As part of the physical exam
carpal tunnel symptoms, your doctor will:
Examine your neck, arms, wrists, and hands,
comparing the strength and appearance of both sides.
thumb for strength and movement by watching you grip or pinch an
Examine other parts of your arm, to check for problems with
another nerve in your arm. If your doctor suspects neck-related
problems, he or she will also check your neck for possible nerve
One or more of the following tests are commonly used to
diagnose carpal tunnel syndrome:
Tinel's sign test
Your doctor taps
on the inside of your wrist over the
median nerve. If you feel tingling, numbness, "pins
and needles," or a mild "electrical shock" sensation in your hand when tapped
on the wrist, you may have carpal tunnel syndrome.
Phalen's sign test
You hold your arms out in front of you and then
flex your wrists, letting your hands hang down for about 60 seconds. If you
feel tingling, numbness, or pain in the fingers within 60 seconds, you may have
carpal tunnel syndrome.
Two-point discrimination test
This test is used
when severe carpal tunnel syndrome is suspected. It is not very accurate for
mild carpal tunnel syndrome. To do the test, your doctor has you
close your eyes and then uses small instruments, such as the tips of two opened
paper clips, to touch two points (fairly close together) on your hand or
finger. Typically, you would feel separate touches if the two points are at
least 0.5 cm (0.2 in.) apart.
In severe carpal tunnel syndrome, you may not be able to tell the difference
between the two touches, so it may feel as though only one place is being
Why It Is Done
A physical exam with a focus on your
neck, arms, wrists, and hands is done if there is tingling, numbness, weakness,
or pain of the fingers, thumb, or hand. The exam is to help find out whether your symptoms are caused by compression of the median nerve as it
passes through the carpal tunnel in the wrist (carpal tunnel syndrome).
There appears to be no sign of altered or loss of feeling
or strength, or pain in the hand, wrist, arm, or neck during the physical
Tinel's sign and Phalen's tests produce mild to severe
signs of tingling, numbness, loss of feeling or strength, or pain in the
What To Think About
If you have mild symptoms of
tingling, numbness, loss of feeling or strength, or pain in a wrist or hand,
you can start nonsurgical (conservative) treatment right away. Nonsurgical
treatment includes rest, stopping activities that may be causing the symptoms,
and the use of a wrist splint at night. Studies have not shown
nonsteroidal anti-inflammatory drugs (NSAIDs) to be effective for carpal tunnel
syndrome. But they may help relieve symptoms.
If it is not
clear that the symptoms are caused by carpal tunnel syndrome, or if the
condition is not improving with home treatment, your doctor may
recommend nerve testing, X-rays, MRI, ultrasound, and/or blood tests. These
test results should help to clarify your diagnosis.
ByHealthwise Staff Primary Medical ReviewerKathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical ReviewerHerbert von Schroeder, MD, MSc, FRCSC - Hand and Microvascular Surgery
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