Clinical Presentations and Diagnosis

Abstract

Carpal tunnel syndrome has some characteristic “typical” presentations in terms of the history of the disorder and findings that can be obtained by inspection and physical examination. This chapter reviews the definition of carpal tunnel syndrome, its incidence, and typical presentations as they relate to the etiology of this disorder. A complete upper extremity evaluation is recommended, and a simple differential diagnosis is featured. Many conditions in the upper limb can “mimic” some of the features of carpal tunnel syndrome, and it is important to distinguish among these. Associated risk factors in terms of the condition and its presentation are reviewed. In obtaining a thorough history, some key factors in terms of who, how, what, when, and where are provided. Common patterns and progressions are discussed. In the physical examination, inspection and a thorough upper extremity exam including the neck and shoulder girdle for proximal nerve compression and “double crush” are reviewed. Images of the most commonly used provocative tests are provided, and their efficacy is discussed. The full range of presentations, typical and atypical, and how the clinician can use skillful history taking coupled with a broad general neck-to-fingertip exam and appropriate specialized tests to establish the diagnosis of carpal tunnel syndrome will be reviewed.