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Carpal Tunnel Syndrome - CLINICAL


Sometimes, patients complain of an intermittent pins-and-needles sensation in the median nerve distribution of the hand. This kind of sensation is generally worse at night.

  • Common symptoms of carpal tunnel syndrome are most often bilateral, insidious in onset and progressive in nature.
    • With advanced nerve compression, the aching sensation is persistent and static and may radiate to the forearm and elbow.


Tapping the volar wrist over the median nerve (Tinel's sign) may produce paresthesias in the median distribution of the hand.

  • Thenar atrophy may be present in advanced cases of carpal tunnel syndrome (CTS).
  • Hyperflexion of the wrist for 60 seconds may also elicit paresthesias (Phalen's sign).


  • Activities involving repetitive wrist flexion, such as assembly packing, computer keyboard work, playing a musical instrument and craftwork, can cause inflammation of the flexor tendon sheath.
  • Pregnancy or oral contraceptive-related related edema can cause compression of the median nerve.
  • Trauma of any type, including fractures, can cause edema that can compress the median nerve.
  • Tuberculosis
  • Hemodialysis
  • Hypothyroidism
  • Amyloidosis
  • Acromegaly
  • Rheumatoid arthritis
  • Gout
  • Renal failure, diabetes mellitus and obesity have all been associated with an increased risk of carpal tunnel syndrome.