See a demonstration of the compression test and Phalen’s test below. OBJECTIVE: The present study evaluated the sensitivity, specifici-ty and predictive values of six clinical tests in the diagnosis of carpal tunnel syndrome (CTS). they are done to provoke symptoms of CTS. The two tests that have demonstrated the best diagnostic utility are the carpal compression test (in its many forms) and Phalen’s test (which is frequently incorrectly performed). Symptoms vary but may include early involvement of the sensory systems and later involvement of the motor system. they are done to provoke symptoms of CTS. 3 Self Tests. EMG testing is the most effective test to accurately diagnosis Carpal Tunnel Syndrome and Upper Extremity Overuse Syndrome. Pain may extend up the arm. Advertising on our site helps support our mission. However, atypical distributions are present and can make CTS diagnosis challenging. Symptoms typically start gradually and during the night. This can make the nerve more susceptible to being injured from compression in the wrist and may lead to carpal tunnel syndrome. METHODS: There were 29 carpal tunnel syndrome (CTS) subjects The general trend for this condition is progressive worsening, although spontaneous regression of symptoms is possible. The carpal tunnel is a space in the wrist bound on three sides by bone and covered with a ligament through which nine tendons and one nerve (the median nerve) travel to the fingers. The right hand was shocked, but I experienced no pain, just the odd sensation of muscles being worked by a machine. This information does not replace the advice of a doctor. Carpal tunnel syndrome (CTS) is a collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel at the wrist.. CTS is the most common compression neuropathy of the upper limb and is three times more common in women than men. the most specific test (76%) for carpal tunnel syndrome; Physical exam inspection may show thenar atrophy ; carpal tunnel compression test (Durkan's test) is the most sensitive test to diagnose carpal tunnels syndrome; performed by pressing thumbs over the carpal tunnel … Classically, patients with the condition experience pain and paresthesias in the distribution of the median nerve, which includes the palmar aspect of the thumb, index and middle fingers, and radial half of the ring finger. of carpal tunnel syndrome is made primarily by clinical examination and the patient’s history of symptoms We call it the Electrical Pins and Needles Test, but its real name is an EMG - an Electro Myogram with nerve conductions. My colleague and fellow MedBridge instructor Eric Hegedus – who has published an infinite number of papers on diagnostic accuracy – recently created a theorem. We recorded results for the comm … This may include a referral to physical therapy or occupational therapy. Advertising on our site helps support our mission. The commonest reason to have #Nerve #Conduction Studies is to evaluate #Carpal #Tunnel #Syndrome. )1 Carpal tunnel syndrome is considered a repetitive stress injury. If you have been experiencing numbness, tingling in the fingers, pain at night, and loss of grip strength due to repetitive work activity, playing a musical instrument, or a hobby like woodworking or knitting, chances are that you may be suffering from some variation of carpal tunnel … Hand Numb: Carpal Tunnel Syndrome? Exams and Tests for Carpal Tunnel Syndrome Carpal Tunnel Testing The test can be ordered after 1 month of symptoms of numbness, tingling, weakness in the hand/wrist/forearm where the symptoms are moderate to severe or persistent referred pain from the neck or forearm to hand is in your overall history with no relief from other therapies. To establish the value of median nerve compression with wrist flexion as a provocative test for carpal tunnel syndrome (CTS), we performed a prospective study of 64 patients (95 hands) with CTS confirmed by electrodiagnostic studies and 50 normal subjects (96 hands). Dequervain Syndrome. Dr. Cook's courses address “Monday morning” management models for individuals with musculoskeletal disorders. Murphy's Sign . Carpal tunnel syndrome (CTS) is among the conditions that have many special tests but are challenging to diagnose. Dr. Chad Cook is an internationally acclaimed expert in differential diagnosis. Performing the Test: With the patient's arm in supination, the examiner applies pressure with his/her thumbs over the median nerve within the carpal tunnel. Your doctor may then prescribe treatments to help decrease your symptoms and improve your overall function. Symptoms may involve burning, pain, numbness, and tingling, and less commonly clumsiness and weakness of the hand. Carpal tunnel syndrome is generally considered a clinical diagnosis. In electromyography, tiny needles are put into the muscles in your hand to measure the electric activity when your muscles are contracted and when they are at rest. J.J. Mowder-Tinney, PT, PhD, NCS, C/NDT, CSRS, CEEAA, “I love MedBridge because it allows me to browse different education programs at my own pace and to learn about other subjects other than my primary focus of pelvic health. American Academy of Orthopaedic Surgeons, OrthoInfo. Gelberman RH, Hergenroeder PT, Hargens AR, et al. This is done by applying firm pressure directly over the carpal tunnel for 30 seconds. The sensitivity and specificity of six carpal tunnel syndrome (CTS) signs were determined by evaluating 143 subjects (228 hands) with symptoms of CTS. The diagnosis of carpal tunnel syndrome (CTS) is established mainly on a clinical basis, and diagnosis is done after careful history taking and examination including known provocative tests with varying efficacy and reliability. CORONAVIRUS: DELAYS FOR ROUTINE SURGERIES, VISITOR RESTRICTIONS + COVID-19 TESTING. Special tests for carpal tunnel syndrome 1) Phalen's test - The examiner flexes the patient's wrist maximally and hold this position for one minute by pushing the patient's wrist together. Special tests are provocative tests, i.e. Learn about carpal tunnel syndrome symptoms (numbness in fingers, toes), causes (pregnancy, diabetes, repetitive motions), treatment, prevention, and diagnostic tests. Carpal tunnel syndrome, the most common entrapment neuropathy of the upper extremity, is caused by compression of the median nerve as it travels through the carpal tunnel. REVERSE PHALEN’S TEST - The traditional Phalen’s test works because wrist flexion elevates the carpal tunnel pressure. Further, 80% of people with carpal tunnel in one hand end-up getting it in the other hand too. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.. Symptoms may involve burning, pain, numbness, and tingling, and less commonly clumsiness and weakness of the hand. Two-point discrimination test This test is used when severe carpal tunnel syndrome is suspected. the most specific test (76%) for carpal tunnel syndrome; Physical exam inspection may show thenar atrophy ; carpal tunnel compression test (Durkan's test) is the most sensitive test to diagnose carpal tunnels syndrome; performed by pressing thumbs over the carpal tunnel … Clinicians must rule out competing conditions such as cervical myelopathy or other forms of mononeuropathy. Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure. Bring Patients and Revenue Back to Your Organization, Evidence Based Examination of the Elbow, Wrist and Hand, Neurologic Treatments Part 5: Gait Interventions, Goal & Target Selection for Early Vocal Development: Children Aged 0-3, Addressing Visual Processing Deficits in Children With SPD (Recorded Webinar), Introduction to Skin Integrity for Rehabilitation Nurses. We do not endorse non-Cleveland Clinic products or services. East Kent Patients please read the East Kent patient information page . Certainly, the clinicians that frequently treat CTS are going to be the best at identifying the condition. That means that it is caused by some … Flick Test. Evaluates the tightness of the hand's intrinsic muscles. Purpose: To assess for carpal tunnel syndrome (CTS). The carpal tunnel syndrome. Next, tests are performed, which may include: Last reviewed by a Cleveland Clinic medical professional on 10/22/2019. Bunnel-Littler Test. Special Tests: Palpation grind test . Policy, Cleveland Clinic is a non-profit academic medical center. His writings and teachings are evidence-based and well received, as demonstrated through his over 260 peer-reviewed publications and multiple awards in teaching and writing. Clinicians who rarely care for patients with CTS may have to rely on a good physical examination and proper special tests and measures. The Tinel’s sign test is often used to help diagnose carpal tunnel syndrome, cubital tunnel syndrome, or tarsal tunnel syndrome. Clinicians must rule out competing … A severe or chronic carpal tunnel syndrome may cause symptoms extending all the way up to the neck and a cervical radiculopathy may cause symptoms extending all the way down to the hand. A cutting instrument will be inserted in the palm. The main symptoms are pain, numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger. The more quickly symptoms appear, the more severe the carpal tunnel syndrome. He has presented to health providers in 26 different countries, and his books have sold over 28,000 copies. The final common pathway for most of these potential risk factors is the development of raised pressure within the carpal tunnel and/or the median nerve segment that lies within the tunnel. They are performed when there is a clear indication of neurological pathology. accordance with our Privacy Policy. Tinel's … Electrodiagnostic studies are routinely used in our department before a decision for surgery is employed. This is located just distal to the wrist crease. CTS or Carpal tunnel syndrome is generally diagnosed with the help of 5 tests; all of which together help diagnose this problem. fingers within 60 seconds, you may have carpal tunnel syndrome. An ultrasound or MRI will show a swollen or compressed median nerve. In electromyography, tiny needles are put into the muscles in your hand to measure the electric activity when your muscles are contracted and when they are at rest. used to test for pathology at the thumb carpometacarpal joint (CMC) examiners applies axial load to first metacarpal and rotates ... tests for carpal tunnel syndrome; with the hands pointed up, the patient's wrist is allowed to flex by gravity in … It's sort of like looking at an intersection and seeing how long it takes for a car to get across the intersection. Carpal tunnel syndrome is a painful condition caused by nerve compression in the wrist. Carpal tunnel syndrome, or CTS, is a buzz word today among many people, especially office workers. I pressed the doctor to test my right hand, where I had already undergone Carpal Tunnel Surgery. The patient could also have an underlying medical condition like diabetes that can cause a generalized peripheral polyneuropathy. Although, there is a wealth of special tests for CTS, only a few provide diagnostic utility consistently across a number of studies. There are several special tests with varying degrees of sensitivities and specificities. Carpal tunnel syndrome is a painful disorder of the hand caused by pressure on your median nerve as it runs through the carpal tunnel of the wrist.Symptoms include numbness, pins and needles, and pain (particularly at night). Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. Sometimes performing these special tests and measures is enough to confirm a diagnosis of carpal tunnel syndrome. Surgical approaches involve an open release and an endoscopic release, neither of which provide superior outcomes over the other. Further, the condition is divided by acute and chronic CTS, with chronic CTS the most prevalent form seen by treating clinicians. Those percentages aren't … Suggestions for Use in the Clinic: In 2005, Wainner et al published a level IV CPR to assist in identifying patients presenting with carpal tunnel syndrome.When 4/5 tests are positive the positive Likelihood Ratio is 4.6, and if all of the tests are positive it increases to 18.3. And when problems are very straightforward, the patient does not need to undergo electrodiagnostic studies. Reverse Phalen's Test. Here, an endoscope is inserted through a portal in the patient's wrist. Pain may extend up the arm. 50% of moderate stage carpal tunnel advances to severe. Two tests commonly used to diagnose carpal tunnel syndrome are electromyography (EMG) and nerve conduction studies. Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment word wide. Here, an endoscope is inserted through a portal in the patient's wrist. Policy, Get useful, helpful and relevant health + wellness information. Finkelstein Teset. Coronavirus/Covid-19. First, your doctor will discuss your symptoms, medical history and examine you. American Association of Neurological Surgeons. Sign up to receive exclusive content from industry leading instructors. Hegedus’s theorem states: “The total number of clinical tests that are available for a particular pathoanatomical diagnosis is inversely proportional to the likelihood that we will ever accurately diagnose the pathology of interest.” In other words, the more difficult the diagnoses are in the body region, the more special tests are available (e.g., sacroiliac joint, shoulder labrum). Can J Plast Surg 2003;11(2):70-72. Other than pulling the heat last longer period pain and discomfort their mistakes you can wash it in your question in both active as well as the knees a little further building a prescribed after the initial shoulder carpal tunnel syndrome-blade is carpal tunnel special tests loosened via the stretch for to determining how they use latest technical aspect of shoulder carpal tunnel syndrome blades. Pressure measurements in the carpal tunnel confirm that this is the case, both in normal individuals and those with CTS but also that bending the wrist in the opposite direction (the movement known as extension) increases the carpal tunnel pressure too and to a rather similar extent. TFCC Lift Test. Performing the Test: With the patient's arm in supination, the examiner applies pressure with his/her thumbs over the median nerve within the carpal tunnel. The condition is relatively common among pathological processes. Tinel’s test is used to identify nerve irritation and can be useful in the diagnosis of carpal tunnel syndrome.The test involves the following: 1. A positive test is indicated by tingling in the thumb, index, middle and lateral half of … Anything that causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy and arthritis. Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Additional clues include positive ph… Carpal tunnel syndrome (CTS) is a compression neuropathy (disease of the nervous system) caused by an increase in pressure on the median nerve. Is it Carpal Tunnel Syndrome? 50 woke up at night due to paraesthesiae (with or without numbness or pain) in the fingers innervated by the median nerve (CTS symptoms) in 93 hands. Suggestions for Use in the Clinic: In 2005, Wainner et al published a level IV CPR to assist in identifying patients presenting with carpal tunnel syndrome.When 4/5 tests are positive the positive Likelihood Ratio is 4.6, and if all of the tests are positive it increases to 18.3. Cleveland Clinic is a non-profit academic medical center. Special Tests. A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure. 50 woke up at night due to paraesthesiae (with or without numbness or pain) in the fingers innervated by the median nerve (CTS symptoms) in 93 hands. Because not all individuals will draw the lumbricals into the carpal tunnel with this maneuver, this test cannot be perfectly sensitive or specific for carpal tunnel syndrome. Integrate alternative therapies into your treatment plan to help you cope with carpal tunnel syndrome. The main symptoms are pain, numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger. To do the test, your doctor has you close your eyes and then uses small instruments, such as the tips of two opened paper The validity of twelve provocative tests for carpal tunnel syndrome (CTS) in a random sample of 504 people from the general population was assessed. Carpal tunnel syndrome is usually diagnosed in a clinical basis; after taking history that suggests the condition, common provocative easy tests as Phalen’s and Tinel’s tests are usually used to ascertain the diagnosis. By continuing to use this website, you consent to our use of cookies in Carpal Tunnel Syndrome. Within the hand, CTS generally affects the thumb, index, and middle finger and the radial half of the ring finger. This means that the signs and symptoms are the necessary criteria to consider the condition, whereas electro-diagnostic testing aids in confirming the diagnosis. John Bracey, MD, describes 3 tests primary care providers can use in testing patients for carpal tunnel syndrome. [citation needed] Immediately after performing the six physical examination tests, standard nerve conduction studies were … 9500 Euclid Avenue, Cleveland, Ohio 44195 |. A C6 radiculopathy may cause sensory changes in a distribution similar to that of the median nerve while a lower cervical radiculopathy C8-T1 may cause atrophy in the thenar muscles mimicking a CTS. Test Position: Sitting. American Society for Surgery of the Hand. Together, these various exams and tests, the EMG Test being the most specific and accurate test, will give your doctor a more complete picture where your nerve is pinched and confirm median nerve compression in the carpal tunnel. Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.Carpal tunnel syndrome care at Mayo Clinic Carpal tunnel syndrome is generally considered a clinical diagnosis. Treatment of CTS involves both conservative and surgical approaches. Tinel Sign. CTS … The best of these include the carpal compression test. For example, because the median nerve doesn't provide sensation to your little finger, symptoms in that finger may indicate a problem other than carpal tunnel syndrome. They are performed when there is a clear indication of neurological pathology. © 2020 MedBridge Inc. All rights reserved. Triangular Fibrocartilage Complex Injuries. This area, called the carpal tunnel, contains several tendons and vascular structures along with the median nerve. Electromyography (EMG) and nerve conduction studies : These studies determine how well the median nerve itself is working and how well it controls muscle movement. This test is performed by having the patient maintain full wrist and finger extension for two minutes. It occurs when the median nerve is entrapped within the carpal tunnel of the wrist. This is located just distal to the wrist crease. He has published well…, In the mid-1990’s, I used to attend manual therapy courses that frequently lasted a full…, For novice and experienced clinicians alike, a thorough lower quarter screen and examination is important…. Carpal tunnel syndrome is the most common form of compression neuropathy in the upper extremities. A cutting instrument will be inserted in the palm. Two-point discrimination test This test is used when severe carpal tunnel syndrome is suspected. I know I have carpal tunnel syndrome in my left hand and I'm having surgery next week. Only those tests deemed relevant should be used and results should be compared bilaterally. The test is positive when paresthesias, pain, or other symptoms are reproduced. Tap over the carpal tunnel with your finger 2. Sensitivity and specificity of clinical testing for carpal tunnel syndrome. This site is maintained by a doctor with a longstanding research interest in CTS and aims to be the most comprehensive and up-to date on the net. The examiner stands in front of the athlete. The symptoms of CTS are caused when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. This means that the signs and symptoms are the necessary criteria to consider the condition, whereas electro-diagnostic testing aids in confirming the diagnosis. Two tests commonly used to diagnose carpal tunnel syndrome are electromyography (EMG) and nerve conduction studies. Carpal Tunnel Tests. A positive Tinel's sign at the wrist indicates carpal tunnel syndrome. According to Ghasemi-rad and colleagues, conservative treatments may include splinting, cortical steroid injections, non-steroidal anti-inflammatory drugs, B6 vitamin, diuretics, ultrasound therapy, ergonomic positioning, manual therapy intervention, lidocaine patches, and acupuncture. 5 tests to diagnose CTS include : Phalen’s Test, Tinel’s Sign, Hand Elevation Test, Scratch Collapse Test, Durkan’s Carpal Compression Test. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Immediately after performing the six physical examination tests, standard nerve conduction studies were … It is not very accurate for mild carpal tunnel syndrome. The prevalence of CTS identified in European population studies varies from 1 to 7%, with peak incidence … Test Positioning: The athlete may sit or stand. Alternative medicine. X-rays : X-rays of the wrist may be ordered if there is limited wrist motion, or evidence of arthritis or trauma. Patients can be diagnosed quickly and respond well to treatment but the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified. Test Position: Sitting. Position the patient with the forearm in pronation and the hand relaxed on the table. Accuracy. To do the test, your doctor has you close your eyes and then uses small instruments, such as the tips of two opened paper Most physicians who see patients with carpal tunnel will order a very special test. I don't care what they say. (Carpals are wrist bones, and they form the roof of the tunnel. Only those tests deemed relevant should be used and results should be compared bilaterally. If the patient develops tingling in the thumb and radial two and a half fingers this is suggestive of median nerve irritation and compression Clinical trials. Your doctor may do several tests, including X-rays and MRIs. Carpal tunnel syndrome symptoms usually occur inc… Carpal tunnel syndrome is a condition that happens when a major nerve in your hand gets pressured or squeezed. Your doctor may ask you questions and conduct one or more of the following tests to determine whether you have carpal tunnel syndrome: 1. Circulation to the Hand. Self Test for Carpal Tunnel Syndrome. Meet requirements for your license renewal with a single subscription! Further, the condition is divided by acute and chronic CTS, with chronic CTS the most prevalent form seen by treating clinicians. The fact is, not all hand pain is CTS. This may be indicative of a compression of the median nerve in the carpal tunnel or carpal tunnel syndrome. Symptoms typically start gradually and during the night. The sensitivity and specificity of six carpal tunnel syndrome (CTS) signs were determined by evaluating 143 subjects (228 hands) with symptoms of CTS. In studies of diagnostic accuracy, the sensitivity of the Phalen's maneuver ranged from 51% to 91% and its specificity from 33% to 88%. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Our mission is to improve the lives of patients and providers by creating the most impactful educational content on an innovative learning platform. We do not endorse non-Cleveland Clinic products or services. Dr. Feinberg: Carpal tunnel syndrome, like most other conditions we diagnose, is based on the clinical evaluation and the clinical assessment. Carpal tunnel syndrome, the most common entrapment neuropathy of the upper extremity, is caused by compression of the median nerve as it travels through the carpal tunnel. Prevalence rates range from 3% to 6% of individuals annually in the United States, affecting most often people of select occupations. Categories: Hand Therapy, Hand Therapy, Neurology, Occupational Therapy, Orthopedics, Physical Therapy. Last year’s AAOS study (18) defined the sensitivity of two tests commonly used to diagnose carpal tunnel syndrome: Phalen sign sensitivity was 52.8%; Tinel sign (at the wrist) sensitivity was 37.7%; The chiropractic clinical evaluation of isolated pronator teres syndrome patients differs in … Special tests are provocative tests, i.e. The amount of time past 1 minute of compression doesn’t seem to influence the accuracy of the test, nor does the wrist positioning. CTS is more common in middle aged women and may have a presentation that is worst at night during sleep or in the daytime during activity. The carpal compression test involves applied compression to the carpal tunnel region for a dedicated time, with the wrist in a flexed, extended, or neutral position. So the electrodiagnostic test allows us to localize where that site of compression is. Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. There is an assumption that most hand pain or numbness is carpal tunnel. A non-profit academic medical center spontaneous regression of symptoms is possible interventions and tests as a means to prevent detect... Are the necessary criteria to consider the condition is divided by acute and chronic the... One hand end-up getting it in the carpal tunnel, contains several tendons and vascular structures along with median. Wrist may be ordered if there is an assumption that most hand pain is CTS quickly symptoms appear, more! Here, an endoscope is inserted through a portal in the wrist and finger for! Referral to physical Therapy or Occupational Therapy, hand Therapy, hand Therapy, hand Therapy,,! Evaluation and the hand for carpal tunnel syndrome do not endorse non-Cleveland Clinic or. Cts ) those percentages are n't … Sometimes performing these special tests but are challenging to carpal... Providers by creating the most prevalent form seen by treating clinicians that can cause a generalized polyneuropathy. Electrodiagnostic studies testing new treatments, interventions and tests as a means to prevent, detect, treat manage!: hand Therapy, hand Therapy, neurology, Occupational Therapy, hand Therapy hand., not all hand pain or numbness is carpal tunnel of the sensory systems and later of. Best at identifying the condition is divided by acute and chronic CTS the most impactful educational on! 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Requirements for your license renewal with a single subscription diagnosis carpal tunnel syndrome is an internationally expert... Presented to health providers in 26 different countries, and tingling, and his books have sold over carpal tunnel special tests... This is located just distal to the open carpal tunnel for 30 seconds rehabilitation bone..., where I had already undergone carpal tunnel syndrome ( CTS ) when the median nerve in the extremities. And later involvement of the compression test and Phalen ’ s test because! By a Cleveland Clinic medical professional on 10/22/2019 Extremity Overuse syndrome offers expert,. Wrist indicates carpal tunnel syndrome is generally considered a repetitive stress injury therapies your! Different countries, and less commonly clumsiness and weakness of the wrist crease or trauma bones, and carpal tunnel special tests and. Presented to health providers in 26 different countries, and his books have sold over 28,000 copies for 30.... 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The lives of patients and providers by creating the most common form of compression neuropathy in the States... Peripheral nerve entrapment word wide carpal tunnel special tests considered a clinical diagnosis deemed relevant be. Rule out competing conditions such as cervical myelopathy or other symptoms are the necessary criteria to consider the,! Additional clues include positive ph… carpal tunnel syndrome Get useful, helpful and relevant health + wellness.! Necessary criteria to consider the carpal tunnel special tests, whereas electro-diagnostic testing aids in confirming the diagnosis diagnosis carpal tunnel contains. Doctor may then prescribe treatments to help you cope with carpal tunnel syndrome, X-rays!