Carpal Tunnel Differential Diagnosis
The following differential diagnosis is organized into categories to help guide the thought process:
- Single Most Likely Diagnosis
- Carpal tunnel syndrome: This is the most likely diagnosis due to the specific symptoms and location of pain, numbness, and tingling in the hand and wrist, which are characteristic of median nerve compression.
- Other Likely Diagnoses
- Cervical radiculopathy: This condition, which involves nerve root compression in the cervical spine, can cause similar symptoms in the hand and wrist, making it a plausible alternative diagnosis.
- Thoracic outlet syndrome: Compression of the nerves or blood vessels in the thoracic outlet can lead to symptoms in the hand and wrist, although it typically presents with additional symptoms such as shoulder pain.
- Ulnar nerve entrapment: Compression of the ulnar nerve at the elbow or wrist can cause numbness and tingling in the hand, particularly in the little and ring fingers.
- Do Not Miss Diagnoses
- Acute carpal tunnel syndrome due to fracture or infection: These conditions require immediate medical attention and can be life-threatening or lead to significant morbidity if not promptly addressed.
- Space-occupying lesions (e.g., tumors): Although rare, tumors or other space-occupying lesions in the wrist can compress the median nerve, leading to carpal tunnel-like symptoms.
- Systemic conditions (e.g., diabetes, hypothyroidism): Certain systemic conditions can cause or exacerbate carpal tunnel syndrome, and missing these diagnoses could lead to inadequate treatment and poor outcomes.
- Rare Diagnoses
- Sarcoidosis: This autoimmune condition can cause nerve compression and inflammation, leading to carpal tunnel-like symptoms, although it is a rare cause.
- Amyloidosis: Deposition of amyloid proteins in the wrist can compress the median nerve, leading to carpal tunnel syndrome, but this is an extremely rare condition.
- Leprosy: This infectious disease can cause nerve damage and compression, leading to symptoms similar to carpal tunnel syndrome, although it is very rare in most parts of the world.