Clinical Features of the Carpal Tunnel Syndrome (CTS)

 

Anatomic structures innervated by the median nerve:

(1) thumb (sensory)

(2) index finger (sensory)

(3) middle finger (sensory)

(4) radial side of the fourth finger (sensory)

(5) abductor pollicis brevis muscle (motor)

(6) flexor pollicis brevis (motor)

(7) opponens pollicis (motor)

 

Sensory findings in CTS:

(1) sensory changes in the fingers supplied by the median nerve, which may include:

(1a) numbness

(1b) tingling

(1c) pain

(1d) decrease in 2 point discrimination

(1e) decrease in ability to detect vibration

(2) pain or aches in the wrist

(3) pain radiating up the ventral surface of the arm

 

Sensory findings may get worse at night and on awakening in the morning.

 

Signs:

(1) flick sign: The patient tries to relieve symptoms in the hand by shaking it in the air.

 

Motor findings in CTS:

(1) weak grip

(2) history of dropping things

(3) wasting of muscles at the thenar eminence

(4) weak thumb abduction

Provocative Test	Elicitation of Symptoms in the Distribution of the Median Nerve
closed fist test	The patient actively flexes hand into a closed fist for 60 seconds.
tourniquet test	A blood pressure cuff inflated above systolic blood pressure for 60 seconds.
pressure provocation test	The examiner's thumb is pressed across the wrist for 60 seconds.
Tinet sign	The examiner continuously taps the distal wrist crease over the median nerve for 60 seconds.
Phalen sign	The patient flexes the wrist to 90 degrees for 60 seconds.