Diagnosis

There is no single reference standard for the diagnosis of CTS. Rather diagnosis is characterized by a combination of signs, symptoms, and test results, including,
  • Accurate patient history: symptoms are classically bilateral, insidious in onset, and progressive in nature. Note that with advanced nerve compression, there may be a persistent and static aching sensation that may radiate to the forearm and elbow. Also of note are any significant trauma and ongoing illnesses
  • Physical examination: including patient characteristics
  • Sensory and motor examination of the upper extremity
  • Provocative tests for CTS: traditionally still performed despite conflicting evidence of efficacy
  • Discriminatory testing: rule out other diagnoses
  • Electrodiagnostic testing: provides diagnostic and prognostic information as well as helps to guide clinical management

Classic Presentation
A classic presentation would include symptomatic involvement of at least two of the thumb, index or middle fingers. Occasionally pain may radiate to the wrist and elbow. Symptoms are exacerbated by activities that involve the extrinsic flexor muscles, such as using hand tools, driving a car, or even holding a phone. Nocturnal symptoms are often described but may be absent in some patients. Typically the history is positive for provocative occupational exposures such as a recent change in duties, static loads, repetitive movements, forceful movements, non-neutral postures, hand-arm vibration, and temperature extremes.


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