Carpal Tunnel Syndrome (CTS) is technically a “pinched nerve” in the wrist (carpal tunnel) that results in numbness, tingling and later, weakness in the distribution of the median nerve (thumb, index, 3rd, and half of the 4th finger). There is a limited amount of space within the carpal tunnel. In addition to the median nerve, there are 9 tendons and their sheaths, a network of blood vessels, the joint capsules, the bony “roof” and ligamentous “floor.” Any condition that distorts the shape of the tunnel (inflammatory conditions like rheumatoid arthritis, ganglion cysts, bony spurs, or conditions that result in swelling like overuse, pregnancy, taking birth control pills, hypothyroid, obesity, and/or conditions that create neuropathy like a pinched nerve in the neck, shoulder or elbow, diabetes and post-chemotherapy) can result in median nerve irritation. The carpal tunnel naturally changes its shape when we flex and extend the wrist, so occupations that require wrist bending (especially if it’s prolonged and a fast pace is required) such as carpentry (especially the use of vibrating tools), waitressing, assembly line work, typists, and even sleeping at night with the wrist bent can result in CTS.
The diagnosis can be tricky because of all the possible causes (of which, some are described above) and to make matters even more challenging, there can be two, three, or more of the causes all contributing to the problem at the same time! In the clinic, there are certain positions to test how long (in seconds) it takes for the numbness, tingling and/or pain to occur when we place the wrist in extreme flexion or extension. We’ll compress the carpal tunnel (and nerve pathways at the elbow, shoulder, and neck), as well as tap over the carpal tunnel with a reflex hammer creating a “funny bone” sensation usually into the 2nd or 3rd finger. Blood tests for rheumatoid (and other inflammatory) arthritis, diabetes and thyroid dysfunction are very helpful when trying to differentiate between several possible causes. An electrical conduction test called electromyogram (EMG) and nerve conduction velocity (NCV) can also be very helpful in determining the severity of CTS.
So the question is, can you “self-diagnose” CTS? The answer is: sometimes. However, with that said, if the symptoms are “classic” (numbness/tingling in the thumb, fingers 2-4, which shaking and flicking your fingers relieves at least partially; it’s waking you up at night especially, if a night splint helps reduce the frequency of waking and intensity of numbness), then you “probably” have CTS. Here are some common questions included in a CTS questionnaire that we often use in the clinic to assist with the diagnosis: SYMPTOM SEVERITY (score each on a 0-4 scale): 1) Pain severity at night? 2) Nighttime frequency of waking with pain? 3) Amount of daytime hand/wrist pain? 4) Frequency of daytime hand/wrist pain? 5) Duration (in minutes) of daytime pain/numbness? 6) Severity of numbness? 7) Severity of weakness? 8) Tingling intensity? 9) Nighttime severity of numbness or tingling? 10) Nighttime frequency of numbness or tingling? 11) Difficulty grasping / using small objects like keys or pens? FUNCTION SEVERITY (0-4 scale): 1) Writing. 2) Buttoning clothes. 3) Holding a book while reading. 4. Gripping of a telephone handle. 5) Opening jars. 6. Household chores. 7. Carrying grocery bags. 8. Bathing and dressing. The maximum score for SYMPTOM SEVERITY is 11×4 = 44 and for FUNCTION 8×4 = 32. To determine the percentage, divide your score by 76 (the maximum possible) and multiply it by 100. In general, scores >50% may be indicative of CTS. However, as previously stated, a definitive diagnosis must include a detailed history, examination, sometimes special tests. Therefore, it is important to see us! If you have CTS, we will outline the type and length of care with you and MOST IMPORTANT, we can usually manage CTS without the need for surgery!