Carpal tunnel syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Dheeraj Makkar, M.D.[2]
Overview
Carpal tunnel syndrome symptoms usually start slowly. The first symptoms often include numbness or tingling in fingers and also discomfort in wrist and/or the palm of hand.
Sign and Symptom
History
Excessive use of the hands, particularly in association with vibrating tools or repetitive computer activities, is a recognized risk factor for carpal tunnel syndrome (CTS).
Symptoms
Patients typically present with numbness and tingling affecting the radial three and a half digits. They may report clumsiness, nocturnal pain, and paresthesias severe enough to disrupt sleep.
Physical Examination
- Inspection
- Thenar muscle atrophy may be observed.
- In some cases, due to the Riche-Cannieu anastomosis (a communication between the deep branch of the ulnar nerve and the recurrent motor branch of the median nerve), thenar strength may be preserved despite the presence of severe CTS.
- Self-administered hand diagram
- Considered the most specific test for CTS (specificity \~76%).
- Palpation
- Direct tenderness over the carpal tunnel is rare but may be elicited.
- Provocative Tests
- Carpal tunnel compression test (Durkan’s test):** The most sensitive diagnostic maneuver for CTS. It involves applying direct thumb pressure over the carpal tunnel for 30 seconds. The reproduction of pain or paresthesias in the median nerve distribution within this interval constitutes a positive test.
- Phalen’s test:** Passive wrist flexion held for approximately 60 seconds against gravity may reproduce symptoms. This test is less sensitive than the Durkan compression test.
- Tinel’s test:** Tapping over the volar aspect of the carpal tunnel may provoke tingling sensations along the median nerve distribution.
- Sensory Testing
- Semmes–Weinstein monofilament testing:** The most sensitive modality for detecting early CTS. It assesses the threshold of perception mediated by individual nerve fibers innervating sensory receptors.
- Innervation density testing:** Includes both static and dynamic two-point discrimination. Inability to distinguish two points positioned ≤5 mm apart is suggestive of CTS. This method evaluates the integration of multiple overlapping sensory units and cortical processing. It is also a reliable tool for monitoring functional recovery following nerve repair.