Carpal tunnel syndrome: warning signs, tests and common treatments

Carpal tunnel syndrome is a common condition causing tingling, numbness and sometimes pain in the hand and arm. There are many warning signs and tests which you can do at home or a doctor can perform to confirm if you have this condition or not. To find out which tests there are, we asked Mr James Nicholl, a urological surgeon based in Tunbridge Wells:

What are the first symptoms of carpal tunnel syndrome?

The first symptoms of carpal tunnel syndrome are typically tingling or pins and needles extending down into the hand. It's often first an issue at nights and the numbness and tingling may wake you up. It could also occur when you are driving, in which your hand goes numb and you need to take their hand off the wheel to shake it to get the life back. It is possible to also occur when you are just sitting still, for example, while reading the paper.

What happens during a physical examination for carpal tunnel syndrome by a doctor?

If you come to see me, I first begin by asking you about your medical history. To carry out the exam, the first thing I look at is the hand. If it's a severe case, then there may be wasting of the muscles in the pad of the palm at the base of the thumb. I also look for any evidence of an old injury to the wrist which could increase the likelihood of carpal tunnel syndrome. I then subsequently assess the feeling of your skin by applying soft brush strokes to see if there is any change or loss of sensation.

What are the different tests used?

There are special tests that we do as part of the examination. These include:

• Tinel's test: the examining surgeon will tap on the front of the wrist. If you have carpal tunnel syndrome, you may experience a tingling sensation going down in the fingers or going up the arm. Sometimes, patients feel an unpleasant, electric shock-type sensation. 
• Phalen's test: this is a provocative test where the median nerve is compressed or squeezed at the wrist by placing the backs of the hands together and both wrists are completely flexed.
• Reverse Phalen's test: the wrists are bent backward and the patient maintains a position of full wrist and finger extension for two minutes.
• Durkan's test: the wrist is bent forward and pressure is applied to the front of the carpal tunnel.

The tests that I find the most sensitive are a combination of the Phalen's test and Durkan's test, where I bend the wrist forward and then apply pressure to the front of the carpal tunnel. If that brings on the symptoms in the fingers, then that is quite suggestive of carpal tunnel syndrome.

If from the history and examining them there's doubt as to whether the diagnosis is carpal tunnel syndrome or not, then they can be referred for what's called a nerve conduction test. This is an electrical test where a neurophysiologist records the conduction of electricity across the carpal tunnel and they can work out whether there is slowing of the conduction consistent with the diagnosis of carpal tunnel syndrome.

How can I check myself for carpal tunnel syndrome?

If you are concerned that you might have carpal tunnel syndrome, the most important thing is to make a mental note of when the symptoms appear and also what you have been doing to relieve them. For example, if you’ve been woken up at night with numbness and tingling in the hand and you’ve been shaking it around or hanging it over the sides of the bed to relieve symptoms, then that is quite suggestive of carpal tunnel syndrome.

Another way to test this is to wear a splint on the front of the wrist at night to stops the wrist moving. If you have a better night's sleep, then that might suggest that the diagnosis is carpal tunnel syndrome.

What are some treatment options and when is surgery required?

Carpal tunnel syndrome can clear up spontaneously. So, when someone first presents with symptoms, it's not unreasonable to give it a bit of time to see if it settles down.

Often the splint can control it, which is a perfectly good way to manage the symptoms. If, for example, a pregnant lady has developed carpal tunnel syndrome, then managing the symptoms with a splint is often all that's required. in the majority of cases, once she's had her baby the symptoms usually settle.

Another treatment that can be offered is a cortisone injection into the carpal tunnel. This will often relieve symptoms, but in many cases, this will just be temporary relief. If you have persisting symptoms, and you’ve tried more conservative measures but you are still very troubled by them, then surgery may well become appropriate.

Surgery is usually recommended if the patient has permanent numbness of the fingertips, or if the muscle in the hand is getting weaker or wasting away. In this situation, surgical release of the nerve is the only treatment that is likely to reverse the changes.

If you would like to book a consultation with Mr James Nicholl, visit his Top Doctors profile and check his availability.