Diagnosis of Carpal Tunnel Syndrome

Early diagnosis and treatment are important to avoid further damage to the median nerve. To see if you have CTS, your doctor may do the following:

  • Physical exam. Most cases of CTS can be diagnosed through a physical exam by your doctor. Your doctor will examine your hands, arms, shoulders, and neck to help determine if your symptoms are related to daily activities or to another disorder and to rule out other causes. Your wrist will be examined to see if tapping or pressing on your median nerve, or flexing your wrist, causes a numbing or tingling sensation. Your fingers will be tested for sensation, and your muscles at the base of your hand will be tested for strength and signs of atrophy or weakening.
  • Laboratory tests and x-rays. In some cases, your doctor may order laboratory tests and x-rays. This will help find any fractures, arthritis, or nerve-damaging diseases, such as diabetes.
  • Tests using electric signals. In some cases where your CTS can not be diagnosed using physical exam alone, other tests may be ordered.
    • nerve conduction study measures how quickly signals are transmitted along a nerve to see if the signals are slowed down at the carpal tunnel
    • Electromyography can determine the severity of muscle damage due to the CTS
    • Ultrasound can be used to see if the median nerve is swollen at the carpal tunnel

Treatment of Carpal Tunnel Syndrome

Treatments for CTS should begin as soon as possible. Underlying causes such as diabetes or arthritis should be treated first.

Nonsurgical Treatments

Nonsurgical treatments can improve the symptoms of CTS in the short term, but they do not treat the underlying problem with the median nerve or lead to long term improvements in your symptoms. 

  • Splinting/Bracing. Using a splint on the hand and wrist at night is a common initial treatment option for CTS symptoms. 
  • Steroid injection. An injection of steroid into your carpal tunnel can alleviate symptoms of CTS temporarily. 

Surgical Treatments

Carpal tunnel release is one of the most common surgical procedures in the United States. It involves using a small incision and cutting a ligament to relieve the pressure on the median nerve. Some people with CTS may need surgery on both wrists. There are two different methods of carpal tunnel release surgery:

  • Open release surgery is the traditional procedure used to correct CTS. A surgeon makes an incision in your wrist and then cuts the carpal ligament (the tissue that holds joints together) to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis.
  • Endoscopic surgery involves a surgeon making one or two small incisions in your wrist and palm. A camera attached to a tube is then inserted to look at the nerve, ligament, and tendons on a monitor. Using the image as a guide, the surgeon then cuts the carpal ligament with a small knife that is inserted through the tube. This type of surgery may allow for faster recovery and less discomfort than traditional open release surgery. However, it also carries a higher risk of complications and need for repeat surgery.

Although carpal tunnel surgery may quickly relieve symptoms, full recovery is based on the severity of the CTS and can take months to years. All surgeries carry risks. Some people may have infections, nerve damage, stiffness, or pain at the scar.

Surgery usually solves the issue permanently. It is very rare for carpal tunnel syndrome to come back after surgery. 

Who Treats Carpal Tunnel Syndrome?

Carpal tunnel syndrome is usually initially seen and treated by:

  • Neurologists, who diagnose and treat nerve disorders.
  • Neurosurgeons, who specialize in the diagnosis and surgical treatment of peripheral nerve disorders. 
  • Orthopaedic surgeons, who specialize in diagnosing and treating injuries to bones, joints, ligaments, tendons, muscles, and nerves.
  • Primary health care providers, including family doctors, internists, and rheumatologists who treat problems as they arise and coordinate care between the different specialized health care providers.

You may also see:

  • Occupational and physical therapists, who teach ways to strengthen muscles and joints, minimize pain, and perform activities of daily living.
  • Pain management specialists, which are physicians trained in the evaluation and treatment of pain.
  • Physiatrists, which are doctors who specialize in nonsurgical management of musculoskeletal conditions and can develop a plan of care, including rehabilitation.

Living With Carpal Tunnel Syndrome

There are many things you can try to help you manage early carpal tunnel syndrome symptoms, including:

  • Wearing a splint on your hand and wrist at night.
  • Using ice packs as needed.
  • Taking medications as prescribed by your doctor.
  • Seeking medical care when you need it.
  • Resting your hands periodically.
  • Minimizing repetitive movements.
  • Taking short breaks when doing repetitive tasks with your hands.
  • Using ergonomically designed tools and furniture when possible.

Research Progress Related to Carpal Tunnel Syndrome

Scientists supported by NIH are seeking to better understand, treat, and prevent CTS by using advanced brain imaging in people with the disorder. Researchers also are looking at the role of cellular senescence—the process by which cells age and stop dividing—in CTS to learn more about the disorder.

In another study, scientists are building a tool to help people with CTS evaluate treatment options in consultation with their doctor. Other NIH-funded researchers are exploring the use of noninvasive brain stimulation along with physical therapy to treat chronic pain in people with CTS. 

In addition, NIH investigators are exploring new ways to understand the mechanisms involved in grasp and other forces that impact the hand. This study may lead to the development of better assistive and/or rehabilitation devices.