Houston Methodist. Leading Medicine

Hand FAQ

Question:

The doctor finally figured out I have carpal tunnel syndrome. It took forever to get a diagnosis. I thought it would be simpler to get through the treatment now that I actually have a diagnosis, but that's been complicated too. How can such a simple problem be so complex?

Answer:

Good question! And one that many, many experts have applied themselves to in trying to answer. Despite the fact that many people are affected by this condition, there just hasn't been enough consistent evidence to point us in the right direction. Clinical tests used for years to diagnose carpal tunnel syndrome have been tested and compared trying to find one test that could be used as the gold standard. If a test like that could be found, the physician could conduct the test and say with certainty, Yes you do or No you don't have this problem. It isn't always clear that the symptoms are coming from compression of the median nerve in the carpal tunnel area. For example, similar symptoms can be caused by pressure on the peripheral nerves in the cervical (neck) spine. Electrodiagnostic tests like nerve conduction velocity (NCV) and electromyography (EMG) can be used to confirm the diagnosis. But even when the tests are negative (indicating no problem with conduction of signals along the nerve), there are some folks who still really have carpal tunnel syndrome. Once a diagnosis has been made and confirmed, then as you found out, it's not a cut and dried decision about treatment. There isn't a magic pill that takes away this compressive neuropathy disorder. Steroids (oral or injection) might be of some help. Ultrasound (heat energy) has been used with some success by physical therapists over the patient's wrist where the nerve passes through the carpal bones. Splinting the forearm and wrist to hold it immobile and in a position that doesn't stretch or stress the nerve can also yield positive results with decreased pain and other symptoms. That's the conservative (nonoperative) approach to treating carpal tunnel syndrome. Studies show that if splinting doesn't help after three months and oral (pill form) steroid medications haven't improved symptoms in eight weeks, then it's time to consider surgery. Don't let these various treatment choices confuse or confound you. Your surgeon will be able to help you navigate the treatment path. There are several options. If one doesn't work, there are others available. The majority of patients do get permanent relief from the pain and numbness/tingling. Kyle D. Bickel, MD. Carpal Tunnel Syndrome. In The Journal of Hand Surgery. January 2010. Vol. 35A. No. 1. Pp. 147-152.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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