Physical Exam for Carpal Tunnel Syndrome

Exam Overview

As part of the physical exam for carpal tunnel symptoms, your doctor will:

• Examine your neck, arms, wrists, and hands, comparing the strength and appearance of both sides.
• Check your thumb for strength and movement by watching you grip or pinch an object.
• Examine other parts of your arm, to check for problems with another nerve in your arm. If your doctor suspects neck-related problems, he or she will also check your neck for possible nerve compression.

One or more of the following tests are commonly used to diagnose carpal tunnel syndrome:

Tinel's sign test

Your doctor taps on the inside of your wrist over the median nerve. If you feel tingling, numbness, "pins and needles," or a mild "electrical shock" sensation in your hand when tapped on the wrist, you may have carpal tunnel syndrome.

Phalen's sign test

You hold your arms out in front of you and then flex your wrists, letting your hands hang down for about 60 seconds. If you feel tingling, numbness, or pain in the fingers within 60 seconds, you may have carpal tunnel syndrome.

Two-point discrimination test

This test is used when severe carpal tunnel syndrome is suspected. It is not very accurate for mild carpal tunnel syndrome. To do the test, your doctor has you close your eyes and then uses small instruments, such as the tips of two opened paper clips, to touch two points (fairly close together) on your hand or finger. Typically, you would feel separate touches if the two points are at least 0.5 cm (0.2 in.) apart. In severe carpal tunnel syndrome, you may not be able to tell the difference between the two touches, so it may feel as though only one place is being touched.