diagnosis
Last reviewed 07/2023
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)
Reference: