Symptom Survey

Dr. Roger S. Rahn’s Carpal Tunnel / Hand Pain Symptom Survey
Copyright 2004 Rahn & Rahn
Use this tool to help determine if arm or hand pain comes from the neck, shoulder and/or wrist. This is not a substitution for an evaluation and diagnosis by a qualified healthcare provider. Disclaimer

If you answer yes to any of these questions, add the following points to your score:
Does the pain seem to come from the neck (the center or midline where the spine is)?	+10 points
Is the pain aggravated, or does the pain occur, when you move your head (turning to the side, or bending forward, or moving your ear towards the shoulder while looking straight ahead)? This pain may be from muscle spasm.	+5 points
If someone else pushes gently on the top of your head, while you are sitting, does the pain become sharp & shoot out from the middle of the neck to the shoulder or arm?	+ 15 points
Have someone gently massage the tops of shoulders (while you are laying on your back). Does this reproduce your pain?	-2 points
Add up your points

If you scored:

20 points or more, it is likely that you have a neck (spine) problem (usually pressure on a nerve root or a disc problem). This score warrants an exam by a health care provider. Continue with the Survey to determine other areas contributing to the problem.

3 to 20 points, you may have muscle tightness/spasm and could benefit from a stretching/strengthening exercise program and ergonomics education from a Chiropractor or Physical Therapist. You will also benefit from deep therapeutic massage, and stress reduction (see our Treatment section). Continue with the survey to determine if there are other areas contributing to the problem.

0 points, then your pain, weakness, or numbness may not be coming from muscle tightness or nerve compression in the neck area. Continue with the Survey to determine the cause of the problem.

If you answer yes to any of these questions, add the following points to your score:
If you press below the collar bone (move your finger tip from left to right, and feel from the center of the chest to the armpit) are there hard bumps or does the muscle feel hard (muscle spasm) and tender?	+ 10 points
When you feel your radial pulse with the index finger of the other hand, (on the inside of the wrist toward the thumb side of the arm) does it feel weak?	+ 10 points
Have someone else can feel the pulse while gently pulling the arm to the side, then back. Does the pulse strength diminish, or disappear?	+ 15 points
Are the muscles around the front of the shoulder (upper chest) tender when pressed? Or is the shoulder painful when moved?	+ 10 points
Add up your points

If you scored:

20 points or more, there is a good chance that you have TOS (Thoracic Outlet Syndrome). This is when the nerves and blood vessels in the front of the shoulder are compressed by muscles that are too tight or in spasm. This can cause swelling in the arm & hand from backed up lymphatic fluid. This compression can also cause weakness, numbness, and/or pain in the hands. This score also warrants an exam by a health care provider. Prolonged pressure on nerves or the blood supply to the nerves or other tissue can cause impairments and permanent damage. Continue with the survey to determine if you may also have a problem in the wrist that is contributing to the problem.

10 to 20 points, then you may have some TOS involvement. A mild to moderate case of TOS combined with a mild muscle spasm in the neck and/or mild nerve compression in the wrist can cause severe arm/hand pain, tingling, numbness or weakness. In other words, when a nerve is mildly compressed in 2 or 3 areas it can cause as much of a problem as when the nerve is severely compressed in 1 area. Continue with the survey to determine if you may also have a problem in the wrist that is contributing to the problem.

0 points, and you have correctly performed the above tests, then you may not have TOS involvement. Continue with the Survey to determine if you may also have a problem in the wrist that is contributing to the problem.

Typically an EMG (nerve conduction study) is used to determine compression of a nerve in the carpal tunnel. However, this compression is not always because the tunnel itself is too small. There can be too much pressure in the tunnel by backed up lymphatics and blood vessels in the shoulder area (TOS) making the tissues in the carpal tunnel swell, causing undue pressure on the nerves. In this case you may have been given an accurate diagnosis of Carpal Tunnel Syndrome (CTS) based on an EMG, but CTS may only be a symptom of Thoracic Outlet Syndrome. Treatment of only the Carpal Tunnel Syndrome will not warrant long term successful results.

There are times however when the integrity of the tunnel itself becomes damaged and the ligament becomes overstretched (usually from a fall on the hand) In this case the nerves/vessels to the hand become crushed inside the tunnel whenever the wrist is bent forward or backward because the tunnel flattens out.

Use this test to help determine if you are having this problem:

If you place your hand flat (palm down) on the table, and press firmly on the high point of the wrist (go to the midline of the arm, find where the wrist joint bends, and move 1 inch towards the fingers); and the wrist bones feel springy (moving more than 1/8th of an inch) give yourself 20 points because you probably have carpal tunnel syndrome from instability of the carpal tunnel.
Dr. Rahn's wrist/hand brace addresses this problem along with the swelling in the hand caused from TOS. His brace also helps when the nerves are irritated from lack of blood supply and/or from compression. It provides protection and limits extreme forward/backward bending of the wrist.

Sometimes CTS/TOS may not cause pain. The only symptom noticed is weakness, such as dropping things or having difficulty opening jars.
Please note that pain, weakness, and numbness in the hands usually indicates problems with the nerves; however, this does not determine if the problem is from the neck, shoulder or hand! Swelling in the hand may be from muscle spasm in the shoulder, arm or hand. A trained health care provider such as a M.D., Chiropractor (D.C.), or Physical Therapist (P.T.) can determine which areas are causing the problems, however, many are unaware of TOS and it's contribution to CTS, let alone being aware of how to successfully treat these problems.

You can learn more from our Treatment section of this website. You may also obtain a video or DVD of Dr. Rahn teaching this protocol for your own information. Some patients, living out of our area, have purchased our video so their health care provider could learn our hands-on technique and successfully treat their pain / disability. Our video may also help refine the technique of a massage therapist under the supervision of a P.T., D.C. or M.D.