Do I have carpal tunnel syndrome (CTS)?

From the Guidelines

Carpal tunnel syndrome diagnosis should be based on clinical evaluation combined with electrophysiologic studies, and further imaging is usually not needed, but in selected circumstances, either wrist US or MRI without contrast may be appropriate. When diagnosing carpal tunnel syndrome, it is essential to consider the patient's symptoms, medical history, and physical examination findings. According to the American College of Radiology 1, suspected carpal tunnel syndrome is diagnosed by clinical evaluation combined with electrophysiologic studies. Some key points to consider in the diagnosis and management of carpal tunnel syndrome include:

• Clinical evaluation: A thorough clinical evaluation, including a physical examination and medical history, is crucial in diagnosing carpal tunnel syndrome.
• Electrophysiologic studies: Electrophysiologic studies, such as nerve conduction studies and electromyography, can help confirm the diagnosis of carpal tunnel syndrome.
• Imaging: Further imaging, such as wrist US or MRI without contrast, may be appropriate in selected circumstances, but is usually not needed for diagnosis. Treatment options for carpal tunnel syndrome may include:
• Conservative treatments: Wearing a wrist splint, taking over-the-counter pain relievers, and avoiding activities that worsen symptoms can help manage mild symptoms.
• Corticosteroid injections: Corticosteroid injections can help reduce inflammation and relieve symptoms.
• Physical therapy: Physical therapy can help improve wrist and hand function and reduce symptoms.
• Surgical release: In severe or persistent cases, surgical release of the carpal tunnel may be necessary to relieve pressure on the median nerve.

From the Research

Symptoms of Carpal Tunnel Syndrome

• Pain and paresthesias in the distribution of the median nerve, which includes the palmar aspect of the thumb, index and middle fingers, and radial half of the ring finger 2
• Nighttime symptoms are more common earlier in the disease process, with daytime symptoms becoming more frequent as the condition progresses 3
• Additional clues include positive physical examination findings, such as the flick sign, Phalen maneuver, and median nerve compression test 2

Diagnosis of Carpal Tunnel Syndrome

• Ultrasonography and electrodiagnostic studies are useful to confirm the diagnosis in atypical cases and rule out other causes 2
• Electrodiagnostic studies may be performed to confirm a diagnosis of carpal tunnel syndrome or to obtain a baseline before surgical treatment 3
• Electrodiagnostic studies may be normal in a subset of patients who have carpal tunnel syndrome 3

Treatment Options for Carpal Tunnel Syndrome

• Conservative treatment may be offered initially to patients with mild to moderate carpal tunnel syndrome, including options such as splinting, corticosteroids, physical therapy, therapeutic ultrasound, and yoga 2
• Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 2
• Patients with severe carpal tunnel syndrome or whose symptoms have not improved after four to six months of conservative therapy should be offered surgical decompression 2
• Acupuncture and electroacupuncture therapy may improve symptoms and aid nerve repair as well as improve sensory and motor functions 4
• Pharmacology, electrotherapy, and manual therapy have shown benefits for handling carpal tunnel syndrome, although the most effective combination of techniques is unknown 5

Surgical Treatment for Carpal Tunnel Syndrome

• Endoscopic and open techniques are equally effective, but patients return to work an average of one week earlier with endoscopic repair 2
• Carpal tunnel release should be performed in patients in whom nonsurgical treatment fails and patients who have acute carpal tunnel syndrome secondary to infection or trauma or have advanced symptoms 3
• Recalcitrant carpal tunnel syndrome, which may occur in as many as 25% of patients who undergo carpal tunnel release, most commonly results from an incomplete transverse carpal ligament release or an incorrect initial diagnosis 3