Clinical manifestations and diagnosis of carpal tunnel syndrome
- Milind J Kothari, DO
Milind J Kothari, DO
- Professor of Neurology
- Penn State College of Medicine
Carpal tunnel syndrome (CTS) refers to the complex of symptoms and signs brought on by compression of the median nerve as it travels through the carpal tunnel. Patients commonly experience pain and paresthesia, and less commonly weakness, in the median nerve distribution. CTS is the most frequent compressive focal mononeuropathy seen in clinical practice.
This topic will review the clinical manifestations and diagnosis of CTS. Other aspects of CTS are discussed separately. (See "Etiology of carpal tunnel syndrome" and "Treatment of carpal tunnel syndrome".)
The hallmark of classic CTS is pain or paresthesia (numbness and tingling) in a distribution that includes the median nerve territory, with involvement of the first three digits and the radial half of the fourth digit (figure 1). The symptoms of CTS are typically worse at night and often awaken patients from sleep. Some patients react to these symptoms by shaking or wringing their hands or by placing them under warm running water .
Although the sensory symptoms of CTS are usually limited to the median-innervated fingers, there is a wide range of variability. The pain and paresthesia may be localized to the wrist or involve the entire hand. It is not uncommon for sensory symptoms to radiate proximally into the forearm, and less frequently to radiate above the elbow to the shoulder .
CTS symptoms are often provoked by activities that involve flexing or extending the wrist or raising the arms, such as driving, reading, typing, and holding a telephone [1,2].
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