Carpal Tunnel Syndrome (CTS) is a common condition resulting from the compression of the median nerve as it travels through a narrow passageway in the wrist called the carpal tunnel. This space is formed by wrist bones and a strong ligament, housing the nerve and nine flexor tendons. Increased pressure within this confined space irritates the median nerve, leading to noticeable symptoms. This guide is for preliminary self-screening to identify if your symptoms align with potential median nerve compression, but it is not a substitute for a formal medical diagnosis.
Recognizing the Symptoms
The earliest and most characteristic symptoms of median nerve compression involve sensory changes, specifically paresthesia. You may notice numbness, tingling, or a “pins-and-needles” sensation primarily affecting your thumb, index finger, middle finger, and the thumb-side half of your ring finger. The little finger is typically spared because its sensation is controlled by a different nerve.
These sensations often begin subtly and may be intermittent, frequently worsening at night or upon waking. Many people with CTS report being woken up and needing to shake out their hands to restore feeling. The discomfort can also radiate upward from the wrist, sometimes extending into the forearm or shoulder. As the condition progresses, you may experience reduced strength, leading to clumsiness or difficulty with fine motor tasks. Untreated, chronic pressure can eventually cause the small muscles at the base of the thumb (the thenar muscles) to weaken and shrink.
Performing Self-Screening Tests
Several simple maneuvers used by healthcare providers can be adapted for self-screening to temporarily increase pressure on the median nerve and reproduce symptoms. The Phalen’s Test, or wrist flexion test, involves placing the backs of your hands together with your fingers pointing down and your elbows out. Maintain this position for up to 60 seconds, forcing the wrist into full flexion. If you feel numbness, tingling, or an electric-shock sensation in the median nerve distribution within that minute, it suggests a positive result, indicating nerve irritation.
A similar test, the Reverse Phalen’s Test (or Prayer Sign), involves pressing your palms together with your fingers pointing up, extending your wrists. Keep your hands together and lower them toward your waist while keeping your elbows level with your chest. Holding this position for up to 60 seconds also reduces the space in the carpal tunnel, and a positive result is the reproduction of the same sensory symptoms.
The third common assessment is Tinel’s Sign, which requires lightly tapping over the median nerve at the wrist crease. Hold your hand palm-up in a neutral position, then use a finger from your opposite hand to gently tap the center of your wrist. A positive result is indicated if this tapping causes a sudden, electric-shock-like sensation that travels into the fingers. While these tests are highly suggestive of CTS, they are screening tools and not definitive diagnostic measures.
Identifying Contributing Risk Factors
CTS is rarely caused by a single event and is often the result of several contributing factors. Repetitive or forceful hand and wrist motions, particularly those involving vibration, can aggravate the tendons, leading to inflammation and swelling. Anatomical factors can also predispose individuals, such as a naturally smaller carpal tunnel or a history of wrist fracture or dislocation.
Underlying health conditions increase the risk of developing CTS. Systemic diseases that affect nerve health or cause fluid retention and inflammation include diabetes, which can damage nerves, and thyroid dysfunction, particularly hypothyroidism.
Inflammatory conditions like rheumatoid arthritis can cause the lining around the tendons (synovium) to swell, directly encroaching on the median nerve space. Hormonal changes are another factor, evidenced by the condition’s higher incidence in women and its frequent appearance during pregnancy and menopause due to fluid retention.
Next Steps After Self-Checking
If your self-screening tests consistently reproduce symptoms, consult a healthcare provider for a professional evaluation. A physician will perform a physical examination and may order specific diagnostic tests. The most common confirmation involves electrodiagnostic testing, such as nerve conduction studies and electromyography (EMG), which measure the speed and strength of nerve signals through the wrist.
Initial management focuses on non-surgical treatments. These commonly include wearing a wrist splint, especially at night, to keep the wrist in a neutral position and avoid excessive flexion or extension. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation in the short term.
Making ergonomic adjustments to your workspace, such as modifying your keyboard height and chair position, can also help maintain a neutral wrist posture during prolonged activity. For more persistent symptoms, a physician may recommend a corticosteroid injection directly into the carpal tunnel for localized, temporary relief. Surgery to release the transverse carpal ligament is typically reserved for severe cases where conservative treatments have failed or when there is evidence of muscle wasting.