Last reviewed: July 2020
Last updated: October
2019
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
Treatment algorithm
Contributors
Authors
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
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.
Associate Professor
The University of Western Ontario
London
Ontario
Canada
Disclosures
TJD declares that he has no competing interests.
Consultant Rheumatologist
The James Cook University Hospital
South Tees Hospitals NHS Foundation Trust
Middlesbrough
UK
Disclosures
MP declares that he has no competing interests.
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