Carpal Tunnel Syndrome: Symptoms, Diagnosis, and Treatment Options

Q: Carpal Tunnel Syndrome: Symptoms, Diagnosis, and Treatment Options

Hello, Miss： You mentioned that "the electromyography (EMG) examination requires inserting a needle into the muscles of the hand." May I ask if your needle sensation is in the index, middle, and part of the ring finger? This would correspond to the area of the median nerve in car

Carpal Tunnel Syndrome

Hello, Doctor.
Recently, I've been experiencing numbness in my left hand for over a month, specifically in my palm and fingers, which feel swollen and tingly.
My mobility is generally fine, but I notice the symptoms more when I'm at rest.
Occasionally, I wake up at night due to the numbness, and I experience some shaking and weakness when lifting objects.
Since I primarily use my left hand and often type on the computer, I suspect I might have carpal tunnel syndrome.
I want to go to the hospital, but due to the severe pandemic situation, I'm hesitant.
I've also read that an electromyography (EMG) test requires needles to be inserted into the muscles of the hand, which makes me a bit anxious.
If I choose not to undergo this test, can the doctor still confirm if I have carpal tunnel syndrome? Should I make an appointment with a neurologist or a rehabilitation specialist? Thank you, Doctor!

Pipa Gao, 30~39 year old female. Ask Date: 2022/04/17

Dr. Jiang Junyi reply Neurology

Hello, Miss: You mentioned that "the electromyography (EMG) examination requires inserting a needle into the muscles of the hand." May I ask if your needle sensation is in the index, middle, and part of the ring finger? This would correspond to the area of the median nerve in carpal tunnel syndrome, which typically requires EMG assistance for diagnosis only when combined with other potential causes.
Carpal tunnel syndrome refers to the clinical symptoms caused by the compression of the median nerve as it passes through the wrist, which is enclosed by the carpal bones and ligaments forming the "carpal tunnel." The median nerve is responsible for the movement of the thumb and provides sensation to the thumb, index finger, middle finger, and part of the ring finger.
Diagnosis of carpal tunnel syndrome can be made through physical examination.
Nerve conduction studies involve using very small electrical currents to stimulate the median nerve, assessing the nerve's response and the extent of injury, which may show reduced waveform amplitude and slowed conduction velocity.
Mild carpal tunnel syndrome can be treated conservatively, with methods including avoiding excessive wrist movements, taking anti-inflammatory medications, and wearing wrist splints.
Using a wrist splint can help reduce excessive wrist motion and should be worn continuously for 2-4 weeks.
I recommend that you consult a neurologist or a rehabilitation physician to discuss examination and treatment options.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health and peace.
Dr.
Jiang Junyi, Neurology, Taoyuan Medical Center.

Reply Date: 2022/04/17

More Info

Carpal Tunnel Syndrome (CTS) is a common condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed at the wrist. This condition can lead to a variety of symptoms, including numbness, tingling, and weakness in the hand and fingers. Your description of experiencing numbness and tingling in your left hand, especially during rest and at night, aligns well with the typical symptoms of CTS.

Symptoms
The symptoms of CTS often include:
- Numbness or tingling in the thumb, index, middle, and part of the ring fingers.

- Pain that may radiate up the arm.

- Weakness in the hand, making it difficult to grasp objects.

- Symptoms that worsen at night or with activities that involve wrist flexion, such as typing or using a mouse.

Diagnosis
While your symptoms suggest CTS, a definitive diagnosis typically requires a thorough clinical evaluation. This often includes:
1. Physical Examination: A healthcare provider will assess your symptoms, medical history, and perform specific tests, such as the Phalen's maneuver (holding the wrists in flexion) or Tinel's sign (tapping over the median nerve).

2. Electromyography (EMG) and Nerve Conduction Studies (NCS): These tests measure the electrical activity of muscles and the speed of nerve conduction. While you expressed concern about the discomfort associated with needle insertion, these tests are crucial for confirming the diagnosis and ruling out other conditions.

Treatment Options
If CTS is confirmed, treatment options vary based on the severity of the condition:
1. Non-Surgical Treatments:
- Wrist Splinting: Wearing a splint at night can help keep the wrist in a neutral position, reducing pressure on the median nerve.

- Activity Modification: Reducing repetitive wrist movements and taking frequent breaks during activities like typing can alleviate symptoms.

- Physical Therapy: Stretching and strengthening exercises can improve wrist flexibility and reduce symptoms.

- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation.

2. Surgical Treatments: If non-surgical methods fail to relieve symptoms after several months, surgical intervention may be considered. The procedure involves cutting the ligament that is pressing on the median nerve, which can provide immediate relief.

Choosing the Right Specialist
Regarding your concern about which specialist to consult, both a neurologist and a rehabilitation physician (physiatrist) can evaluate and treat CTS. A neurologist may focus more on diagnosing nerve-related issues, while a physiatrist may offer a broader range of rehabilitation options. If you are primarily concerned about diagnosis and nerve function, starting with a neurologist may be beneficial. However, if you are looking for a comprehensive treatment plan that includes physical therapy, a physiatrist could be a good choice.

Conclusion
While it is understandable to have apprehensions about diagnostic procedures like EMG, they are essential for an accurate diagnosis and effective treatment plan. If you are experiencing significant symptoms, it is advisable to seek medical attention sooner rather than later. In the meantime, consider implementing wrist splinting and modifying your activities to alleviate symptoms. Remember, early intervention can often lead to better outcomes in managing Carpal Tunnel Syndrome.

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