Diagnosis of carpal tunnel syndrome

Definition of carpal tunnel syndrome

The carpal tunnel syndrome is caused by chronic compression of the median nerve and manifests itself early on in nocturnal pain in the index and middle fingers, as well as in the thumb. In the process it comes to shrinkage (atrophy) the muscles of the ball of the thumb.

Read more on the topic: Symptoms of carpal tunnel syndrome

The disease is more common in women and the incidence peak of initial diagnosis is middle age.

It is not always a trigger The cause of the development of a carpal tunnel syndrome to make out, but apply overload and chronic tendinitis at rheumatoid arthritis as favoring factors.

If you want to know more about the causes, read: Causes of Carpal Tunnel Syndrome

Also at abnormal enlargement of the limbs (Acromegaly) the median arm nerve can become narrowed.
An increase in new diagnoses can also be seen in women in the pregnancy and at familial occurrence of carpal tunnel syndrome.

introduction

Every medical diagnosis consists of the Medical history (Anamnesis), the Examination findings (Clinic) and off imaging procedures.

There are a number of different diseases of the wrist as well as others Nerve congestion disordersto be considered when making a diagnosis. In addition, diseases of other joints must also be taken into account.

Diagnosis is difficult if the constellation of findings is unclear, for example if two different diseases are present at the same time, or the disease is still in its infancy There are no trend-setting symptoms. Than are Misdiagnosis also possible with such a well-known clinical picture as carpal tunnel syndrome.

Clinical examination

Due to the large number of possible underlying diseases, the physical exam should not focus solely on the Examination of the wrist restrict. During the initial examination you should at least rule out other diseases Cervical spine, shoulder and the Elbow joint also be examined, as well as possible other nerve disorders can be requested. The examination should always be compared to the other "healthy" hand.

When looking at the hand should be on scar attention must be paid, as this is an indication of a previous one injury or one preceding it accident could be. In the advanced stage you can already get involved collapsed muscle belly recognize in the area of ​​the ball of the thumb.

Then the carpal tunnel can open Tenderness be checked.

In the early stages, especially nocturnal palm pain and Parasitic sensations in the first three fingers indicated, which can be relieved by massaging and shaking hands.

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Diagnosis through clinical tests

During the further examination, the doctor uses various tests with which he can provoke symptoms in the patient.

• The so-called Hoffmann-Tinel sign can be checked by tapping the carpal tunnel lightly. If the patient expresses electrical shooting pain, the test is positive.
• From Phalen sign one speaks when, with maximum flexion of the hands in the direction of the palm or extension in the direction of the back of the hand for a period of about one minute, pain or sensory disturbancesParesthesia)occur.
• Checking the so-called Bottle mark can bring further clarity. This tests whether there is an inability to grasp a round vessel, caused by an inadequate ability to spread (abduct) the thumb.

If one or more of these clinical tests are positive, the presence of carpal tunnel syndrome is very likely.

During the further examination, the doctor uses various tests with which he can provoke symptoms in the patient.

• The so-called Hoffmann-Tinel sign lets through easy Check tapping the carpal tunnel. If the patient expresses electrical shooting pain, the test is positive.

• From Phalen sign one speaks when with maximum flexion of the hands towards the palm or stretching towards the back of the hand for a period of about a minute Pain or sensory disturbance (Paresthesia)occur.

• Checking the so-called Bottle mark can bring further clarity. It is checked whether a inability exists, a round vessel to embrace, caused by an insufficient ability to Spreading (Abduct) of the thumb.

If one or more of these clinical tests are positive, it is there Carpal tunnel syndrome most likely.

Diagnosis using electroneurography

To confirm the suspected diagnosis of "carpal tunnel syndrome", one more machine diagnostics connected.

Especially the Electroneurography is here very meaningful, and therefore counts as Diagnostic method of choice.

Here the Median nerve (Median nerve) the affected side with a electrical stimulus irritated wrist, and the time up to one muscular response the one supplied by this nerve Ball of thumb muscles measured. The nerve conduction speed can be determined from this. With the help of electroneurography, both place as well as Degree of damage of the nerve.

If there is a carpal tunnel syndrome, this is the period of time elevated.

So that the test delivers comparable values, always on both arms measured.
In addition, the Master speed of the Ulnar nerve (Elbow nerve) intended to be one individual reference value to have. This can cause any causes for incorrect measurements, such as too cold hands, be excluded.

In addition to delaying muscle response, the sensitive parts of the median nerve have a reduced nerve conduction velocity.

To check this, the measured values ​​of the Median nerve and des Ulnar nerve compared.

Diagnosis using electromyography

In the Electromyography (EMG), the measurement of the muscular conductivity of the affected hand, fall among others abnormal spontaneous activities the muscles supplied by the constricted median arm nerve.

This examination method can also determine whether the nerve damage temporarily or persistent is.

As with the Electroneurography also, will be here too always in side comparison measured.

Diagnosis using ultrasound

By narrowing the Median nerve Local nerve swelling often occurs in the carpal tunnel.

This can be in a Ultrasound examination be proven by the Nerve cross section On different parts measured and compared becomes. You can also Bulging of the wrist capsule or Soft tissue tumors which can also lead to a narrowing in the carpal tunnel.

Can one clear narrowing can be proven, the determination of the nerve conduction velocity (see above) can also be dispensed with.

Diagnosis using X-rays / MRI

To diagnose carpal tunnel syndrome are X-rays not necessarily suitable.

However, they can be helpful to detect other diseases that are often associated with carpal tunnel syndrome (e.g. the Arthrosis of the thumb saddle joint).

A MRI examination is usually not necessary and is not part of the routine diagnosis of carpal tunnel syndrome.
Only at concrete suspicion to a Tumor disease in the wrist, the MRI is considered to be makes sense.