowly. They include:
- Frequent burning, tingling or itching numbness in the palm of the hand and fingers (especially the thumb, index and middle fingers).
- Waking up and feeling the need to shake out their hand or wrist. The symptoms often first occur during sleep, because many people sleep with their wrists flexed.
- Tingling during the day, in more advanced cases
- Hand weakness
- Difficulty gripping objects
- Difficulty making a fist, grasping small objects or performing other manual tasks
- Inability to tell between hot and cold by touch
Symptoms may occur not only when you are using your hand, but also at night when you are at rest. Even in cases where work is the suspected cause, symptoms typically first occur when you are not at work. Carpal tunnel syndrome may be distinguished from similar conditions by pain that occurs at night after you go to bed.
Diagnosis includes a physical exam of the hands, arms, shoulders, and neck. The doctor will examine the wrist to see if it is tender, swollen, warm, or discolored. The exam will include testing each finger for sensation, and testing muscles at the base of the hand to see how strong it is.
The doctor may test for thumb weakness by asking whether you can raise your thumb from the plane of your palm, and stretch your thumb so its pad rests on the little finger pad.
Another test of carpal tunnel syndrome is called the “flick” signal. The doctor asks what you do when your symptoms are worse. If you respond with a motion that resembles shaking a thermometer, that is a strong indication you may have carpal tunnel syndrome.
You may be asked to rest your elbows on a table and let your wrists dangle, with your fingers pointing down and the backs of your hands pressed together. If carpal tunnel symptoms develop within a minute, that may indicate you have the syndrome.
Tests used to confirm a diagnosis of carpal tunnel syndrome may include:
- A nerve conduction study. Electrodes are placed on the hand and wrist, and small electric shocks are applied. The study tests the speed with which nerves transmit impulses.
- Electromyography. This test, which involves a small needle inserted into a muscle, determines how severe damage is to the median nerve.
- Ultrasound imaging of the median nerve.
The doctor will evaluate you to see if you have any underlying medical conditions that may be contributing to symptoms of carpal tunnel syndrome. For instance, the doctor may order tests for thyroid disease and rheumatoid arthritis. An x-ray may be used to check for arthritis or fractured bones. Arthritic conditions, such as rheumatoid arthritis, osteoarthritis and gout, can cause pain in the hands and fingers that are similar to symptoms caused by carpal tunnel syndrome.
Muscle and nerve diseases can also produce symptoms that are similar to the syndrome.