| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have pain, tingling, numbness, or feeling of weakness in the wrist, hand, or fingers? Is pain intermittent, often worsening at night or when individual first gets up in the morning?
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Does individual complain of dropping items more frequently than usual?
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Do fingers feel "locked" at times? Is associated but untreated trigger digit present?
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Does individual have problems pinching or grasping objects?
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Does physical exam reveal changes in sensation along the median nerve in the thumb and first three fingers?
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Does palm appear to be wasting away near the thumb (thenar eminence atrophy) indicating potentially severe neuropathy, or comorbid osteoarthritis of the thumb carpal-metacarpal joint?
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Does individual have Tinel's or Phalen's sign?
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Does the individual have comorbid lateral elbow tendinopathy or ulnar neuropathy at the elbow?
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Does the individual have comorbid shoulder or neck pathology?
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Were nerve conduction studies performed to evaluate the nerve function (distal latency, nerve conduction velocity, electromyography needle testing), and if so, were the results normal or abnormal?
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Was testing for inflammatory disease (sedimentation rate) and thyroid disease (TSH) that might cause or masquerade as CTS performed?
Regarding treatment:
- If conservative methods have failed to relieve symptoms, is individual a candidate for carpal tunnel release?
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If the case is atypical, did an injection of steroids reduce numbness and pain prior to an attempt at surgery?
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Did individual undergo open or endoscopic carpal tunnel release?
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Did individual experience any complications from the surgical procedure itself?
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Did the operation report describe inflammatory synovium suggesting inflammatory disease and not idiopathic CTS was present? If “yes”, was a synovial biopsy done? If the biopsy showed inflammatory cells in the synovium, has the patient been referred to a rheumatologist?
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Does individual continue to experience symptoms even after surgical intervention? If yes, were repeat nerve conduction tests done by the same physician to see if the nerve function improved?
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What further treatment options are being considered?
Regarding prognosis:
- Does pain persist even after 2 months have passed since treatment?
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Does individual perform repetitive tasks such as gripping a tool for prolonged periods of time?
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Can individual refrain from activities that may increase the symptoms for as long as pain or other symptoms persist?
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Until symptoms resolve, should individual be transferred temporarily to a position that does not require repetitive motion?
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Is individual's work station or computer keyboard ergonomically designed to provide support for the hand and wrist?
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Was individual given a splint to provide support for the wrist and hand? If so, is it being used as instructed?
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Does individual have a coexisting condition such as diabetes or pregnancy that may affect recovery?
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Source: Medical Disability Advisor