Dr. Ebraheim’s educational animated video describes the condition of carpal tunnel syndrome can the patient selfdiagnose this condition?
Carpal tunnel syndrome is the most common type of nerve compression. It may affect from 110% of the population in some studies. Repetitive motion, vibrations, certain athletic activities and certain conditions can predispose to carpal tunnel syndrome.
Most common associated conditions of carpal tunnel syndrome:
•Diabetes
•Rheumatoid arthritis
•Pregnancy
•Hypothyroidism
•Advanced age
Carpal tunnel syndrome is a clinical diagnosis. In patients who have a clinical diagnosis of carpal tunnel syndrome based on the history and the physical exam, the electrodiagnostic tests did not change the probability of diagnosing this condition.
So the question is….. can you selfdiagnose carpal tunnel syndrome?
These are the most common clinical presentations for carpal tunnel syndrome
Symptoms in median nerve distribution
•Nocturnal numbness
•Thenar atrophy or weakness
•Positive Phalen test
•Positive Tinel sign
•Carpal compression test
Symptoms in the distribution of the median nerve
•Pain and burning sensation
•Numbness and tingling in the thumb, index and middle finger. The small finger should not be affected (patient should not have any symptoms in the small finger). Any symptoms in the small finger are not associated with carpal tunnel syndrome. The little finger sensation is part of the ulnar nerve distribution. Ulnar nerve involvement is not a part of carpal tunnel syndrome.
•Selfadministered hand diagram is extremely helpful (most specific test for carpal tunnel syndrome). The patient should highlight the areas where they are experiencing the symptoms.
Night symptoms
•Night symptoms is considered to be a good prognosis for the effectiveness of treatment.
•The patient will experience numbness, pain and paresthesia that is more prominent when the patient is asleep.
•This will wake the patient from sleep and the patient shakes the hand to try and relieve the symptoms.
Thenar atrophy
•The patient may experience weakness, clumsiness or thenar atrophy.
•Thenar atrophy means that there is a longstanding problem.
•Try to compare the affected hand to the other unaffected hand or even a friend’s hand or the hand of a relative.
Positive Phalen test
•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 the wrist.
Positive Tinel 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 causing radiating paresthesia distally into the median nerve innervated digits is positive of carpal tunnel syndrome.
Positive compression test (Durkan’s test).
•The examiner places even pressure with two thumbs directly over the patients median nerve in the carpal tunnel for about 30 seconds.
•Reproduction of the symptoms such as pain, paresthesia an 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 carpal tunnel syndrome is high.
Although the patient can probably selfdiagnose carpal tunnel syndrome, it is critical for the patient to see their doctor to get a formal accurate diagnosis and to begin treatment. You also see a doctor because other conditions may mimic carpal tunnel syndrome.
The patient may have double crush syndrome. A patient with carpal tunnel syndrome may also have a second problem elsewhere in the course of the median nerve.
Symptoms of cervical disc herniation can also mimic carpal tunnel syndrome. C5C6 is the most common level that is affected in the neck. The affected area in sensation is almost the same like carpal tunnel syndrome, however, the clinical examination by the doctor will show a herniated disc rather than carpal tunnel syndrome.
Proximal median nerve entrapment such as pronator teres syndrome can mimic carpal tunnel syndrome. In case of pronator teres syndrome, the palmar cutaneous branch of the median nerve is also involved. 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.
MartinGruber anastomosis is median to ulnar nerve communication in the proximal forearm. With MartinGruber anastomosis, the patient may present with atypical (not usual) examination findings.
In my opinion, selfdiagnosing carpal tunnel syndrome is possible, but not advisable.

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