Carpal tunnel syndrome diagnostic study of choice

Jump to navigation Jump to search

Carpal tunnel syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Carpal tunnel syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Carpal tunnel syndrome diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Carpal tunnel syndrome diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Carpal tunnel syndrome diagnostic study of choice

CDC on Carpal tunnel syndrome diagnostic study of choice

Carpal tunnel syndrome diagnostic study of choice in the news

Blogs on Carpal tunnel syndrome diagnostic study of choice

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Carpal tunnel syndrome diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

CTSs Symptoms include numbness, pain, or paresthesia in the median nerve distribution.

Commonly used provocative tests include wrist flexion (Phalen), nerve percussion (Tinel), and carpal compression (Durkan) tests.

Electrodiagnostic studies (EDS) and imaging evaluations are used in order to confirm diagnosis.

Diagnosis

Clinical assessment by history taking and physical examination can frequently diagnose CTS. Diagnostic criteria of CTS:

  • numbness and tingling in the median nerve distribution
  • weakness and/or atrophy of the thenar musculature
  • nocturnal numbness
  • loss of two point discrimination
  • Phalen's maneuver is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. A positive test is one that results in numbness in the median nerve distribution. The quicker the numbness starts, the more advanced the condition.
  • Tinel's sign, a classic, though less specific test, is a way to detect irritated nerves. Tinel's is performed by lightly tapping (percussing) the area over the nerve to elicit a sensation of tingling or "pins and needles" in the nerve distribution.
  • The carpal compression test, or applying firm pressure of the palm over the nerve to elicit symptoms has also been proposed.

Other conditions may also be misdiagnosed as carpal tunnel syndrome. Thus, if, based on history and physical examination, a CTS diagnosis is suspected but not clear, patients will likely be tested electrodiagnostically with nerve conduction studies and electromyography; MRI or ultrasound imaging are also used.

Diagnostic Value of History and Physical Examination Findings for Carpal Tunnel Syndrome

D'Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome? [published correction appears in JAMA. 2000;284(11):1384]. JAMA. 2000;283(23):3110–3117.

FINDING SENSITIVITY (%) SPECIFICITY (%)
Flick sign 93 96
Hypalgesia 39 88
Square wrist sign 53 80
Classic or probable pattern on hand symptom diagram 64 73
Abduction weakness 65 65
Thenar atrophy 16 90
Tinel sign 36 75
Phalen maneuver 57 58
Nighttime or morning symptoms 70 43
Electrodiagnostic 49–84 95–99
Ultrasonography 82 92
MRI 63-83 78-80
Computed tomograph 67 87

References