Florida trial lawyer and doctor of chiropractic medicine, Guy S. DiMartino, explains how an injured client's doctor will diagnose carpal tunnel syndrome after an accident.
You've been involved in a car, motorcycle, truck accident where your wrist was jammed against the steering wheel, dash board or console. You don't think much of it because you are dealing with your neck or back pain. A couple of weeks after the incident, you begin to notice any one of the following symptoms:
- Tingling in your wrist or fingers
- Your hand is falling asleep
- Pain or numbness in your hand wakes up at night
- You're losing strength in your hand
- You're dropping things
Do you have carpal tunnel syndrome? If so, how will your doctor diagnose the condition?
Your doctor will probably follow a three step path to diagnose carpal tunnel syndrome:
- Physical exam
- Diagnostic testing
The most important part of the process will be on the injured person. It is very important to provide a detailed and accurate history of the accident and your complaints. It is best to write the information down before you get into the doctor's office so you don't get flustered or feel rushed during the office visit.
All healthcare providers learn in school that that 90% of a diagnosis comes from the history component of the doctor's visit. Based on the information the patient provides the doctor, the doctor will come up with a differential diagnosis and then do an exam and tests to confirm or exclude the different diagnoses.
You need to provide your doctor with the following during your visit:
- A history of the event – how were you hurt? (i.e. “I jammed my wrist on the steering wheel”)
- Your complaints
- Length of time that you have had the complaints
- Activities that make your complaints worse
- Activities that make your complaints better
- Have you done anything for your complaints? Did it help?
- Once the doctor has this information he/she will perform an exam on the wrist and hand.
When examining your wrist and hand, the doctor will do the following:
- Look at the area to see if there are any changes in the skin, temperature or atrophy (shrinking) of the muscles
- Palpate the area – feel the area for muscle spasm, tenderness, atrophy of the muscles
- Neurologic exam that may include checking your reflexes, and the ability to perceive pain and light touch
- Tinel's sign – is a test where the doctor will use a reflex hammer or finger and tap along the carpal tunnel to see if he/she can reproduce your symptoms.
Once the physical examination is done your doctor may order a number of tests to confirm the diagnosis. These tests can include:
- NCV – nerve conduction velocity- is an electrodiagnostic nerve test that looks at the sensory component (the ability to feel) of the nerves in the wrist and hand.
- EMG – electromyography – is an electrodiagnostic nerve test that looks at the motor component (ability to fire muscles) of the nerves in the wrist and hand.
- MRI – magnetic resonance imaging – is an imaging study that can look at the structures of the wrist and hand including the carpal tunnel.
- Lab tests – sometimes underlying medical conditions such as diabetes or hypothyroidism can cause similar symptoms as carpal tunnel syndrome so your doctor may order blood tests to confirm or exclude these conditions.
As you can see, the diagnosis of carpal tunnel syndrome can be complex and requires a number of steps. The most important step is providing your doctor with a complete and accurate history so he/she can do the appropriate testing to diagnose the condition. Without a proper diagnosis, the carpal tunnel syndrome patient will not get proper treatment.
If you believe that your carpal tunnel syndrome is because of an accident or injury, give me a call at (352) 267-9168 or fill out the internet consultation form on the right hand side of the screen.