Diagnostic Considerations

CTS versus C6 or C7 radiculopathy

Cervical radiculopathy usually causes neck and shoulder pain and restricted neck movements in acute radiculopathy.
Cervical radiculopathy has absence of nocturnal pain and paresthesias.
In cervical radiculopathy, paresthesias are usually limited to 1 side, whereas in CTS they are often bilateral. Root compression maneuvers may elicit paresthesias in radiculopathy.
Cervical radiculopathy of C6, produces weakness in C6-innervated muscles (biceps brachii, deltoid, pronator teres, brachioradialis) and depressed biceps tendon reflex; sensory loss may be restricted to thumb or digits 1-2 and may involve the dorsal more than palmar aspects.
Cervical radiculopathy of C7 produces weakness in C7-innervated muscles including triceps and finger extensors, and depressed triceps tendon reflex; sensory loss over the region of the middle finger involves the dorsal and palmar aspects.
In cervical radiculopathy of C6 or C7, the intrinsic hand muscles are not affected due to C8/T1 innervation.
In cervical radiculopathy, the median nerve sensory nerve conduction study results are normal.

CTS versus proximal median nerve problem

The flexor pollicis longus muscle is innervated by the anterior interosseus branch of the median nerve. This muscle flexes the distal phalanx of the thumb and is not involved in CTS
In CTS, sensation over the thenar area is spared, as it is innervated by the palmar cutaneous sensory branch that exits from the median nerve proximal to the wrist.

CTS versus de Quervain tenosynovitis syndrome

Tenosynovitis develops in the abductor pollicis longus and extensor pollicis brevis tendons, which are held in a groove of the radius by a firm segment of the extensor retinaculum.
Signs and symptoms include the following: (1) pain in the radial aspect of the wrist and thumb that is aggravated by movement of the wrist and thumb; (2) pain and paresthesias radiating into the thumb, dorsum of the hand, and index finger due to irritation of the radial nerve by severe inflammation; and (3) pain when the thumb is flexed into the palm while the examiner deviates the wrist in the ulnar direction (ie, Finkelstein test).

CTS versus lacunar/thalamic infarcts

Sensory symptoms in thalamic infarcts may affect the hand unilaterally. The paresthesias are more constant and associated with the perioral involvement.

Differential Diagnoses

Workup

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Media Gallery

Scars from carpal tunnel release surgery.
Anatomy of the carpal tunnel.
Anatomy of the median nerve and the carpal tunnel.

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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, American Academy of Pain Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Neil A Busis, MD Chief of Neurology and Director of Neurodiagnostic Laboratory, UPMC Shadyside; Clinical Professor of Neurology and Director of Community Neurology, Department of Neurology, University of Pittsburgh Physicians

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Neurology<br/>Serve(d) as a speaker or a member of a speakers bureau for: American Academy of Neurology<br/>Received income in an amount equal to or greater than $250 from: American Academy of Neurology.

Chief Editor

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL Co-Founder and Former Chief Publishing Officer, eMedicine and eMedicine Health, Founding Editor-in-Chief, eMedicine Neurology; Founder and Former Chairman and CEO, Pearlsreview; Founder and CEO/CMO, PHLT Consultants; Former Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, CPE, MHCM, FAAPL is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for Physician Leadership

Disclosure: Nothing to disclose.

Additional Contributors

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

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

Disclosure: Nothing to disclose.