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.