What Tests Help Diagnose Carpal Tunnel Syndrome?

Two useful clinical tests for diagnosing carpal tunnel syndrome are the Tinel and Phalen maneuvers. Tingling sensations in the fingers caused by tapping on the palm side of the wrist is a positive Tinel test, whereas reproduction of symptoms by flexing the wrist is a positive Phalen test. (Dr. Phalen created this maneuver many years ago when he was a hand surgeon at The Cleveland Clinic.)
If needed, an electromyogram, which includes nerve conduction studies, is done to document the extent of nerve damage. An electromyogram is a test that measures the electrical activity in your nerves and muscles. Nerve conduction studies measure the ability of specific nerves to transmit electrical impulses or messages.
The nerve conduction studies, however, will not become positive until there is significant nerve damage. In addition, the severity of a person's symptoms is often not correlated with the findings of a nerve conduction study.

Interesting Info

What Happens in Severe Cases of Carpal Tunnel Syndrome?
When chronic irritation occurs around the median nerve, it becomes constricted and is continually pushed against the ligament above it. When the nerve is continually constricted, it can become compressed to the point that it begins to deteriorate. This results in a slowing of nerve impulses, which may cause a loss of feeling in the fingers and a loss of strength and coordination at the base of the thumb. If the condition is not treated, it could result in permanent deterioration of muscle tissue.
Do Certain Medical Conditions Make People More Likely to Develop Carpal Tunnel Syndrome?
People with rheumatoid arthritis, diabetes or other metabolic conditions like thyroid disease may be more likely to develop carpal tunnel syndrome. These conditions affect the nerves directly, making them more vulnerable to compression.

The Symptoms

What Are the Symptoms of Carpal Tunnel Syndrome?
Usually, people with carpal tunnel syndrome first notice that their fingers "fall asleep" and become numb at night. They often wake up with numbness and tingling in their hands. The feeling of burning pain and numbness may generally run up the center of the person's forearm, sometimes as far as the shoulder. As carpal tunnel syndrome becomes more severe, symptoms are noticed during the day.

CTS from WebMd

The carpal tunnel is the passageway in the wrist and is made
up of the arching carpal bones (eight bones in the wrist) and the ligament
connecting the pillars of the arch (the transverse carpal ligament). The median
nerve and the tendons that connect the fingers to the muscles of the forearm
pass through the tightly spaced tunnel.
Carpal tunnel syndrome occurs when
the median nerve becomes pinched due to swelling of the nerve or tendons or
both. The median nerve provides sensation to the palm side of the thumb, index,
middle fingers, as well as the inside half of the ring finger and muscle power
to the thumb. When this nerve becomes pinched, numbness, tingling and sometimes
pain of the affected fingers and hand may occur and radiate into the
forearm.

While there are many possible causes of carpal tunnel
syndrome, the vast majority of people with the condition have no known
cause.
However, we do know that excessive repetitive movements of the arms,
wrists or hands can aggravate the carpal tunnel bringing out the symptoms of
carpal tunnel syndrome. Untreated, this can become chronic, but when detected
early, carpal tunnel syndrome can be treated and recovery is possible in a few
months. Severe carpal tunnel syndrome can also be treated, but recovery may take
up to a year or longer and may not be complete.

source- webmd.com

Great CTS Information

Carpal tunnel is due to a compression of the median nerve as it crosses the wrist and enters the hand. At that point there is a fibrous band (flexor retinaculum ) which is non elastile and wrist swelling results in median nerve compression against the band.
It is frequently seen in females and is often worse in the morning on waking up. Other occupational causes are described including computer mouse / typing . Some diseases may present with it - especially hypothyroidism and Rheumatoid arthritis. It may be seen post pregnancy.
It is characterized by numbness / tingling / weakness in the fingers. Usually the first three fingers are affected the most , but the whole hand can be affected. It can occur bilaterally. It is worse in the morning and may be relieved by shaking the wrists.
The problem can be confirmed by a nerve conduction study - which a neurologist would do.
The therapy is : Treat the cause -ie- repetitive stress syndromes / hypothyroidism / Rheumatoid etc.. A wrist splint may be of benefit. I use the futuro wrist splint. A short course of a diuretic may help including hydochlorthiazide 12.5mg / day . If that doesn’t help...some people inject around the band - but I don’t personally recommend this. At this stage I’d rather recommend surgery, where the band is divided by a incision over the front aspect of the wrist and slightly into the palm. It is a relatively small operation and may be done under a regional anaesthetic block. A neglected severe carpal tunnel may produce wasting of the muscles in the hand and therapy can be less than perfect regarding final outcome.


What about Carpal tunnel in Rheumatoid Arthritis ?
This is a common problem in RA, and in fact often preceeds the initial presentation of the arthritis itself. The swelling of the synovium -the joint lining - at the wrist - causes the median nerve compression. Therapy of the swelling - by treating the arthritis - frequently resolves the carpal tunnel symptoms and therefore avoids the need for surgery.
Frequently asked questions of Rheumatoid arthritis patients :
If I do nothing, what is the possible scenario?
Answer -IF the CARPAL TUNNEL (CT) causes ongoing pain and weakness and it is not sorted out - ie for months to years -( the length of time varies depending on the severity of the compression and symptoms ) - permanent pain and weakness can follow as the nerve becomes permanently damaged despite release. However if your symptoms are mild and there are no signs of neurological benefit.... then you can observe progress without an urgent need for surgery.
Can I simply learn to live with it?
Answer - as long as you dont have WEAKNESS in the fingers from paralysis or numbness - suggesting significant compression to the nerve. If its ONLY symptoms of discomfort - you can.
Will the RA make it worse
Yes - the cause -IS the swelling at the wrist obstructing the nerve.
CAN I USE ANY OTHER THERAPY: (I know you meant to ask this)
YES- YOU CAN : If a splint and medications haven't helped - Ask your doc about a wrist joint injection of corticosteroid and local anaesthetic. That will usually get the swelling down and thereby help the carpal tunnel.

source-arthritis.co.ca

At a glance... CTS

Carpal Tunnel Syndrome At A Glance

Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. Symptoms of carpal tunnel syndrome include numbness and tingling of the hand. Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing. Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.

CTS treatment

How is carpal tunnel syndrome treated?

The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and any underlying disease which might be causing the symptoms.
Initial treatment usually includes rest, immobilization of the wrist in a splint, and occasionally ice application. Patients whose occupations are aggravating the symptoms should modify their activities. For example, computer keyboards and chair height may need to be adjusted to optimize comfort. These measures, as well as periodic resting and range of motion stretching exercise of the wrists can actually prevent the symptoms of carpal tunnel syndrome that are caused by repetitive overuse. Underlying conditions or diseases are treated individually. Fractures can require orthopedic management. Obese individuals will be advised regarding weight reduction. Rheumatoid disease is treated with measures directed against the underlying arthritis. Wrist swelling that can be associated with pregnancy resolves in time after delivery of the baby!
Several types of medications have been used in the treatment of carpal tunnel syndrome. Vitamin B6 (pyridoxine) has been reported to relieve some symptoms of carpal tunnel syndrome, although it is not known how this medication works. Nonsteroidal anti-inflammatory drugs can also be helpful in decreasing inflammation and reducing pain. Side effects include gastrointestinal upset and even ulceration of the stomach. These medications should be taken with food and abdominal symptoms should be reported to the doctor. Corticosteroids can be given by mouth or injected directly into the involved wrist joint. They can bring rapid relief of the persistent symptoms of carpal tunnel syndrome. Side effects of these medications when given in short courses for carpal tunnel syndrome are minimal. However, corticosteroids can aggravate diabetes and should be avoided in the presence of infections.
Most patients with carpal tunnel syndrome improve with conservative measures and medications. Occasionally, chronic pressure on the median nerve can result in persistent numbness and weakness. In order to avoid serious and permanent nerve and muscle consequences of carpal tunnel syndrome, surgical treatment is considered. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. This surgical procedure is called "carpal tunnel release." It can now be performed with a small diameter viewing tube, called an arthroscope, or by open wrist procedure. After carpal tunnel release, patients often undergo exercise rehabilitation. Though it is uncommon, symptoms can recur.

CTS glossary-part 3

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time.
Condition: The term "condition" has a number of biomedical meanings including the following:
An unhealthy state, such as in "this is a progressive condition."
A state of fitness, such as "getting into condition."
Something that is essential to the occurrence of something else; essentially a "precondition."
As a verb: to cause a change in something so that a response that was previously associated with a certain stimulus becomes associated with another stimulus; to condition a person, as in behavioral conditioning.
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus . Diabetes mellitus and diabetes insipidus share the name "diabetes" because they are both conditions characterized by excessive urination (polyuria).
Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV.
Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs). Disruption sequence: The events that occur when a fetus that is developing normally is subjected to a destructive agent such as the rubella (German measles) virus. Elbow: The juncture of the long bones in the middle portion of the arm. The bone of the upper arm (humerus) meets both the ulna (the inner bone of the forearm) and radius (the outer bone of the forearm) to form a hinge joint at the elbow. The radius and ulna also meet one another in the elbow to permit a small amount of rotation of the forearm. The elbow therefore functions to move the arm like a hinge (forward and backward) and in rotation (outward and inward). The biceps muscle is the major muscle that flexes the elbow hinge, and the triceps muscle is the major muscle that extends it. The primary stability of the elbow is provided by the ulnar collateral ligament, located on the medial (inner) side of the elbow. The outer bony prominence of the elbow is the lateral epicondyle, a part of the humerus bone. Tendons attached to this area can be injured, causing inflammation or tendonitis (lateral epicondylitis, or tennis elbow). The inner portion of the elbow is a bony prominence called the medial epicondyle of the humerus. Additional tendons from muscles attach here and can be injured, likewise causing inflammation or tendonitis (medial epicondylitis, or golfer's elbow).