Clinical Diagnosis

Abstract

Diagnosis of carpal tunnel syndrome is substantially clinical. The most common subjective symptom is “nocturnal acroparesthesia”, consisting of a painful tingling sensation which may evan disturb sleep. Paresthesias are generally resolved by changing the position of the upper limb, by shaking or massaging it, or letting it hang down. Many patients also report relief after immersing their hand in cold water. Parenthesias may even occur during the day and are often triggered by the certaion positions or activities such as the act of sewing, driving, holding the phone or a book while reading. During a first look, a high percentage of patients are not able to describe on which fingers parenthesia occurs; they thus relate it to whole hand and often, to the back of the hand as well as to palmar surface. When asked to be more precise or, after performing some semeiotic maneuvers aimed at reproducing symtomatology, they adequately describe spreading of the disorder o the three radial fingers and to the radial side of the fourth finger. They futhermore recognize induced parethesia as “overlapping” the spontaneous one, albeit of a lesser entity. Moreover,sensitivity disorders are frequently related to only one finger,generally the middle finger or the thumb,or to both middle fingers. Often,the pain radiates out to the forearm or to the shoulder. Some patients refer that pain in these sites is dominant or is the only pain they experience. Also, as previously stated, following provocation maneuvers,they recognize that the pain is like the spontaneous symptom.