STEP #1: Relating your medical and work history to your doctors is the first step in diagnosing Carpal Tunnel Syndrome ("CTS"). Your doctor will ask you to describe your symptoms. The commonly associated symptoms include:
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:
STEP #3: During your physical exam, your doctor will use two basic diagnostic tests to screen for "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.