Carpal Tunnel Syndrome
Signs and Symptoms

2) Signs and Symptoms:  As mentioned before, the main complaints of patients suffering from carpal tunnel syndrome include pain and/or tingling, burning, and numbness in the hand along the distribution of the median nerve in one or both hands.  Patients often complain of the hand "going to sleep" or a feeling of "needles and pins" in the thumb, index, long, and ring fingers.  The symptoms are usually most marked in the early morning hours and often awaken sufferers from sleep.  They may also experience pain in the elbow or shoulder, as fibers of the median nerve originate from the spinal cord in the neck and travel through the shoulder and elbow areas.  Repetitive use activities involving the hands often initiate or worsen the symptoms.  Such activities often reported by patients as initiating the symptoms include:  keyboarding, driving, talking on the phone, crocheting, and other activities which involve maintaining a certain wrist position for prolonged time periods.  The hand will most often look normal; however, if the process is long-standing, there may be some atrophy (loss of mass) in the thenar muscles (group of muscles at the base of the thumb).

- Possible Causes:  Anything which increases the pressure within the carpal tunnel may bring on Carpal Tunnel Syndrome (CTS).  The most commonly thought of factor is repetitive trauma to the contents of the tunnel, caused by repetitive movements at the wrist due to jobs or hobbies which involve these movements (keyboarding, playing a musical instrument, etc.).

Other often cited factors include:
* Systemic disorders (diabetes, rheumatoid arthritis, decreased thyroid function, amyloidosis (rare condition involving unusual tissue deposits)
* General swelling - can be caused by direct tissue injury, congestive heart failure, liver disease or pregnancy
* Wrist injury - fractures or dislocations at the wrist may cause disruption of the tunnel, damage to and swelling of its contents

Diagnosis:  A physician makes the diagnosis of CTS through the patient's history and physical examination. Phalen's test is a fairly reliable physical exam tool which a physician may use to evaluate the presence of CTS.  The wrists are held in flexion for 60 seconds or less (if the patient begins to experience symptoms earlier) and the test is positive if it causes a reproduction of the patients symptoms (due to increased pressure in the tunnel caused by wrist flexion).  The physician may also tap over the location of the median nerve in the carpal tunnel (termed Tinel's sign).  The diagnosis of CTS is supported if the tapping produces paresthesias (tingling sensations) in the affected hand.

-  In some cases the patient's symptoms may be difficult to differentiate from nerve compression at the level of the neck (termed cervical spondylosis).  In this case (and in more straightforward cases to prove the diagnosis), the physician may also order nerve conduction velocities (NCVs) which measure the speed of impulse conduction of the median nerve.  If the patient is experiencing compression of the median nerve at the level of the wrist, the speed of the impulse conducted along the nerve will usually be slowed.  However, if the compression is mild or if the damage is minimal, the NCVs may be normal.  Given time, the NCVs may become abnormal.  The diagnosis should not be based solely on the NCV results; the entire clinical picture must be considered when making the diagnosis.