Diagnosis and Investigation

* overlaps with Jas' cause we're both doing the same topic. HAHA.*

1. Our Monash way of taking the musculoskeletal history.

2. See if there is a presence of risk factors

3. Conduct a physical ( The examination – Ask, look, feel, move, measure and perform specific tests ) and neurological examination ( yet to learn.. )

A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome.

Look : Discolouration, Swelling, Wasting of the muscles at the base of the hand, Erythema, Asymmetry, Trauma and Scars.
Feel : Tenderness and warmth, identify numbness in certain fingers and test the grip of the patient.
Move : Flexion, Extension, Radial displacement, Ulnar displacement.
Measure : * I .. don’t know * :(
Specific tests? * refer to the section below *

Neurological examination

a) Testing the muscle that abducts the thumb away from the palm (called the abductor pollicis brevis)
b) The ability to bend the thumb toward the palm (flexion) and ability to move the thumb toward the other fingers (opposition).
c) Tinel's sign - Tap on or presse on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs
d) Phalen's sign or wrist-flexion, test - having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute


4. Diagnostic tests
Nerve conduction velocity (NCV) and electromyography (EMG)

Used to evaluate nerve and muscle function

EMG :
Records and analyzes the electrical activity in the muscles.
When a normal muscle is at rest, it is electrically silent.
A very thin needle electrode is inserted through the skin into the muscle.
The electrode on the needle picks up the electrical activity given off by the muscles.
The activity is displayed on an oscilloscope, and may be heard through a speaker.
Patients are then asked to flex the arm.
The action potential produced on the monitor provide information about the muscle's ( APB ) ability to respond when the nerves are stimulated.
May reveal delayed nerve conduction in the median nerve or the area of the carpal tunnel

Risks? Trauma to the muscle from EMG may cause false results on blood tests, including creatine kinase, a muscle biopsy. There may be a small risk of bleeding


NCV :
Usually done with EMG.
Diagnose nerve damage or destruction.
In healthy nerves, electrical signals can travel at up to 120 miles per hour, if the nerve is damaged, the signal would be slower and weaker.
Placing electrodes on the skin above the median nerve to monitor the speed at which an impulse travels along the nerve.
Electrodes, similar to those used for ECG, are placed on the skin over nerves at various locations. Each electrode patch gives off a very mild electrical impulse, which stimulates the nerve.
The nerve's resulting electrical activity is recorded by the other electrodes.
The distance between electrodes and the time it takes for electrical impulses to travel between electrodes are used to determine the speed of the nerve signals.
Electromyography is often done at the same time as this test.

Extra precautions :
Normal body temperature must be maintained (low body temperature slows nerve conduction).


Ultrasound imaging : show impaired movement of the median nerve.


Magnetic resonance imaging (MRI) : shows the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.



CT Scan and X-Ray : To rule out arthritis and other bony conditions.

* Here's a link from Para-Para Sakura, there are pictures, so.. yeah, go ahead and read :) *
Click here.




References :

http://www.neurologychannel.com/carpaltunnel/diagnosis.shtml
http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000433.htm
http://www.mayoclinic.com/print/wrist-pain/DS01003/DSECTION=all&METHOD=print
http://www.nlm.nih.gov/medlineplus/ency/article/003929.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003927.htm
http://orthoinfo.aaos.org/topic.cfm?topic=A00270
http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm