Carpal Tunnel Syndrome Differential Diagnosis

The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis
  • Carpal tunnel syndrome itself: This is the most likely diagnosis given the presentation of symptoms such as numbness, tingling, and pain in the hand and wrist, particularly in the distribution of the median nerve.
• Other Likely Diagnoses
  • Cervical radiculopathy: Symptoms can mimic carpal tunnel syndrome, especially if the C6 or C7 nerve roots are involved, causing pain and numbness in the arm and hand.
  • Thoracic outlet syndrome: Compression of the nerves and/or blood vessels that pass into the thoracic outlet can cause similar symptoms in the arm and hand.
  • Ulnar nerve entrapment: Compression of the ulnar nerve at the elbow or wrist can cause numbness, tingling, and weakness in the hand, particularly affecting the little and ring fingers.
  • Ganglion cysts: These are non-cancerous lumps that can develop on the wrist and, if large enough, can compress the median nerve, causing symptoms similar to carpal tunnel syndrome.
• Do Not Miss Diagnoses
  • Acute carpal tunnel syndrome due to fracture or infection: These conditions require immediate medical attention to prevent permanent nerve damage or to treat the underlying infection.
  • Tumor (e.g., schwannoma, neurofibroma): Although rare, tumors can compress the median nerve, leading to symptoms of carpal tunnel syndrome.
  • Systemic conditions (e.g., diabetes, hypothyroidism): These conditions can cause or exacerbate symptoms of carpal tunnel syndrome and need to be identified and managed appropriately.
• Rare Diagnoses
  • Sarcoidosis: A condition that can cause nerve compression due to granulomatous inflammation.
  • Amyloidosis: A condition where abnormal proteins (amyloid) accumulate and can deposit in nerves, causing compression.
  • Leprosy: A chronic bacterial infection that can cause nerve damage and symptoms similar to carpal tunnel syndrome, particularly in endemic areas.
  • Charcot-Marie-Tooth disease: A group of inherited disorders that affect the peripheral nerves, potentially causing symptoms that could be confused with carpal tunnel syndrome.

Each diagnosis in these categories is considered based on the potential to cause symptoms similar to carpal tunnel syndrome, with an emphasis on not missing critical diagnoses that could have significant consequences if left untreated.