The diagnosis of carpal tunnel syndrome
COMPRESSION of the median nerve in the carpal tunnel is the most common cause of pain, numbness, and tingling in the thumb, and index, middle, and ring fingers. Despite the frequency of this syndrome, many patients each year are referred to me because of median nerve compression at the wrist which has not been diagnosed correctly. Some of these patients have had long courses of physical therapy treatments on their necks, and some have in vain undergone scalenotomy or cervical laminectomy in an effort to obtain relief from the burning pain and numbness in their fingers. Other patients have been referred to a psychiatrist because the examining physician made the diagnosis of a purely functional disorder.
The diagnosis of carpal tunnel syndrome is not difficult to make if one remembers to include this condition in the differential diagnosis of pain and numbness in the hand. When a physician has seen a patient with carpal tunnel syndrome and has treated this patient successfully, the physician will not miss the diagnosis in subsequent patients. There are no more grateful patients than those who endured, for many years the pain and numbness in their fingers and who have been relieved by surgical decompression of the median nerve in the carpal tunnel.
Any condition that alters the contour or increases the contents of the carpal tunnel may press the median nerve against the transverse carpal ligament. This pressure on the median nerve produces a compression neuropathy that is manifested by motor and sensory changes . . .