What are the signs and symptoms of carpal tunnel syndrome (CTS)?

Updated: Mar 30, 2020
  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

The patient's history often is more important than the physical examination in making the diagnosis of carpal tunnel syndrome (CTS).

  • Numbness and tingling

    • Among the most common complaints, patients will reveal that their hands fall asleep or that things slip from their fingers without their noticing (loss of grip, dropping things); numbness and tingling also are commonly described.

    • Symptoms are usually intermittent and are associated with certain activities (eg, driving, reading the newspaper, crocheting, painting). Nighttime symptoms that wake the individual are more specific to CTS, especially if the patient relieves symptoms by shaking the hand/wrist. Bilateral CTS is common, although the dominant hand is usually affected first and more severely than the other hand.

    • Complaints should be localized to the palmar aspect of the first to the fourth fingers and the distal palm (ie, the sensory distribution of the median nerve at the wrist). Numbness existing predominantly in the fifth finger or extending to the thenar eminence or dorsum of the hand should suggest other diagnoses. A surprising number of CTS patients are unable to localize their symptoms further (eg, whole hand/arm feeling dead). This generalized numbness may indicate autonomic fiber involvement and does not exclude CTS from the diagnosis.


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