Carpal tunnel syndrome
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- numbness of hand(s)
- night-time worsening
- numbness in median nerve distribution
- numbness confined to palmar aspect of the first 4 fingers
Other diagnostic factors
- symptoms are intermittent
- onset is gradual
- weakness of hand
- clumsiness
- aching and pain in arm
- weakness of thenar muscles (abductor pollicis brevis, or APB, in particular)
- normal reflexes
- finger stiffness
- cold sensitivity
- atrophy of thenar eminence
Risk factors
- age over 30 years
- high BMI
- female sex
- smoking cigarettes
- white ethnicity
- alterations in carpal tunnel space
- fractured wrist/carpal bones
- square wrist
- rheumatoid arthritis
- diabetes
- thyroid disorders
- dialysis
- pregnancy
- hormone replacement therapy and/or oophorectomy
- congenital carpal tunnel stenosis
- occupation involving exposure to repetitive bending, twisting, or vibration of the hands or wrists
- occupational keyboard/computer use
- physical inactivity
- sports and activities
- mobility aids
Diagnostic investigations
1st investigations to order
- electromyogram (EMG)
Investigations to consider
- ultrasound of the wrist
- MRI of the wrist
Treatment algorithm
clinical diagnosis of CTS without electromyogram (EMG) confirmation, or pregnant women
mild or moderate based on EMG findings (non-pregnant)
severe based on EMG findings (non-pregnant)
moderate based on EMG findings + failed splint and corticosteroid injections
refractory to surgery
Contributors
Authors
Nigel Ashworth, MBChB, MSc, FRCP(Can)
Professor
Division of Physical Medicine & Rehabilitation
Faculty of Medicine & Dentistry
University of Alberta
Edmonton
Canada
Disclosures
NA is an author of a number of references cited in this topic.
Peer reviewers
Shawn Marshall, MD, MSc
Associate Professor
University of Ottawa
Ottawa
Ontario
Canada
Disclosures
SM declares that he has been primary author and co-author of Cochrane systematic reviews of nonsurgical interventions for treatment of carpal tunnel syndrome.
Tim J. Doherty, MD, PhD
Associate Professor
The University of Western Ontario
London
Ontario
Canada
Disclosures
TJD declares that he has no competing interests.
Michael Plant, MD, FRCP
Consultant Rheumatologist
The James Cook University Hospital
South Tees Hospitals NHS Foundation Trust
Middlesbrough
UK
Disclosures
MP declares that he has no competing interests.
Differentials
- Osteoarthritis (OA)
- Stroke, acute
- C6 radiculopathy
More DifferentialsGuidelines
- ACR appropriateness criteria: chronic wrist pain
- Hand, wrist and forearm disorders guideline
More GuidelinesPatient leaflets
Carpal tunnel syndrome
More Patient leaflets
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