When bending the wrist 90 degree or as much as possible for 30-60 seconds it often reproduces the pins and needles (Phalen’s test). It is positive in the vast majority of patients.
Permanent numbness of the thumb, index or middle finger or weak grip.
Patients should always have Electrophysiological tests (nerve conduction studies) to confirm the diagnosis. These tests check how well the ‘electricity’ goes through the nerve and if the blockage is at the level of the wrist. Pressure on nerves as they leave the spine (radiculopathy) can cause very similar symptoms and an MRI scan of the cervical spine (neck) might be indicated in unclear cases.
In mild and moderate cases a night splint for the wrist can be very useful. Avoiding repetitive hand/ finger movements like using a computer keyboard might also help. If rest is not sufficient, a carpal tunnel injection might be helpful.
Surgery in form of a carpal tunnel decompression is indicated, if conservative treatment has failed or if the compression is severe.