Which signs and provocative tests are typical for carpal tunnel syndrome?

Which signs and provocative tests are typical for carpal tunnel syndrome?

• A. Radial nerve distribution numbness and wrist drop; Finkelstein test.
• B. Median nerve distribution numbness/paresthesias, weakness at thenar eminence; Phalen's maneuver and Tinel sign may reproduce symptoms.
• C. Ulnar nerve distribution numbness at little finger; Froment sign.
• D. Brachial plexus traction pain with weakness in deltoid; Spurling maneuver.

Answer: (B)

The signs and provocative tests for carpal tunnel syndrome revolve around the median nerve at the wrist. Compression there causes numbness or tingling in the lateral (thumb-side) three and a half digits and weakness of the thenar muscles, especially the abductor pollicis brevis. Phalen’s maneuver (holding the wrists in full flexion to increase carpal tunnel pressure) and Tinel’s sign (tapping over the carpal tunnel to elicit tingling) are classic tests that reproduce symptoms when median nerve function is compromised. This combination of sensory disturbance in the median nerve distribution and thenar weakness, with positive Phalen’s and Tinel’s signs, is characteristic of CTS. By contrast, symptoms or tests pointing to the radial nerve (wrist drop) fit a radial neuropathy, De Quervain’s tenosynovitis is suggested by Finkelstein’s test, ulnar nerve involvement shows numbness at the little finger and Froment’s sign, and cervical radiculopathy is suggested by brachial plexus/Spurling findings.

The signs and provocative tests for carpal tunnel syndrome revolve around the median nerve at the wrist. Compression there causes numbness or tingling in the lateral (thumb-side) three and a half digits and weakness of the thenar muscles, especially the abductor pollicis brevis. Phalen’s maneuver (holding the wrists in full flexion to increase carpal tunnel pressure) and Tinel’s sign (tapping over the carpal tunnel to elicit tingling) are classic tests that reproduce symptoms when median nerve function is compromised. This combination of sensory disturbance in the median nerve distribution and thenar weakness, with positive Phalen’s and Tinel’s signs, is characteristic of CTS.

By contrast, symptoms or tests pointing to the radial nerve (wrist drop) fit a radial neuropathy, De Quervain’s tenosynovitis is suggested by Finkelstein’s test, ulnar nerve involvement shows numbness at the little finger and Froment’s sign, and cervical radiculopathy is suggested by brachial plexus/Spurling findings.