When an individual’s hands and fingers start tingling, they will most often suspect carpal tunnel syndrome (CTS). However, pressure on the median nerve anywhere along its course from the neck to the hand can produce similar symptoms in the hand and fingers. So what is the best way to diagnose CTS and differentiate it from other conditions?
A 2021 study reported that a Timed Phalen’s Test (TPT) could predict abnormal nerve findings on diagnostics like electromyography (EMG). In the TPT, a patient pushes the back of their hands together with the wrists bent at 90 degrees and the doctor uses a stopwatch to time how long it takes for numbness to occur. In 403 patients with confirmed CTS, 69% had a positive TPT in less than ten seconds, thus supporting TPT as a VERY accurate test to clinically help diagnose CTS.
In 2000, a systematic review of twelve studies concluded that the following clinical in-office tests are also predictive of a positive CTS diagnosis:
- Hand dysesthesias (numbness/tingling) that follow the median nerve distribution (thumb, index, middle, and thumb-half of the ring finger).
- A Katz hand diagram (a drawing of where symptoms are located) that matches the areas of the hand innervated by the median nerve.
- Weak thumb abduction strength.
Typically, a doctor is more secure in their diagnosis when several tests are positive. Researchers refer to multiple positive tests as “clusters”, while others use the term “clinical prediction rule”.
If compression of the median nerve at the carpal tunnel is confirmed, it’s important to examine the other likely places for median nerve compression because it’s common for issues to be present at two or more locations. Each of these conditions will need to be addressed for the patient to have a satisfactory treatment outcome. Doctors of chiropractic are trained to examine the whole patient and not just the area of chief complaint because dysfunction in one part of the body can affect other regions.
The good news is that CTS patients often respond favorably to the non-surgical treatments provided in the chiropractic clinical setting, especially when a diagnosis is made early in the course of the disease. This is why it’s important to consult your doctor of chiropractic when symptoms first begin as they may be resolved quickly with in-office treatment, home-based exercises, and work modifications before more serious and activity-limiting symptoms develop.
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