musculoskeletal and connective tissue disorders
Carpal Tunnel Syndrome
Diagnosis of Carpal Tunnel Syndrome
Clinical evaluation Sometimes nerve conduction testing The diagnosis of carpal tunnel syndrome is strongly suggested by the Tinel sign, in which median nerve paresthesias are reproduced by tapping at the volar surface of the wrist over the site of the median nerve in the carpal tunnel. Reproduction of tingling with wrist flexion (Phalen sign) or with direct pressure on the nerve at the wrist in a neutral position (median nerve compression test) is also suggestive. The median nerve compression test is positive if symptoms develop within 30 seconds. The six-item carpal tunnel syndrome symptom scale (CTS-6) is a diagnostic aid that uses 6 clinical criteria. A score ≥ 12 correlates with a high probability of carpal tunnel syndrome. However, clinical differentiation from other types of peripheral neuropathy may sometimes be difficult. If symptoms are severe or the diagnosis is uncertain, Nerve conduction studies should be done on the affected arm for diagnosis and to exclude a separate or coexistent more proximal neuropathy. 