Doctor’s Corner: Behind a Carpal Tunnel Syndrome Diagnosis

As many professional jobs become more and more computer-based, disabilities that involve nerve, muscle or tendon damage in the hands have become a major issue.  These conditions prevent people from typing reports, replying to e-mails, and completing the day-to-day tasks of their jobs.  These conditions can range from work modifications to a short-term disability, simply requiring a short period of rest away from the office and the stresses of work, to a total and permanent disability.  One common condition causing such disability claims is carpal tunnel syndrome (CTS).  In today’s blog, I am going to walk through the information many doctors will look for and use in writing a report for your disability insurance company.  Even if you aren’t suffering from carpal tunnel syndrome, this article can be useful to show the steps an examiner follows when diagnosing your condition.

Around 1 in 20 U.S. workers will experience carpal tunnel syndrome during their working lives, with women being diagnosed at 3 times the rate of men.  CTS is the result of tendons and ligaments in the wrist compressing the median nerve in your hand, which provides control and sensation to the thumb, middle, index, and part of the ring fingers.  As the nerve is pinched and compressed, it can cause serious pain and numbness in the fingers along with serious hand weakness that renders the hand nearly useless.  If left untreated (and sometimes even with treatment), the pain can spread to the arms, shoulders, and neck.  In fact, continued non-treatment of CTS can cause noticeable tingling across your body and deterioration of the muscles across the bottom of your thumb.

There are few definite risk factors for CTS.  There is limited and somewhat contradictory clinical data to show repetitive hand and wrist movements cause the disease, so no single ergonomic factor has been directly identified to cause the condition.  Contrary to carpal tunnel syndromepopular belief, typing or writing for long periods of time are not necessarily considered triggers for carpal tunnel syndrome.  However, there are several underlying conditions that may lead to CTS, such as obesity, tuberculosis, rheumatoid arthritis, diabetes, renal failure, and injuries involving the elbow.  Trauma that affects the median nerve passageway is also a cause of many cases of CTS.  The lack of definite, proven causal factors makes diagnostic testing the most common objective medical evidence of the condition.

Prior to diagnostic testing though, a physician will go through a physical examination to look for a few different red flags.  Tapping on the wrist near the median nerve can replicate the tingling sensation many sufferers report.  Also, sensation may be altered in the affected fingers, but the palm will remain normal.  In severe cases, you may be able to physically see the deterioration of the muscle at the base of the thumb.  Physical testing often doesn’t reveal any abnormalities.  After this initial step is completed, there are a battery of tests that may be conducted to substantiate a diagnosis.

The most useful tests for CTS are often electrodiagnostic nerve tests, of which there are two main types:

  1. Nerve conduction tests use small electric shocks to measure the length of time your nerves take to transmit impulses from Point A to Point B.  The longer the time it takes for your nerves to respond to this test, the more severe the case of CTS.
  2. Electromyography uses a small needle inserted into the muscles in your hand, which then records the electrical impulses.  Cases in which voltage or conduction blocks are recorded indicate nerve damage within the muscle being tested.

These are not the only types of tests for CTS.  Blood tests are done to check for underlying conditions, such as rheumatoid arthritis, diabetes, and thyroid problems.  X-rays are taken to check for bone spurs or other orthopedic conditions that could be causing the symptoms.  In some cases, MRI and ultrasound tests can be used to diagnose the presence of CTS.

After affirming the presence of the condition, it’s important for the doctor to check the treatment history of the patient to make sure they’re receiving what is considered appropriate care and treatment.  Like many conditions, there are both surgical and non-surgical options for the treatment of CTS.  Surgical treatment, called open carpal tunnel release (or trigger release), involves cutting the tendon over the top of the median nerve to relieve the pressure that is causing the pain and numbness in the affected hand.  This surgical treatment is usually only recommended for more severe cases, and the full strength in the hand may not  return for up to 2 years.

carpal tunnel releaseNon-surgical treatments provide many more options and are usually recommended for mild to moderate cases of CTS.   After pinpointing some of the triggers that led to the exacerbation of CTS in the first place, addressing the elimination of those trigger actions is a great place to start.  This may include adding ergonomic supports in the office, using wrist braces to hold your hand steady, anti-inflammatory medications, stretching/strengthening  exercises, and even yoga.  Patients with CTS should also be regularly visiting an occupational therapist, physical therapist, and/or hand therapist.  Recurrence of CTS after a successful treatment plan (either surgical or non-surgical) is rare, and most patients can look forward to a complete recovery.

The cases in which a claimant does not experience a complete recovery or the treatment and recovery period is extended are the disability claims that often draw the most insurance company scrutiny.  Published medical guidelines suggest that non-surgical rehabilitation averages 8 weeks, while surgical rehabilitation has a slightly shorter rehabilitation time of 6 weeks.  This is not to say the condition is completely healed, just that the patient should be able to return to work and regain most use in the affected hand.  If the condition still persists after these time periods, there are several questions a physician may ask, including:

  • If non-surgical methods were used, is the patient now a candidate for carpal tunnel release surgery?
  • If surgical procedures were used, was the synovial membrane inflamed to suggest inflammatory disease rather than CTS, whether idiopathic or not?
  • Does the patient have another condition, such as diabetes or pregnancy, that is affecting recovery?
  • Is the patient prescribed any orthopedic aids and are they being used appropriately?
  • Can the patient perform certain repetitive tasks, such as gripping tools or using a computer?
  • Does the patient’s job allow them to refrain from activities that are triggers or increase symptoms?

Obviously, these aren’t all of the possible questions, but they represent some of the basics a physician will consider when evaluating your condition.  The insurance company goes by tables produced by their underwriters and other assessors that give expected periods of time claimants should be disabled for specific conditions and procedures, so when a claim continues beyond those timelines, red flags are raised in the claim file for the claims examiner to investigate.  New and different approaches and lines of questioning are introduced, including Independent Medical Examinations, as the claims department looks for ulterior motives for the claim along with reasons (or excuses) to delay or deny the disability benefits.

While this blog is focused on carpal tunnel syndrome, there are many conditions that follow the same basic guidelines for claims examiners.  When dealing with various representatives of the insurance company, including attorneys and IME doctors, make sure you’re prepared for their questions, take your time, and be thorough, complete, and honest.  If you’re more comfortable reading and responding in writing, instruct them to do that.  The goal of some disability claims professionals is to try to intimidate you through their language, attitude, and actions, but don’t let this happen by staying composed and understanding how you’re entitled to your disability benefits.

If you have any further questions about the information and documents provided by attending physician’s appointments or any other issues surrounding your disability claim, please fill out the contact form on the right-hand side of this page to obtain a free consultation or call our offices toll-free at (855) 828-4100.

One thought on “Doctor’s Corner: Behind a Carpal Tunnel Syndrome Diagnosis

  1. Pingback: Carpal Tunnel Syndrome | Carpal Tunnel Help

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