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How Do You Know When You Have Carpal Tunnel Syndrome?

Ask a Doctor

My right hand is starting to get periods of numbness that are getting more frequent. I’ve also noticed I’m becoming more fumble-fingered lately. I think I’m developing this problem from repetitive typing. How do you know when you have carpal tunnel?

Doctor’s Response

The following are symptoms associated with carpal tunnel syndrome. You may still have carpal tunnel syndrome if you have only a few symptoms.

  • Numbness, pain (usually a burning pain), and tingling in your thumb, index, and middle fingers
  • Tingling, numbness, or pain, which may move up your arm to your elbow
  • Hand weakness
  • Dropping objects
  • Difficulty feeling and handling small objects

Symptoms are usually worse at night and are sometimes temporarily relieved by "shaking out" your hands.
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 two-point discrimination (the ability to feel two 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.
  • Physical tests to evaluate for carpal tunnel syndrome include the following:
    • Phalen's 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 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 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 referred 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 with which an electrical impulse travels in the median nerve across the wrist. For people with carpal tunnel syndrome, this nerve impulse will travel more slowly across the wrist than normal. For people who have advanced carpal tunnel syndrome, measurements of electrical activity in the hand muscles may reveal signs of muscle deterioration.

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References
Fauci, A.S., and C.A. Langford. Harrison's Rheumatology New York: McGraw-Hill Medical Publishing, 2006.treatment-pdq>.