Can a Patient Self-Diagnose Carpal Tunnel Syndrome?

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Carpal Tunnel Syndrome is the most common type of nerve compression and may affect up to 1-10% of the population in some studies. Repetitive motion, vibrations, certain athletic activities, and certain conditions can predispose individuals to carpal tunnel syndrome (Figure 1). The most common associated conditions of carpal tunnel syndrome include: diabetes, rheumatoid arthritis, pregnancy, hypothyroidism, and advanced age. In patients who have a clinical diagnosis of carpal tunnel syndrome based on the history and the physical exam, an electrodiagnostic test does not change the probability of diagnosing this condition.

So, the question is, can you self-diagnose Carpal Tunnel Syndrome?

To begin, we must look at the most common clinical presentations for carpal tunnel syndrome.

1. Symptoms in the Distribution of the Median Nerve

The individual will feel a pain and burning sensation as well as numbness and tingling in the thumb, index, and middle fingers (Figure 2). The small finger should not be affected (asymptomatic). Any symptoms in the small finger are NOT associated with carpal tunnel syndrome. The little finger sensation is part of the ulnar nerve distribution. The self-administered hand diagram is extremely helpful—most specific test for carpal tunnel syndrome. The patient should highlight the areas where they are experiencing the symptoms.

2. Night Symptoms

Night symptoms are considered to be a good prognosis for effectiveness of treatment. During sleep, the patient will experience numbness, pain, and paresthesia that is more prominent (Figure 3). This discomfort is so severe that it will wake the patient from sleep and cause the patient to shake the hand to try and relieve the symptoms.

3. Thenar Atrophy

The patient may experience weakness, clumsiness, or thenar atrophy (Figure 4). Thenar atrophy indicates a long standing problem. You will want to compare the affected hand to the other nonaffected hand or the hand of a friend or relative in order to detect the differences.

4. Positive Phalen Test

The Phalen’s maneuver is performed by flexing the wrist for 60 seconds. This will increase the carpal tunnel pressure temporarily and produce the symptoms. If the test is positive, the patient will have numbness and tingling in the hand and wrist (Figure 5).

5. Positive Tinel’s Sign

This is a common provocative test for median nerve entrapment (indicates irritation of the nerve). Light tapping over the nerve at the carpal tunnel will cause radiating paresthesia distally into the median nerve’s innervated digit, this indicates carpal tunnel syndrome (Figure 6).

6. Positive Compression Test (Durkan’s Test)

This is the most sensitive test in diagnosing Carpal Tunnel Syndrome. The examiner places equal pressure with two thumbs directly over the patient’s median nerve in the carpal tunnel for about 30 seconds (Figure 7). Reproduction of symptoms such as pain, paresthesia, and numbness in the distribution of the median nerve distal to the carpal tunnel means that the test is positive for carpal tunnel syndrome.

If the patient has at least three of these six clinical findings, then the probability of the patient having Carpal Tunnel Syndrome is high.

Although the patient can probably self-diagnose carpal tunnel syndrome, it is critical for the patient to see their doctor to get a formal and accurate diagnosis in order to begin treatment. Additionally, other conditions may mimic carpal tunnel syndrome, and the patient will want to have an accurate diagnosis. Another scenario may be that the patient could have double crush syndrome.

A patient with carpal tunnel syndrome may also have a second problem elsewhere in the course of the median nerve (Figure 8). Symptoms of cervical disc herniation can also mimic carpal tunnel syndrome, C5-C6 is the most common level that is affected in the neck. The affected area in sensation is almost the same as in Carpal Tunnel Syndrome; however, the clinical examination by the doctor will reveal a herniated disc rather than carpal tunnel syndrome. Proximal median nerve entrapment such as pronator teres syndrome can mimic carpal tunnel syndrome. In the case of pronator teres syndrome, the palmar cutaneous branch of the median nerve is also involved (Figure 9). This nerve supplies sensation to the thenar eminence. In carpal tunnel syndrome, the patient does not lose the sensation on the radial aspect of the palm; however, in pronator teres syndrome, the patient will lose sensation on the radial aspect of the palm. Martin-Gruber Anatomosis is median to ulnar nerve communication in the proximal forearm. The patient may present with atypical (not usual) examination findings.

In my opinion, self-diagnosing Carpal Tunnel Syndrome is possible but, not advisable.

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