Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome typically presents with numbness, tingling, and pain in the thumb, index finger, middle finger, and radial half of the ring finger, often worse at night and relieved by shaking the hand. 1, 2
Classic Sensory Symptoms
The hallmark sensory symptoms occur in the median nerve distribution:
- Numbness and tingling affecting the palmar aspect of the thumb, index finger, middle finger, and radial half of the ring finger 2
- Paresthesias (abnormal sensations like "pins and needles") in these same digits 1, 3
- Burning dysesthetic wrist pain that can be quite bothersome 1
Atypical Sensory Presentations
Importantly, sensory symptoms frequently extend beyond the classic median nerve distribution, which can mislead clinicians:
- Over 50% of patients report tingling or numbness over the entire hand, including ulnar and radial nerve distributions 4
- Symptoms may radiate proximally along the volar forearm, medial arm, and even to the shoulder 1, 3
- Despite these widespread sensory complaints, objective sensory signs on examination remain confined to the median nerve distribution 4
Temporal Pattern and Exacerbating Factors
The timing and triggers of symptoms are diagnostically important:
- Nocturnal symptoms are characteristic, with patients frequently awakened by pain and abnormal sensations at night 1, 3, 2
- The "flick sign" is pathognomonic: patients shake or flick their hand to relieve symptoms 1, 2
- Symptoms worsen with forceful activity and extreme wrist positions (prolonged flexion or extension) 1
Motor Symptoms
As the condition progresses, motor involvement becomes apparent:
- Loss of grip strength affecting functional hand use 1
- Decreased dexterity and fine motor control 1
- Thenar muscle weakness or atrophy in advanced cases 5
Key Clinical Pitfalls
Numbness and nocturnal pain are the strongest predictors of electrodiagnostically confirmed carpal tunnel syndrome 4. Do not dismiss the diagnosis simply because symptoms extend beyond the median nerve distribution—this "atypical" presentation is actually common and should increase your clinical suspicion rather than decrease it 4. The entire palm may feel numb in some patients, yet this remains consistent with carpal tunnel syndrome 3.
Special Population Considerations
In pregnant women, carpal tunnel syndrome occurs with prevalence as high as 62%, with median nerve function impaired in virtually all pregnant women during the third trimester even without symptoms 1. The American Heart Association and American College of Cardiology note that bilateral carpal tunnel syndrome may signal systemic conditions or amyloidosis, warranting broader evaluation 6, 7.