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Diagnosing carpal tunnel syndrome—clinical criteria and ancillary tests

Nature Clinical Practice Neurology volume 2, pages 366–374 (2006)Cite this article

Abstract

Damage to the median nerve within the carpal tunnel gives rise to carpal tunnel syndrome (CTS), which is associated with a wide spectrum of symptoms. The predominant classic symptoms are nocturnal pain of the hand, and sensory disturbances within the distribution of the median nerve, both of which are characteristically relieved by hand movements. Ancillary tests, including nerve conduction studies (NCS) and imaging techniques, are mainly indicated when the classic defining features are absent. NCS are less accurate in the early stages of CTS, and in younger patients. Imaging tests (ultrasound and MRI), while still having a lower diagnostic accuracy than NCS, are proving to be useful for explaining persistence of symptoms following surgical relief. Supplementary tests of small nerve fiber function and measurement of intracarpal pressure might, in the future, improve early recognition of CTS, especially in the absence of well-defined symptoms.

Key Points

  • Carpal tunnel syndrome is diagnosed in the presence of primary symptoms, which include nocturnal paresthesias relieved by hand movements, hand pain and/or paresthesias evoked by hand force, and sensory symptoms in digits 1, 2, 3 or part of the 4th digit, or in any combination of these digits

  • Clinical provocative tests (e.g. Phalen's or Tinel's test) are useful for supporting a diagnosis of CTS when used in a standardized and well-defined fashion

  • Nerve conduction studies are the initial investigation of choice in the presence of upper limb features without primary CTS symptoms

  • The evaluation of failed CTS release operations is best performed using imaging methods such as ultrasound or MRI

  • Carpal tunnel pressure measurement might prove valuable for documenting sufficient reduction in intracarpal pressure during surgery

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Author information

Authors and Affiliations

  1. senior consultant and heads the neurophysiological section,

    Einar P Wilder-Smith, Raymond C S Seet & Erle C H Lim

  2. consultant neurologist,

    Einar P Wilder-Smith, Raymond C S Seet & Erle C H Lim

  3. registrar, all at the National University Hospital, Singapore

    Einar P Wilder-Smith, Raymond C S Seet & Erle C H Lim

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  1. Einar P Wilder-Smith
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  2. Raymond C S Seet
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  3. Erle C H Lim
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Correspondence to Einar P Wilder-Smith.

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Wilder-Smith, E., Seet, R. & Lim, E. Diagnosing carpal tunnel syndrome—clinical criteria and ancillary tests. Nat Rev Neurol 2, 366–374 (2006). https://doi.org/10.1038/ncpneuro0216

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