How we can help diagnose Carpal Tunnel Syndrome

The carpal tunnel is the space between a group of eight small bones in the wrist joint, and the ligament that links them to the lower neck. Carpal Tunnel Syndrome (CTS) is a medical condition which compresses the median nerve as it travels through the wrist at the carpal tunnel. The median nerve starts at C5 to T1 (the middle lower part of your neck), and travels down the front of the elbow, and into your hand. The nerve gives feeling to parts of your hand. Symptoms materialise as pain, numbness, and tingling in the thumb, index finger, middle finger, and the thumb side of the ring fingers. Due to this, sufferers tend to lose grip strength and if the problem persists, muscles at the base of the thumb may begin to waste away. 

Chances of suffering from CTS increase with obesity, repetitive wrist work, pregnancy, and arthritis. Diabetes has also been shown to have a weak correlation with CTS. There are some things you can do at home to help with CTS. But how can you know if you have CTS?

It has been suggested that there are exercises you can do at home to trigger the median nerve to exaggerate the symptoms. By placing our hands together as if one were praying, and ensure our forearms to our elbows are in a horizontal line, people suffering from CTS are said to feel their symptoms exaggerate. However, this is not a full diagnostic – and will not suffice to tell you if you are suffering from CTS.

We offer full a diagnostic test. An electrodiagnostic supplies us with objective evidence that will tell us if you are suffering from CTS or another medical condition. This helps rule out other medical conditions that mimic the symptoms of CTS, such as cervical radiculopathy.

The symptoms of CTS are equivalent in many ways to cervical radiculopathy (a neurological condition characterized by dysfunction of cervical spinal cords). With home tests, it is easy to conflate the two. Both issues result in numbness pain and weakness in the hand. With an electromyography, physicians can identify not only if you are suffering from CTS, but also – exactly where along the median nerve the problem lies. The root of the problem could be proximal to your lower neck, the median nerve itself, or the three fingers. Our diagnosis will precisely pinpoint the genesis of the condition.

The electrodiagnostic also identifies if patients are suffering from what is called double crush syndrome, where patients suffer from both CTS and cervical radiculopathy – which is increasingly common.

It is important that if you are experiencing the symptoms, you contact us immediately to discuss options. CTS is most easily treatable in the early days, the longer it is left, the higher chance of irreparable damage being caused. Get an accurate diagnosis.  

Mount Sinai specialize in CTS and pain management. If you experience any of the symptoms listed, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 659-8551 or (212) 590-3300

Introducing Parag Sheth

Introducing Parag Sheth – Mount Sinai’s Carpal Syndrome Tunnel Expert

This month, with our continued aim of ensuring our patients know and trust our physicians, Mount Sinai presents to you our long-standing Assistant Professor of rehabilitation medicine, Dr Parag Sheth. Dr Sheth holds a certification in Physical Medicine and Rehabilitation; his specialisation lies in Carpal Tunnel Syndrome (CTS).

Dr Sheth’s expertise is grounded in his rich and varied academic career. Beginning his studies receiving honors at Johns Hopkins University, Dr Sheth moved on to study at Stony Brook School of Medicine, and subsequently held the position of Chief Resident at St. Vincent’s Medical Center’s Rehabilitation Residency Program. Dr Sheth is now a fellow of The Mayo Clinic, where he specialised in Musculoskeletal Rehabilitation; and he has been with us at Mount Sinai for over 20 years. During his time practicing with us, Dr Sheth has always gone beyond the call-of-duty to ensure patient satisfaction.

CTS, Dr Sheth’s specialization, manifest itself as a tingling, numbness and sometimes pain in the hand and fingers. This is caused by a compression of the median nerve, which controls sensation and movement in the hand. It can sometimes be hard to identify as the symptoms are common and often go unchecked. Dr Sheth is renowned for his ability to exercise expert judgement on patient’s symptoms, but always communicates in way understandable to the patient; we believe this to be paramount to a patient’s happiness. Dr Sheth has often been praised for his ability to listen carefully, and explain the process of treatment and aftercare in a concise and easy to follow way; this has made him a patient favorite. 

His clinical focus also extends to: back pain, electrodiagnostic testing, epidural steroid injections, herniated disk, knee pain, low back pain, shoulder pain, neck pain, and spine stimulation.

Outside of his professional career with us, Dr Sheth also teaches a yearly cadaveric dissection and weekly musculoskeletal lectures where he has been awarded the Avital Fast Award and the Department Teacher of the Year award. His research has been published in Nature, Lancet, and The American Journal of Sports Medicine. 

Dr Sheth is “Board Certified” and accepts insurance plans. For more details on appointment availabilities and plan coverages, please contact our call center at: (212) 241-6321.

What Causes Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is the compression – and sometimes squashing – of the median nerve that passes through the wrist. Its symptoms can include numbness, tingling and pain in the thumbs, fingers and wrists, which can travel as far as to the arms and even to the shoulder. Modern medicine has a firm grip on what CTS is; what causes it is quite a different story.

Diagnosing CTS can be done through a relatively simple physical examination. One test is called the ‘flick signal’, for which the patient is asked, ‘what do you do when your symptoms are worse?’ If the patient responds with a hand movement that resembles the shaking of a thermometer, there is good reason to suspect CTS. There are plenty of other tests such as Phalen’s Test and Tinel’s Sign – yet, despite the relative wealth of ways to diagnose CTS, there actually isn’t any kind of test to identify the precise cause CTS, and – except for patients suffering from underlying diseases – the biological mechanisms that create this inflammatory disorder remain unknown. 

It is a common story that CTS is caused through repetitive and often high-stress tasks that involve the wrists and hands – typing, using a computer mouse, manual labour to even playing the piano. While the correlation between CTS and tasks of this nature is undoubted, there is minimal evidence to suggest any clear causality.

In fact, most studies today indicate that CTS’ causes go above and beyond mere so-called ‘workplace factors’ and that they are rather linked to ailments that cause swelling in the wrist (osteoarthritis and rheumatoid arthritis) and others that obstruct blood flow (hypothyroidism and diabetes). We also see CTS pop up in clusters within a family, which suggests that something genetic is at play. Lifestyle also appears to play a significant factor, as those who smoke, drink alcohol excessively, consume excessive salt and who are obese all show increased risk of developing CTS. Women are also three times more likely to develop CTS than men, particularly after childbirth and during menopause.

Despite the range of medical, physical, genetic and life-style related items that are linked to an increased risk in developing CTS, their relationship is that of a correlation and not one of cause and effect. A modicum of clarity might be achieved, however, by overlapping both ends of the spectrum – the ‘workplace effect’ with medical/genetic/lifestyle factors. When somebody is susceptible to CTS – whether it be through genetics, a medical condition or an unhealthy or stressful lifestyle – and they also subject their hands and wrist to frequent, repetitive task, the likelihood of suffering from CTS will be at its greatest.

If you believe you are at risk of developing CTS, we would like to encourage you to seek medical advice on how to prevent it; if you believe you might already be suffering from it, we suggest you speak to one of our specialists for a suitable treatment. The earlier CTS is treated, the more likely – and easier – a full recovery will become.