Which symptoms aid in the diagnosis of carpal tunnel syndrome?
- Pain, paresthesias, or numbness worse at night or during activities that maintain wrist extension or flexion (e.g., driving) or require repetitive wrist motion
- Shaking, wringing, or flicking motions of the hands to relieve symptoms
- Numbness often involving only partial median nerve innervation (e.g., thumb and index finger) rather than entire first three and one-half digits. Pain but not numbness may occur above the wrist.
- Symptoms of intermittent hand weakness before overt weakness of thenar muscles and lateral lumbricals
- Provocative tests such as Tinel’s sign, Phalen’s sign, and reverse Phalen’s sign lack sufficient sensitivity and specificity to be reliable in the clinical setting. The gold standard remains electrodiagnostic confirmation.
