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| {{Carpal tunnel syndrome}} | | {{Carpal tunnel syndrome}} |
| {{CMG}} | | {{CMG}} |
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| == Overview ==
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| CTSs Symptoms include numbness, pain, or paresthesia in the median nerve distribution.
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| Commonly used provocative tests include wrist flexion (Phalen), nerve percussion (Tinel), and carpal compression (Durkan) tests.
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| Electrodiagnostic studies (EDS) and imaging evaluations are used in order to confirm diagnosis.
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| == Diagnosis ==
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| Clinical assessment by history taking and physical examination can frequently diagnose CTS. Diagnostic criteria of CTS:
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| * numbness and tingling in the median nerve distribution
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| * weakness and/or atrophy of the thenar musculature
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| * nocturnal numbness
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| * loss of two point discrimination
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| *[[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.
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| *[[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.
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| *The ''carpal compression test'', or applying firm pressure of the palm over the nerve to elicit symptoms has also been proposed.
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| 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 study|nerve conduction studies]] and [[electromyography]]; [[Magnetic resonance imaging|MRI]] or [[Medical ultrasonography|ultrasound imaging]] are also used.
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| '''Diagnostic Value of History and Physical Examination Findings for Carpal Tunnel Syndrome'''
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| 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.
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| {| class="wikitable"
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| ! colspan="1" rowspan="1" |FINDING
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| ! colspan="1" rowspan="1" |SENSITIVITY (%)
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| ! colspan="1" rowspan="1" |SPECIFICITY (%)
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| |-
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| | colspan="1" rowspan="1" |Flick sign
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| | colspan="1" rowspan="1" |93
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| | colspan="1" rowspan="1" |96
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| |-
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| | colspan="1" rowspan="1" |Hypalgesia
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| | colspan="1" rowspan="1" |39
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| | colspan="1" rowspan="1" |88
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| |-
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| | colspan="1" rowspan="1" |Square wrist sign
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| | colspan="1" rowspan="1" |53
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| | colspan="1" rowspan="1" |80
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| |-
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| | colspan="1" rowspan="1" |Classic or probable pattern on hand symptom diagram
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| | colspan="1" rowspan="1" |64
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| | colspan="1" rowspan="1" |73
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| |-
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| | colspan="1" rowspan="1" |Abduction weakness
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| | colspan="1" rowspan="1" |65
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| | colspan="1" rowspan="1" |65
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| |-
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| | colspan="1" rowspan="1" |Thenar atrophy
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| | colspan="1" rowspan="1" |16
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| | colspan="1" rowspan="1" |90
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| |-
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| | colspan="1" rowspan="1" |Tinel sign
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| | colspan="1" rowspan="1" |36
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| | colspan="1" rowspan="1" |75
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| |-
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| | colspan="1" rowspan="1" |Phalen maneuver
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| | colspan="1" rowspan="1" |57
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| | colspan="1" rowspan="1" |58
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| |-
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| | colspan="1" rowspan="1" |Nighttime or morning symptoms
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| | colspan="1" rowspan="1" |70
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| | colspan="1" rowspan="1" |43
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| |-
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| |Electrodiagnostic
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| |49–84
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| |95–99
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| |-
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| |Ultrasonography
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| |82
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| |92
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| |-
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| |MRI
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| |63-83
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| |78-80
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| |-
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| |Computed tomograph
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| |67
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| |87
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| |}
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| == References ==
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