Carpal Tunnel Syndrome (CTS), is one of the most commonly misdiagnosed conditions of the hand. As a therapist I can say that almost any client walking through the doors to my clinic with a pain in their hand, that has been seen by their GP, has been diagnosed with CTS. According to a literature review by Genova et al., 2020, CTS cases in the UK stand on roughly 9% – 16%, where as in the US the general population reports 5% of actual CTS. If the number states that 16% is the highest reported occurrence rate, I ask how is it that roughly 90% of cases (if not more) presented in the clinic are diagnosed with CTS?
The answer to that question, unfortunately, is overdiagnosis with no relevant test. If you describe some of the symptoms to your GP, you have “doomed” your fate to a CTS diagnosis, even though, you are most likely to have a range of other conditions that could create some of the symptoms of CTS.
To put things in perspective, a false diagnosis of CTS, would lead to a false treatment plan, and more times than none, an unnecessary surgery to resolve the misdiagnosed injury.
To put things in perspective, a false diagnosis of CTS, would lead to a false treatment plan, and more times than none, an unnecessary surgery to resolve the misdiagnosed injury.
Phalen’s Test is a bit like a reverse prayer, you place your hands together and try to get at least 90 degree flexion with your wrists. A positive test would be if you feel any tingling, burning, pricking or prickling, skin-crawling, itching, “pins and needles” or numbness on, or just underneath, your skin in either your thumb, index finger, middle finger or a combination (Brüske et al., 2002). The most you should hold this position is a minute, if by that time nothing has occurred, that is a negative test. According to the same research, this test is only 85% accurate, which is why, if you do this alone and not in a clinic setting, please be sure to follow up on the Prayer test.
Prayer test, as the name suggests, is putting your hands in a praying position, and extending your wrists as much as you can. This position would apply tension to your Carpal Tunnel, and if positive would produce similar symptoms to Phalen’s Test described above. As with Phalen’s this should not be held for longer then 60 seconds.
If both these tests are positive for you, you are very likely to have CTS, and should definitely continue reading on, to see what you should and shouldn’t do. If only one of these tests was positive, you might have CTS, but should get it checked more thoroughly, by either a therapist that has experience with CTS testing, or a physician that will look at you, and not just diagnose you according to your symptoms.
Do
1. Think back, has anything changed for you just before the pain appeared? Could have been a tool change (if you work with tools), office change (keyboard/mouse moved or completely changed), started a new exercise etc. Once you find what could be a potential cause, either change again if possible, or consult a professional on what you are doing wrong with the equipment so you can start over with less pain.
2. You can use a tennis ball / massage ball (or any other similar type ball you may have) and roll around both inside and outside of your elbow on the forearm. This will reduce the tension your muscles are creating, the same tension that is pushing on your nerve and causing you the CTS.
3. Sink your hands in lukewarm water with Epsom Salts for 10 – 20 minutes. In the warm water, the Epsom Salts will break into Magnesium and Sulfate ions, which are easily absorbed through the skin, and will promote muscle relaxation, reduce inflammation and stress levels (Abdelaziz et al., 2020, Joicy et al., 2021).
4. Immerse your hands in icy waters. If you are a bit more like me, and prefer the cold over warmth, this option might suit you better when compared to the Epsom salts option. Be advised, it is not a very nice sensation, and building up to 10 minutes of immersion might take a few tries. One of the many effects of cold immersion is the narrowing followed by thickening of the blood vessels (Espeland, de Weerd and Mercer, 2022), creating a “forge fan” effect of bringing new blood to the area after clearing it completely. The immersion will also reduce inflammatory processes (Dzintare and Krišāns, 2020).
Don’t
1. Work in painful postures. It will only make things worse.
2. Lose hope, there are many ways to treat CTS that do not involve surgical interference.
As always, I am here for any questions you may have, so please reach out if something was unclear. It is always advisable to go to a professional for specific and proper treatment. That being said, this post is aimed to supply you with tools for self assessment and treatment on a first aid basis. Stay Safe!
References
Abdelaziz, S.H., Abdo Elmetwaly, O.I. and Maged, L.A. (2020). Effect of Using Warm Shower and Warm Water Footbath with and Without Adding Epsom Salt on Fatigue Level in Systemic Lupus Patients. | Indian Journal of Public Health Research & Development | EBSCOhost.
Brüske, J., Bednarski, M., Grzelec, H. and Zyluk, A. (2002). The usefulness of the Phalen test and the Hoffmann-Tinel sign in the diagnosis of carpal tunnel syndrome. Acta Orthopaedica Belgica, 68(2), pp.141–145.
Dzintare, M. and Krišāns, A. (2020). THE EFFECT OF COLD-WATER BATHS ON RECOVERY AFTER ANAEROBIC EXERCISE IN 20-30-YEAR-OLD TRAINED MEN. LASE JOURNAL OF SPORT SCIENCE is a Scientific Journal published two times per year in Sport Science LASE Journal for sport scientists and sport experts/specialists, p.47.
Espeland, D., de Weerd, L. and Mercer, J.B. (2022). Health effects of voluntary exposure to cold water – a continuing subject of debate. International Journal of Circumpolar Health, 81(1). doi:https://doi.org/10.1080/22423982.2022.2111789.
Genova, A., Dix, O., Saefan, A., Thakur, M. and Hassan, A. (2020). Carpal tunnel syndrome: A review of literature. Cureus, 12(3). doi:https://doi.org/10.7759/cureus.7333.
Joicy, M.S., Shetty, G.B., Sujatha, K.J. and Shetty, P., (2021). Effect of Neutral Immersion Bath with Epsom Salt on Hypertensive Individuals. Indian Journal of Integrative Medicine, 1(3), pp.75-79.
Widodo, S.A., Rochman, F., Haryadi, R.D. and K, P.M. (2020). The Diagnostic Accuracy of Phalen Test and Prayer Test in Carpal Tunnel Syndrome. | Indian Journal of Forensic Medicine & Toxicology | EBSCOhost.