From the Guidelines
Carpal tunnel syndrome is diagnosed by clinical evaluation combined with electrophysiologic studies, and its symptoms include numbness, tingling, and pain in the hand and fingers, particularly affecting the thumb, index, middle, and half of the ring finger. These symptoms often worsen at night or during activities that involve wrist flexion, such as driving or holding a phone 1. Many people report having to shake their hands to relieve discomfort, a characteristic sign called the "flick sign." As the condition progresses, weakness in the affected hand may develop, making it difficult to grip objects or perform fine motor tasks. Some patients experience a sensation of swelling in their fingers even when no visible swelling is present. Pain may radiate up the forearm toward the elbow. Symptoms typically begin gradually and worsen over time if left untreated. The condition occurs when the median nerve, which runs through a narrow passage in the wrist called the carpal tunnel, becomes compressed due to inflammation, repetitive hand movements, or conditions like pregnancy or diabetes that cause tissue swelling.
Key Symptoms
- Numbness and tingling in the hand and fingers
- Pain in the hand and fingers, particularly affecting the thumb, index, middle, and half of the ring finger
- Weakness in the affected hand
- Sensation of swelling in the fingers
- Pain radiating up the forearm toward the elbow According to the American College of Radiology, suspected carpal tunnel syndrome is diagnosed by clinical evaluation combined with electrophysiologic studies, and further imaging is usually not needed, but in selected circumstances, either wrist US or MRI without contrast may be appropriate 1. Early diagnosis is important, as prolonged nerve compression can lead to permanent nerve damage and muscle atrophy at the base of the thumb.
From the Research
Symptoms of Carpal Tunnel Syndrome
The symptoms of carpal tunnel syndrome (CTS) include:
- Pain in the hand, numbness, and tingling in the distribution of the median nerve 2
- Paresthesia, pain, and numbness in the radial three and one-half digits, typically with nighttime symptoms more common earlier in the disease process 3
- Numbness, tingling sensation, morning stiffness, and self-care difficulties 4
- Hypalgesia, square wrist sign, and a classic or probable pattern on hand symptom diagram 5
- Thenar weakness and autonomic dysfunction, usually seen in advanced cases 6
Characteristics of Symptoms
- Symptoms are related to compression of the median nerve, resulting in pain, numbness, and tingling 5
- Nighttime symptoms are more common earlier in the disease process, with daytime symptoms becoming more frequent as CTS progresses 3
- Symptoms can be constant or intermittent, and may be exacerbated by certain activities or positions 2
Diagnostic Considerations
- Other conditions may provide similar symptoms to CTS, requiring vigorous diagnosis to assert the medical condition of the patients 2
- Electrodiagnostic studies, such as nerve conduction studies and electromyography, can be used to confirm a diagnosis of CTS or to quantify and stratify disease severity 3, 5