Carpal Tunnel Syndrome

What are the signs and symptoms?

Patients with CTS most commonly experience tingling, numbness, weakness, or pain in the digits (thumb, index, middle, half of ring finger) innervated by the median nerve. (see Fig.1 on previous page) Additionally symptoms may affect the palm and radiate up the arm to the shoulder. Additionally, lack of symptoms in the little finger are consistent with median nerve involvement, as sensation in the little finger is supplied by a different nerve (ulnar nerve). CTS can occur in both hands (bilateral involvement). Classically, pain or symptoms in the hand wake patients up at night after they are able to fall asleep without difficulty.

Mild symptoms may include numbness and pain in the hand, wrist, and forearm. One may experience paresthesias, such as a "pins and needles" sensation, or as if one's hand is "falling asleep". Symptoms may cause you to wake up during the night, and may be reduced or relieved by shaking and moving the affected hand/wrist. Patients may notice times of clumsiness or a tendency to drop objects. Increased or excessive use of the hand aggravates or worsens the symptoms, especially with gripping and flexion at the wrist. Early morning stiffness of the digits may also be experienced.

Moderate to severe CTS occurs with prolonged median nerve compromise. Patients may experience numbness in addition to muscular hand weakness. Patients may experience decreased gripping strength (opening a jar or using a screwdriver) or decreased pinch strength between the thumb and first finger (holding a piece of paper).  Long-term, atrophy with weakness of the thenar (thumb) muscles can be appreciated on exam.

 

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Additional Information

Please see the provided Additional Links and Resources about Carpal Tunnel Syndrome for additional information and references.