Clinical features

Clinical features of carpal tunnel syndrome include:

• numbness or paraesthesia in the hand
  • usually, but not always, of the thumb, index, middle, and radial half of the ring finger
• pain in hand, wrist may extend proximally to forearm or to the shoulder region
• symptoms are worst at night which may be relieved by
  • hanging the arm over the side of the bed, or by shaking the arm
  • flicking the wrist - known as the flick sign
• decreased grip strength
• motor wasting and weakness lead to thenar wasting and weakened abduction of the thumb – seen in severe, chronic carpal tunnel syndrome,
• clumsiness or reduced manual dexterity e.g. – difficulty in carrying out fine tasks such as doing up buttons or become clumsy and drop items
• trophic ulcers at the tips of thumb, index finger, or middle finger
• positive Tinel's test
• positive Phalen's test
• electrical studies may show a slowing of nerve conduction across the wrist

Note:

• sometimes symptoms may occur in all fingers (but not in dorsum or palm of the hand)
• permanent sensory changes and motor signs and symptoms are considered as late manifestations of CTS

Reference:

• (1) Middleton SD, Anakwe RE Carpal tunnel syndrome. BMJ. 2014;349:g6437
• (2) LeBlanc KE, Cestia W .Carpal tunnel syndrome. Am Fam Physician. 2011;83(8):952-8.