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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Diagnosis of the condition requires a clear history and examinations directed at identifying standard features and provocative factors (1).

  • patients presents with a history of tingling, numbness, or pain of the fingers in the distribution of the median nerve which is often worse at night and causes wakening
  • provocative tests such as Tinel’s sign, modified Phalen’s test , and Durkan’s compression test are usually positive (2)

The following criteria (described by GPs with a special interest in musculoskeletal health, from the Primary Care Rheumatology Society) followed by a decision tree will be help in diagnosing CTS:

Inquire about the following from patients who presents with hand or wrist symptoms:

  • any numbness or tingling in the wrist, hand, or fingers?
  • does the symptoms spare the little finger?
  • are the symptoms worse at night?
  • do the symptoms wake you up at night?
  • any weakness in the hand e.g. – dropping thing in the hand regularly?
  • shaking the hand, holding the hand or running under water improves the symptoms?
  • symptoms are made worse by driving, holding a telephone, using vibrating tools, or typing?
  • have splints or injections helped with the pain in the past?

Decision tree:

  • if the answer to question 1 is
    • no – diagnosis of CTS is unlikely
    • yes – are ≥3 other questions answered as
      • yes – diagnosis of CTS can be made
      • no – are 2 other questions answered as
        • no – consider further investigations or an alternative diagnosis
        • yes – is Phalen’s test positive
          • yes – CTS diagnosed
          • no - consider further investigations or an alternative diagnosis (1)


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