Median Neuropathy Differential Diagnoses

  • Author: Friedhelm Sandbrink, MD; Chief Editor: Nicholas Lorenzo, MD   more...
 
Updated: Apr 27, 2010
 
 

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Friedhelm Sandbrink, MD  Assistant Professor of Neurology, Georgetown University School of Medicine; Assistant Clinical Professor of Neurology, George Washington University School of Medicine and Health Sciences; Director, EMG Laboratory and Chief, Chronic Pain Clinic, Department of Neurology, Washington Veterans Affairs Medical Center

Friedhelm Sandbrink, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen A Berman, MD, PhD  Professor, Department of Internal Medicine, Section of Neurology, Dartmouth Medical School; Chief, Neurology Service, White River Junction Veterans Medical Center

Stephen A Berman, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Neil A Busis, MD  Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside

Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology

Disclosure: Nothing to disclose.

References

  1. Lundborg G, Dahlin LB. The pathophysiology of nerve compression. Hand Clin. May 1992;8(2):215-27. [Medline].

  2. Bland JD. Carpal tunnel syndrome. Curr Opin Neurol. Oct 2005;18(5):581-5. [Medline].

  3. Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am. Mar 1981;63(3):380-3. [Medline].

  4. Rydevik B, Lundborg G, Bagge U. Effects of graded compression on intraneural blood blow. An in vivo study on rabbit tibial nerve. J Hand Surg Am. Jan 1981;6(1):3-12. [Medline].

  5. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. Aug 18 1973;2(7825):359-62. [Medline].

  6. Kwon HK, Hwang M, Yoon DW. Frequency and severity of carpal tunnel syndrome according to level of cervical radiculopathy: double crush syndrome?. Clin Neurophysiol. Jun 2006;117(6):1256-9. [Medline].

  7. Gelfman R, Melton LJ 3rd, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in carpal tunnel syndrome. Neurology. Jan 6 2009;72(1):33-41. [Medline]. [Full Text].

  8. Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology. Jan 22 2002;58(2):289-94. [Medline].

  9. Gelberman RH, Rydevik BL, Pess GM, Szabo RM, Lundborg G. Carpal tunnel syndrome. A scientific basis for clinical care. Orthop Clin North Am. Jan 1988;19(1):115-24. [Medline].

  10. Papanicolaou GD, McCabe SJ, Firrell J. The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Am. May 2001;26(3):460-6. [Medline].

  11. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol. Apr 1992;45(4):373-6. [Medline].

  12. Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. Feb 2006;77(2):263-5. [Medline]. [Full Text].

  13. Roquelaure Y, Ha C, Pelier-Cady MC, Nicolas G, Descatha A, Leclerc A, et al. Work increases the incidence of carpal tunnel syndrome in the general population. Muscle Nerve. Apr 2008;37(4):477-82. [Medline].

  14. Tanaka S, Wild DK, Seligman PJ, Behrens V, Cameron L, Putz-Anderson V. The US prevalence of self-reported carpal tunnel syndrome: 1988 National Health Interview Survey data. Am J Public Health. Nov 1994;84(11):1846-8. [Medline]. [Full Text].

  15. Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnel surgery. Instr Course Lect. 1995;44:167-72. [Medline].

  16. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. Jan 2008;77(1):6-17. [Medline]. [Full Text].

  17. Phalen GS. Reflections on 21 years' experience with the carpal-tunnel syndrome. JAMA. May 25 1970;212(8):1365-7. [Medline].

  18. Katz JN, Larson MG, Sabra A, Krarup C, Stirrat CR, Sethi R. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med. Mar 1 1990;112(5):321-7. [Medline].

  19. D'Arcy CA, McGee S. The rational clinical examination. Does this patient have carpal tunnel syndrome?. JAMA. Jun 21 2000;283(23):3110-7. [Medline].

  20. Pryse-Phillips WE. Validation of a diagnostic sign in carpal tunnel syndrome. J Neurol Neurosurg Psychiatry. Aug 1984;47(8):870-2. [Medline]. [Full Text].

  21. MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. Apr-Jun 2004;17(2):309-19. [Medline].

  22. Burke DT, Burke MA, Bell R, Stewart GW, Mehdi RS, Kim HJ. Subjective swelling: a new sign for carpal tunnel syndrome. Am J Phys Med Rehabil. Nov-Dec 1999;78(6):504-8. [Medline].

  23. Johnson EW, Gatens T, Poindexter D, Bowers D. Wrist dimensions: correlation with median sensory latencies. Arch Phys Med Rehabil. Nov 1983;64(11):556-7. [Medline].

  24. Kuhlman KA, Hennessey WJ. Sensitivity and specificity of carpal tunnel syndrome signs. Am J Phys Med Rehabil. Nov-Dec 1997;76(6):451-7. [Medline].

  25. Radecki P. A gender specific wrist ratio and the likelihood of a median nerve abnormality at the carpal tunnel. Am J Phys Med Rehabil. Jun 1994;73(3):157-62. [Medline].

  26. de Krom MC, Knipschild PG, Kester AD, Spaans F. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome. Lancet. Feb 17 1990;335(8686):393-5. [Medline].

  27. Durkan JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am. Apr 1991;73(4):535-8. [Medline].

  28. LaBan MM, Friedman NA, Zemenick GA. "Tethered" median nerve stress test in chronic carpal tunnel syndrome. Arch Phys Med Rehabil. Nov 1986;67(11):803-4. [Medline].

  29. Raudino F. Tethered median nerve stress test in the diagnosis of carpal tunnel syndrome. Electromyogr Clin Neurophysiol. Jan-Feb 2000;40(1):57-60. [Medline].

  30. Fleckenstein JL, Wolfe GI. MRI vs EMG: which has the upper hand in carpal tunnel syndrome?. Neurology. Jun 11 2002;58(11):1583-4. [Medline].

  31. Stein D, Neufeld A, Pasternak O, Graif M, Patish H, Schwimmer E, et al. Diffusion tensor imaging of the median nerve in healthy and carpal tunnel syndrome subjects. J Magn Reson Imaging. Mar 2009;29(3):657-62. [Medline].

  32. Khalil C, Hancart C, Le Thuc V, Chantelot C, Chechin D, Cotten A. Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol. Oct 2008;18(10):2283-91. [Medline].

  33. Andreisek G, White LM, Kassner A, Sussman MS. Evaluation of diffusion tensor imaging and fiber tractography of the median nerve: preliminary results on intrasubject variability and precision of measurements. AJR Am J Roentgenol. Jan 2010;194(1):W65-72. [Medline].

  34. [Guideline] Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. Jun 11 2002;58(11):1589-92. [Medline]. [Full Text].

  35. Robinson LR, Micklesen PJ, Wang L. Strategies for analyzing nerve conduction data: superiority of a summary index over single tests. Muscle Nerve. Sep 1998;21(9):1166-71. [Medline].

  36. Chang MH, Liu LH, Lee YC, Wei SJ, Chiang HL, Hsieh PF. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome. Clin Neurophysiol. May 2006;117(5):984-91. [Medline].

  37. Robinson LR, Micklesen PJ, Wang L. Optimizing the number of tests for carpal tunnel syndrome. Muscle Nerve. Dec 2000;23(12):1880-2. [Medline].

  38. Lew HL, Wang L, Robinson LR. Test-retest reliability of combined sensory index: implications for diagnosing carpal tunnel syndrome. Muscle Nerve. Aug 2000;23(8):1261-4. [Medline].

  39. American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of carpal tunnel syndrome. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=13304. Accessed December 23, 2009.

  40. Gooch CL, Mitten DJ. Treatment of carpal tunnel syndrome: is there a role for local corticosteroidinjection?. Neurology. Jun 28 2005;64(12):2006-7. [Medline].

  41. Moghtaderi AR, Jazayeri SM, Azizi S. EMLA cream for carpal tunnel syndrome: how it compares with steroid injection. Electromyogr Clin Neurophysiol. Sep-Oct 2009;49(6-7):287-9. [Medline].

  42. Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med. Jun 6 2002;346(23):1807-12. [Medline].

  43. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. Oct 8 2008;CD001552. [Medline].

  44. [Best Evidence] Hui AC, Wong S, Leung CH, et al. A randomized controlled trial of surgery vs steroid injection for carpal tunnelsyndrome. Neurology. Jun 28 2005;64(12):2074-8. [Medline].

  45. Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomised parallel-group trial. Lancet. Sep 26 2009;374(9695):1074-81. [Medline].

  46. Scholten RJ, Mink van der Molen A, Uitdehaag BM, Bouter LM, de Vet HC. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. Oct 17 2007;CD003905. [Medline].

  47. Jimenez DF, Gibbs SR, Clapper AT. Endoscopic treatment of carpal tunnel syndrome: a critical review. J Neurosurg. May 1998;88(5):817-26. [Medline].

  48. Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Can Fam Physician. Jul 2007;53(7):1161-2. [Medline]. [Full Text].

  49. Di Geronimo G, Caccese AF, Caruso L, Soldati A, Passaretti U. Treatment of carpal tunnel syndrome with alpha-lipoic acid. Eur Rev Med Pharmacol Sci. Mar-Apr 2009;13(2):133-9. [Medline].

  50. Chang MH, Chiang HT, Lee SS, et al. Oral drug of choice in carpal tunnel syndrome. Neurology. Aug 1998;51(2):390-3. [Medline].

  51. Chang MH, Ger LP, Hsieh PF, Huang SY. A randomised clinical trial of oral steroids in the treatment of carpal tunnel syndrome: a long term follow up. J Neurol Neurosurg Psychiatry. Dec 2002;73(6):710-4. [Medline]. [Full Text].

  52. Yang CP, Hsieh CL, Wang NH, Li TC, Hwang KL, Yu SC, et al. Acupuncture in patients with carpal tunnel syndrome: A randomized controlled trial. Clin J Pain. May 2009;25(4):327-33. [Medline].

  53. Altrocchi PH, Daube JR, Frishberg BM. Practice parameter: carpal tunnel syndrome. Neurology. 1993;43(11):2406-9.

  54. Campagna R, Pessis E, Feydy A, Guerini H, Le Viet D, Corlobé P, et al. MRI assessment of recurrent carpal tunnel syndrome after open surgical release of the median nerve. AJR Am J Roentgenol. Sep 2009;193(3):644-50. [Medline].

  55. Campbell WW. Diagnosis and management of common compression and entrapment neuropathies. Neurol Clin. Aug 1997;15(3):549-67. [Medline].

  56. Durkan JA. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am. Apr 1991;73(4):535-8. [Medline].

  57. Gross PT, Tolomeo EA. Proximal median neuropathies. Neurol Clin. Aug 1999;17(3):425-45, v. [Medline].

  58. Lama M. Carpal tunnel release in patients with negative neurophysiological examinations: clinical and surgical findings. Neurosurgery. Oct 2009;65(4 Suppl):A171-3. [Medline].

  59. Levine BP, Jones JA, Burton RI. Nerve entrapments of the upper extremity: A surgical perspective. Neurol Clin. Aug 1999;17(3):549-65, vii. [Medline].

  60. Morgan G, Wilbourn AJ. Cervical radiculopathy and coexisting distal entrapment neuropathies: double-crush syndromes?. Neurology. Jan 1998;50(1):78-83. [Medline].

  61. Nuber GW, Assenmacher J, Bowen MK. Neurovascular problems in the forearm, wrist, and hand. Clin Sports Med. Jul 1998;17(3):585-610. [Medline].

  62. Preston DC, Shefner JM, Rutkove SB. Electrodiagnosis of carpal tunnel syndrome: too many and too few tests. American Academy of Neurology Annual Meeting. 1999;2PC003.

  63. Preston DC. Distal median neuropathies. Neurol Clin. Aug 1999;17(3):407-24, v. [Medline].

  64. Verdon ME. Overuse syndromes of the hand and wrist. Prim Care. Jun 1996;23(2):305-19. [Medline].

  65. Zanette G, Cacciatori C, Tamburin S. Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain. Feb 2010;148(2):227-36. [Medline].

 
Previous
Next
 
Scars from carpal tunnel release surgery.
Anatomy of the carpal tunnel.
Anatomy of the median nerve and the carpal tunnel.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.