Carpal Tunnel Syndrome – Diagnosis and Treatment

Diagnosis

Doctors usually start by listening to your symptoms and running a few tests when they suspect carpal tunnel syndrome (CTS).

You might notice tingling, numbness, or pain in your fingers—often worse at night or after gripping things like your phone or the steering wheel.

One thing that stands out: the little finger usually stays fine, since the median nerve doesn’t affect that finger.

Physical Review

• Doctors check how strong your hand muscles are.
• They test how well you can feel things with your fingers.
• Sometimes, they bend your wrist or tap over the median nerve (that’s Tinel’s sign) to see if symptoms pop up.

Tests Used in CTS Diagnosis

Test	What It Checks	Why It’s Done
X-ray	Looks for arthritis or fractures	Rules out other wrist problems
Ultrasound	Shows images of tendons and nerves in the wrist	Checks for compression on median nerve
Electromyography (EMG)	Measures electrical activity in muscles via a small needle	Finds muscle damage from CTS
Nerve conduction study	Sends small electrical shocks through the median nerve with skin electrodes	Detects nerve signal slow-down

Other Factors Reviewed

• Family history can make CTS more likely.
• Doctors check your grip strength to see if nerves are involved.
• CTS shows up more often in people with diabetes or obesity.

Sometimes, doctors order blood tests to look for things like diabetes that can raise your risk. If they’re still unsure, they might use an MRI, but that’s pretty rare.

Experts say that no single test can confirm CTS. Instead, doctors look for a pattern in your symptoms, signs, and test results. This careful approach helps rule out other wrist problems, like arthritis or nerve issues outside the wrist.

Treatment

Ways to Treat Without Surgery

A lot of people manage carpal tunnel syndrome just fine without surgery, especially when symptoms are mild or haven’t been around too long. You might use wrist splints, take some medicines, or tweak your daily habits.

Wrist Splinting

Wearing a wrist splint at night often helps cut down on tingling and numbness. The splint keeps your wrist straight while you sleep, taking pressure off the nerve.

You can also wear the splint during the day to prevent flare-ups. Pregnant people often choose splints since they don’t involve medication.

Anti-inflammatory Medicines (NSAIDs)

Taking NSAIDs like ibuprofen might ease pain for a little while. But, honestly, these meds don’t fix the root problem—they just help with pain for now.

Steroid Injections

Sometimes, your doctor might suggest a shot of corticosteroids into your wrist to bring down swelling and pressure. They may use ultrasound to guide the needle for better accuracy.

Steroid injections usually work better than pills, calming swelling inside the carpal tunnel. If you have another condition like rheumatoid arthritis, treating that can also help your hand symptoms.

Lifestyle Changes and Occupational Therapy

Simple changes can make a difference:

• Take more breaks from hand-heavy activities.
• Skip tasks that make symptoms worse.
• Use cold packs if your wrist feels swollen.

Occupational therapists might teach you stretches or nerve-gliding exercises. They can also help you adjust your routines so symptoms don’t keep coming back.

Table: Examples of Nonsurgical Methods

Method	How It Helps
Wrist Splint	Keeps wrist straight to ease nerve pressure
NSAIDs	Eases pain for short periods
Corticosteroid Injection	Reduces inflammation and swelling
Activity Changes	Lowers risk of symptom flare-ups
Occupational Therapy	Teaches helpful exercises and habits

Surgical Procedures

Doctors usually consider surgery if symptoms get really bad, last a long time, or just don’t improve with other treatments.

The main goal is to create more space in the carpal tunnel by cutting the ligament that’s pressing on the nerve.

You’ve got a few surgical options:

Type	Description	Special Point
Endoscopic Release	Uses camera and tiny incisions	Less pain after surgery
Open Release	Single cut on palm, ligament cut	Traditional method
Ultrasound-Guided Release	Ultrasound shows structures, ligament cut	Less common, very precise

Endoscopic Carpal Tunnel Release

The surgeon uses a tiny camera (an endoscope) and small tools, sliding them through one or two tiny cuts in your wrist.

Guided by the camera, they cut the ligament. People often feel less pain in the first few weeks after this kind of surgery.

Open Carpal Tunnel Release

Here, the doctor makes a cut in your palm and cuts the ligament directly. It’s the traditional way, and it gives the doctor a clear view, but it might take a bit longer to heal compared to endoscopic surgery.

Surgery Using Ultrasound Guidance

In this less common method, the doctor uses ultrasound to see inside your wrist, then releases the ligament with special tools through a needle. It’s precise but not done as often.

Before any surgery, talk things over with your surgeon. There are some risks, like not cutting the ligament all the way, infection, scar problems, or accidentally hurting nearby nerves or blood vessels.

After surgery, tissues grow back together over a few months, but now there’s more room for the nerve. Most people see their skin heal in a few weeks, though hand soreness or weakness can stick around longer.

Sometimes, if your symptoms were really bad before, they might not go away completely.

Everyday Steps and At-Home Approaches

Small changes in your daily routine can really help with pain, numbness, tingling, or weakness in your wrist and hand. Try taking regular breaks from hand-heavy tasks or exercises to reduce strain.

Simple stretches—like rotating your wrist and spreading your fingers—might help with swelling and discomfort.

Tips for Home Care:

• Wear a wrist splint or brace at night to keep your wrist straight.
• Pay attention to your posture while doing everyday things.
• Use over-the-counter pain relievers like acetaminophen or ibuprofen if you need them.
• Try not to sleep on your hands.

If things don’t get better or start getting worse, reach out to a healthcare provider.

Different Approaches for Non-Traditional Treatments

Some folks try alternative therapies for carpal tunnel syndrome. Yoga, especially poses for the arms and upper body, might help by easing pain and building hand strength.

Acupuncture is another option some people use to reduce wrist discomfort. And then there’s pyridoxine (vitamin B6)—some take it as a supplement, though research is a bit mixed on whether it really helps.

If you’re thinking about these methods, talk to your healthcare provider to see how they might fit into your overall plan.

Getting Ready for Your Visit

Steps You Can Take Beforehand

Jot down your symptoms. Note when they started, which activities make them worse, and what time of day they show up. Keep track of what you’ve already tried—rest, medicines, or changes in how you use your hands.

Bring a list of all the medicines you’re taking, both prescription and over-the-counter.

Information to Bring	Why It’s Helpful
Symptom timeline	Shows pattern or triggers
List of medicines	Prevents drug interactions
Activities tried	Helps guide new treatments

Questions You Might Hear From Your Healthcare Team

Your healthcare provider will probably ask you a few questions to get the full picture. Expect questions like:

• How long have your symptoms been around?
• Did they start suddenly or slowly?
• Have things changed over time?
• Do certain activities make things better or worse?

Giving honest, clear answers can help your provider figure out the best plan for you.

Things To Try Before Your Visit

Before you see your healthcare provider, try to avoid activities that make symptoms worse or change how you do them. Sometimes just shifting your grip—like when you’re driving—can help.

Wearing a wrist splint at night might also give you some relief. These measures can help you manage until your appointment.