Age
CTS is rare under 30 years of age and the peak onset is usually between 40 and 60 years of age. This age group is typically a working population and the fall-off after age 60 may represent a decrease in activity that occurs with retirement.
Symptom Characterization
It is important to have the patient describe what they are feeling or not feeling as the case may be, i.e. distinguish between pain, paraesthesia, anaesthesia and even hypalgesia. Pain and parathesias may indicate that the syndrome is still in the early stages, whereas anaesthesia and hypalgesia may indicate severe, chronic pathology. Temporality of symptoms is also helpful in understanding the severity of disease and determining treatment. Patients often feel an increase in symptoms at night because of venous stasis, which contributes to the compression of the nerve. Ask about onset, was it abrupt indicating a possible musculoskeletal injury or did the symptoms gradually escalate, which is more indicative of CTS. Because of the very specific cutaneous distribution of the median nerve, understanding the location of symptoms is very important. Symptoms are typically bilateral but worse in the dominant hand and follow the cutaneous median nerve distribution, which spares the skin over the thenar eminence. Also note radiation of symptoms as radiation of pain to the whole hand, wrist, and elbow is common. Finally, be sure to comment on the impact the symptoms are having on the patient's ability to function at work and home. Does their hand feel clumsy? Are fine-motor tasks, such as writing or doing up buttons, more difficult? Is their hand weaker? For example, do they have difficulty removing a jar lid? All of this information is helpful in creating a clinical impression as well as prognosis and treatment if CTS is confirmed.
Past Medical HistoryThe clinician should focus on obtaining information about prior musculoskeletal disorders and systemic conditions that may predispose the patient to CTS. Have they ever had any neck or upper extremity injuries? Referred pain from the cervical neck, shoulder, or elbow from a previous disorder or injury may be the source of the patient's current pain. Particularly, fractures of the distal radius (Colle's fracture) or carpals, as a callus or deformity may have resulted in decreased space in the carpal tunnel. Also inquire about tendinosis, tendinitis, or tenosynovitis related conditions as well as osteoarthritis. A history of systemic conditions should include diabetes mellitus, rheumatoid arthritis, thyroid disorders, renal failure, and collagen vascular disorders. For women, a reproductive history should be taken including the possibility of a current pregnancy, use of oral contraception, estrogen replacement therapy, and menopause. Finally, inquire about past surgeries, hospitalizations, and current medications.
Review of Systems
If time permits, a standard comprehensive review of systems should be performed to ensure that possible systemic illness is not overlooked.
Family History
The clinician may consider exploring the family history for systemic conditions that may predispose individuals to CTS.
Social History
The social history is a good opportunity to inquire about non-work activities which may also involve exposure to cumulative trauma. To avoid inadvertently overlooking such exposures, the history should routinely include questions on the home environment, including housework, care of young children, hobbies, and exercise or recreation. Additionally, the social history may provide the clinician with information about factors that may affect treatment, such as emotional stress and economic factors that may prohibit the patient from taking time off work, attending physical therapy or recovery in general. As in all social histories, it is good practice to routinely inquire about cigarette, alcohol, and recreational drug use.
Previous ι Next