Your Guide to Carpal Tunnel Testing and Diagnosis Options

Carpal tunnel tests evaluate wrist and finger movement, strength, and sensation. You can conduct some of these tests at home. Here’s how.

Carpal tunnel syndrome (CTS) occurs when the median nerve in the wrist is compressed, leading to symptoms like pain, numbness, and tingling in the hand and fingers.

Diagnosing CTS typically involves physical exams, nerve conduction studies, and sometimes imaging tests such as ultrasounds or MRI scans. These tests help determine how severe the nerve compression is and what may be causing it.

Doctors may also use simple tests like the Phalen test to help diagnose CTS. You can also try this test at home.

Let’s delve into these tests for CTS in more detail.

How do I check myself for carpal tunnel?

Here are some self-tests to help you identify CTS :

• Physical examination: Typically, a doctor will first check for numbness in your thumb, index finger, or parts of your middle finger. If you have numbness in these areas, they may then recommend further testing.
• Tinel sign: Tap the middle area of your affected wrist lightly with a finger on your opposite hand. If this tapping causes numbness or tingling in the fingers of your affected hand, it may indicate CTS.
• Phalen test: Sit or stand with your elbows bent at right angles and your forearms parallel to the floor. Press the backs of your hands together, pointing your fingers downward, and hold this position for about 60 seconds. If this posture increases numbness, tingling, or pain in your hand, it could be a sign of CTS.
• Reverse Phalen test: This is similar to Phalen’s test, but this time, place your hands palm to palm, with your fingers pointing upward, resembling a prayer position. Hold this position for 60 seconds and check for increased pain, numbness, or tingling.
• Wrist flexion with pressure: Flex your wrist and apply gentle pressure for 60 seconds. Increased numbness or tingling may mean you have CTS.
• Wrist flexion with fingers flexed: Flex your wrist with your fingers in a fist position and hold for 60 seconds. Increased symptoms may suggest CTS.
• Durkan test: Sit or stand comfortably and use your thumb or fingers to apply firm pressure to the middle of your wrist on the palm side for about 30 seconds. If this causes numbness, tingling, or pain in your fingers, it may mean you have CTS.
• Phdurkan test: Sit or stand comfortably and flex your wrist downward, similar to Phalen’s test. Then, use your thumb or fingers to apply firm pressure to the middle of your wrist on the palm side for about 60 seconds. If this posture and pressure increase numbness, tingling, or pain in your fingers, it may suggest carpal tunnel syndrome.

One 2020 study looked at the Tinel sign, Phalen test, Durkan test, and Phdurkan test.

The results showed that:

• The Tinel sign was moderate at both detecting true cases and ruling out those without CTS.
• The Phalen test was moderate at detecting true cases but not great at ruling out those without CTS.
• The Durkan test was good at detecting true cases but not so good at ruling out those without CTS.
• The Phdurkan test was the best at detecting true cases but not good at ruling out those without CTS.

Overall, the more intense the test, the better it was at finding CTS, but it was also more likely to suggest CTS when it wasn’t actually there. This means that while these tests can help, they’re not perfect, and doctors often need to use a combination of tests and clinical judgment to diagnose CTS accurately.

How can doctors check for carpal tunnel?

Doctors can check for CTS through several methods:

• Physical examination: The doctor will examine your hands, arms, shoulders, and neck to assess symptoms and rule out other conditions. They may tap or press on your median nerve or flex your wrist to check for numbness or tingling. They’ll also test your finger sensation and hand muscle strength.
• Nerve conduction study: This test measures how quickly electrical signals travel along your nerves, helping the doctor determine if the median nerve signals are slowed down at the carpal tunnel.
• Ultrasound: This imaging method can show whether the median nerve is swollen at the carpal tunnel.
• Electromyography (EMG): EMG can assess the severity of muscle damage caused by CTS.
• Magnetic resonance imaging (MRI): Doctors can use MRI to tell whether any masses, such as ganglion cysts , could be compressing the nerve.
• Blood tests and x-rays: A doctor may order a blood test or hand X-ray to identify underlying causes such as arthritis, fractures, or conditions like diabetes that can contribute to CTS.

What could be misdiagnosed as carpal tunnel syndrome?

Conditions that doctors may misdiagnose as carpal tunnel syndrome (CTS) include cervical radiculopathy, peripheral neuropathy, thoracic outlet syndrome, tendonitis, arthritis , radial tunnel syndrome, and ganglion cysts.

These conditions share similar symptoms, such as hand pain, numbness, and weakness, which can lead to confusion in diagnosis.

A comprehensive evaluation by your primary healthcare professional can distinguish between these conditions.

Is it OK to leave a carpal tunnel untreated?

While some cases of CTS may resolve on their own, others may require treatment to prevent long-term damage and ease symptoms . Leaving CTS untreated can lead to worsening symptoms and potential complications, including permanent nerve damage that affects hand function and causes chronic pain.

According to a 2016 research review , studies suggest that certain factors, such as younger age, female sex, and shorter duration of symptoms, may increase the likelihood of CTS improving on its own without treatment. But symptoms in both hands or a positive Phalen test result may suggest a poorer outlook.

Pregnancy-induced CTS often improves after delivery, but some people may still experience symptoms a year later.

Takeaway

Carpal tunnel syndrome (CTS) is a common condition that can significantly impact hand function and quality of life. Various tests, including physical exams, nerve conduction studies, and ultrasounds, can help diagnose and assess how severe CTS is.

At-home tests like the Tinel sign and the Phalen test can also give you valuable initial insights. You can use the results as a starting point for discussion with your doctor.

If you suspect you have CTS, consider consulting a healthcare professional for an accurate diagnosis and appropriate treatment plan. Early detection and intervention can help you manage symptoms effectively and prevent long-term complications, improving your overall quality of life.