What are the common symptoms of carpal tunnel syndrome?

Common Symptoms of Carpal Tunnel Syndrome

The most common symptoms of carpal tunnel syndrome include numbness, tingling, and pain in the distribution of the median nerve, specifically affecting the thumb, index finger, middle finger, and radial half of the ring finger. 1

Primary Symptoms

• Sensory Symptoms:

  • Numbness and tingling in the median nerve distribution (thumb, index, middle, and radial half of ring finger) 1, 2
  • Burning or dysesthetic wrist pain 3
  • Symptoms often worse at night 3, 4
  • Pain may radiate proximally along the volar forearm, medial arm, and shoulder 3

• Motor Symptoms:

  • Loss of grip strength 3
  • Decreased dexterity 3
  • Thenar weakness (occurs in advanced cases) 4

Symptom Characteristics

• Timing and Triggers:

  • Nocturnal pain is particularly characteristic 5, 4
  • Symptoms exacerbated by:
    • Forceful activity 3
    • Extreme wrist positions 3
    • Repetitive wrist movements 1
    • Use of vibratory tools 1

• Symptom Progression:

  • Early stages: Primarily sensory symptoms (numbness, tingling) 4
  • Advanced stages: Motor weakness and autonomic dysfunction 4

Diagnostic Indicators

• Clinical Tests:
  • Positive Tinel's sign (tapping over the median nerve produces tingling) 6
  • Positive Phalen's maneuver (wrist flexion test) 6, 4
  • Hypalgesia and weak thumb abduction (more predictive of abnormal nerve conduction) 6

Special Considerations

• Pregnancy-Related CTS:

  • Extremely common in pregnancy (prevalence up to 62%) 3
  • Often resolves spontaneously postpartum 6
  • Median nerve function is impaired in virtually all pregnant women during the third trimester, even without symptoms 3

• Occupational Factors:

  • Higher risk in occupations involving high pressure, high force, repetitive work, and vibrating tools 5
  • However, occupational CTS is less common than previously thought 5

Distinguishing Features from Other Conditions

• Unlike polyneuropathy symptoms, carpal tunnel symptoms typically improve with walking and worsen when lying in bed 7
• Symptoms are specifically localized to the median nerve distribution, unlike more diffuse neuropathies
• Symptoms can be confused with cervical radiculopathy or pronator syndrome 1

Understanding these characteristic symptoms helps in early diagnosis and appropriate management, which is crucial for preventing progression to more severe forms with permanent nerve damage and muscle atrophy.