Basic 4 Step Procedure for diagnosing CTS and other RSI

STEP #1: Provide your doctor with a complete and accurate medical and work history. Your doctor will ask you to describe your symptoms. The commonly associated symptoms  include:

  • Tingling, pain or numbness in the hand(s). These symptoms commonly occur  while you are sleeping. People often mistakenly believe this sensation occurs because they are sleeping on their hands.  This is the most common symptom associated with CTS and it is probably the earliest indication that you have CTS.
  • Tingling, pain or numbness which has spread to the  lower arm from the elbow down. When left untreated, the tingling, pain, or numbness can develop into excruciating pain.
  • Loss of sensation or feeling in the hand(s).  The loss of sensation occurs when the median nerve is damaged.  Loss of sensation can result in your inability to feel things in your hands and loss of grip strength. You may also experience a decreased sensitivity to hot and cold
  • Loss of muscle tone and strength. Loss of muslce tone and strength at the base of the thumb is an indication that you have advanced CTS.  Noticeable changes in the size of the fleshy area at the base of your thumb is an indication that that area has atrophied.

STEP # 2: Your doctor will review your medical history to determine if you had, in the past or have presently, any of the non-occupational factors associated with “CTS”, including arthritis, diabetes, gout, hypothyroidism, menopause, pregnancy, wrist fractures and dislocations.

Your doctor will ask you a series of questions regarding your work history. Most questions will focus on your present job. For example, does your job involve repetitive motions, high levels of force, vibrations, etc? How often do you take rest brakes? Is your job stressful, etc? Your medical and work history are important factors in accurately diagnosing “CTS”.

Unfortunately, many doctors are not aware of the prevalence of Repetitive Stress Injuries and their association with job related risk factors. Others are hesitant to indicate that your Carpal Tunnel Syndrome is related to your work activities, simply because they do not want to get involved with Workers’ Compensation insurance companies.

IMPORTANT NOTE: The initial visit to your doctor with symptoms “consistent with CTS” is legally significant for three reasons:

  1. Even though you may have a non-occupational “CTS”  factor (i.e. diabetes), you are, nevertheless, entitled to receive Workers’ Compensation benefits if your work responsibilities aggravated or accelerated such pre-existing conditions.
  2. Your doctor’s records indicating your symptoms, work activities and your doctor’s opinion that your “CTS” is related to your work, is significant legal evidence to establish your right to receive Workers’ Compensation benefits.
  3. The date that you are informed by a doctor that you have developed work-related “CTS” is the “official” date of accident in Repetitive Stress Injury Workers’ Compensation claims. This date is significant to the filing and notice requirements of the Workers’ Compensation Act.

STEP #3: During your physical exam, your doctor will use two basic diagnostic tests to screen for “CTS”:

  • Phalen’s maneuver– Requires you to put the backs of your hands together with your wrists flexed and your fingers pointing toward the ground. Because this forces compression of the median nerve, you will reproduce your symptoms of “CTS” after one minute in this position if you have this disorder.
  • Tinel’s sign– A simple test in which you rest your hand, palm side up, and tap on your wrist where the median nerve passes through. If you experience tingling or numbness in the parts of the hand that receive sensations via the median nerve, you have reason to suspect that you have “CTS”.

STEP # 4: Doctors currently rely primarily on two different methods of electrodiagnostic testing-nerve conduction velocity (NCV), electromyography (EMG) to diagnose Carpal Tunnel Syndrome and other nerve related Repetitive Stress Injuries such ulnar nerve entrapment and thoracic outlet syndrome:

(1)Nerve Conduction Velocity Testing– Your nerves conduct electrical signals. NCV testing measures the speed at which the signal travels. A damaged nerve transmits the signal at a slower than normal speed.

If the result of your NCV test indicate nerve damage, it is likely that you have a relatively severe case that requires immediate attention and treatment. If your test does not indicate nerve damage, however, this does not put you in the clear.

NCV tests have a high threshold-that is, they usually detect nerve damage only when it has progressed significantly. Because NCV tests can cost anywhere from $150 to $500 depending on where you live and the extent of the tests, and because they are of limited use, at best, for detecting nerve damage at early stages, they are used with restraint. Often, self-reporting of symptoms and simple so called provocative tests such as Phalen’s test and Tinel’s sign are more sensitive, far less expensive and therefore, more practical.

(2) Electromyography– EMGs measure the response of muscles to electrical stimuli, just as electrocardiogram (EKG’s) measure the responses of heart muscles.

You have two kinds of nerves-those that carry sensory signals (allowing you to feel sensations) and those that carry motor signals (that move your muscles.) EMGs are used to test the latter.

Even more than NCV tests, EMGs detect only advance nerve damage. They are not generally useful in testing for RSI involving tissue damage.

Magnetic Resonance Imaging (MRI), while effective in diagnosing Carpal Tunnel Syndrome, are rarely used due to their considerable expense.

 

IMPORTANT NOTE: As a result of recent advances in digital imaging, high frequency sonography is gaining acceptance as a cost-effective test for diagnosing “CTS”. Unlike MRIs, sonography is an examination which can be performed with the wrist placed in different positions.