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Carpal Tunnel Syndrome (cont.)

Exams and Tests

Expect your doctor to perform several simple carpal tunnel syndrome tests to evaluate the nerve function of your hand. You can also perform a few of these tests at home.

Your doctor will most likely start with a visual and manual inspection of your hand looking for any obvious abnormalities that may help to explain your problem.
Range of motion of the wrist is often evaluated. By placing the palms of the hands together, wrist extension can be evaluated. By placing the backs of the hands together, wrist flexion can be evaluated. People who have had prior wrist injuries or wrist arthritis often have abnormalities in wrist range of motion.
The sensation over your hand will often then be checked to see if your sensation of soft touch, pinprick, or 2-point discrimination (the ability to feel 2 points distinctly using a sharp pin on the fingertips) is abnormal in any areas.
The strength in your hands and fingers can be checked, often using your opposite, or good side, for comparison.
A few tests are described to evaluate for carpal tunnel syndrome that your doctor can perform and you can perform at home.
- Phalen sign
  - Hold your elbows at shoulder level and place the backs of your hands together with your wrists bent at 90 degrees.
  - Hold this position for 60 seconds.
  - This position increases the pressure in the carpal tunnel and on the median nerve.
  - If the test reproduces or worsens your symptoms (pain and tingling in your hands), you may have carpal tunnel syndrome.
- Tinel sign
  - Have someone hold your wrist as shown in the picture and tap on the palm side of your wrist.
  - A positive test produces tingling into the thumb, index, or middle fingers. This is a sign of an irritable nerve where the tapping was done.
  - If this test gives you tingling in your thumb, index, or middle fingers, you may have carpal tunnel syndrome.
You may also be sent to a specialist (neurologist, rheumatologist, or orthopedic surgeon) for evaluation of your nerve conduction or the presence of possible arthritis leading to carpal tunnel syndrome. Nerve conduction testing measures the speed an electrical impulse travels in the median nerve across the wrist. For people with carpal tunnel syndrome, this impulse will travel more slowly across the wrist than for people who do not have carpal tunnel syndrome. For people who have advanced carpal tunnel syndrome, measurements of electrical activity in the hand muscles may reveal signs of muscle deterioration.