Carpal Tunnel Syndrome
Carpal tunnel syndrome is becoming increasingly prevalent due to the increased time we spend at a keyboard. The cause of carpal tunnel syndrome is pinched nerves within the wrist. The symptoms are numbness, tingling and weakness of the first 3 digits of the hand. There are many other conditions that cause the same exact symptoms. It’s important to differentially diagnose the “root cause” of your symptoms. Most often the knee jerk reaction is carpal tunnel syndrome.
These very same symptoms can be caused by a pinched nerve in your neck, and 2 anatomical anomalies; cervical rib, and a different shaped collarbone. The most common of all is pinched nerves within the forearm, known as tunnel syndromes. The diagnostic tests for carpal tunnel syndrome are MRI and EMG. Unfortunately, neither of these 2 tests differentially diagnose any of the conditions as listed above. EMGs are subject to many faults positives. MRI is an excellent diagnostic test however the test is only performed at the wrist, and it is very subjective. Very often you see on an MRI what you are looking for. For example, a lumbar MRI with a working diagnosis of a herniated disc of L5-S1, can show no herniation at this level but a herniation at L2-L3 which would produce different symptoms than the working diagnosis. There would be little correlation on the physical exam however, the diagnosis would be herniated disc of the lower lumbar vertebrae.
To diagnose any condition, it is imperative to first have a conversation between the patient and the doctor. Symptoms, probable causes, other medical conditions, and present medication are all important to ascertain. A comprehensive examination should follow, which would include all related orthopedic, neurological and functional tests. Only then can you order the proper advanced tests if necessary.
9 times out of 10, the “root cause” of carpal tunnel syndrome is a pinched nerve within the forearm. By digitally compressing known areas in the forearm, the symptoms can be reproduced or increased in intensity. There can be multiple causes of the symptoms from carpal tunnel syndrome at the same time. By eliminating treatable conditions in the office and making ergonomic changes, most if not all symptoms can be alleviated without surgery. There are many other medical problems that have the same scenario especially now with “corporate medicine.”
