Скачать или смотреть Tingling Fingers at Night? It Might Be More Than Carpal Tunnel

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Can a patient self-diagnose carpal tunnel syndrome?
Carpal tunnel syndrome is the most common type of nerve compression. According to some studies, it affects between 1% and 10% of the population. Repetitive motion, exposure to vibration, certain athletic activities, and specific medical conditions can increase the risk of developing carpal tunnel syndrome.

The most commonly associated conditions include diabetes, rheumatoid arthritis, pregnancy, hypothyroidism, and older age.

Carpal tunnel syndrome is diagnosed clinically.

In patients with a clinical diagnosis based on history and physical examination, electrodiagnostic studies typically do not change the likelihood of the diagnosis.

So the question remains: Can a patient self-diagnose carpal tunnel syndrome?

These are the most common clinical features of carpal tunnel syndrome:

Symptoms in the distribution of the median nerve—this includes pain, burning, numbness, and tingling in the thumb, index finger, and middle finger. The small (pinky) finger should not be affected. If a patient has symptoms in the small finger, this is not carpal tunnel syndrome.

The small finger is innervated by the ulnar nerve. Therefore, involvement of the ulnar nerve is not consistent with carpal tunnel syndrome.

One of the most specific tools is the self-administered hand diagram. The patient marks the areas where symptoms are felt. This can be extremely helpful and accurate in suggesting carpal tunnel syndrome.

Another common feature is night symptoms.

Nighttime numbness, pain, or tingling—often severe enough to wake the patient from sleep—is a strong clinical indicator. Patients frequently shake their hands to relieve the discomfort. The presence of night symptoms is also a good sign for treatment success.

Another finding is thenar muscle atrophy.
Patients may notice weakness, clumsiness, or visible wasting of the thenar muscles. If thenar atrophy is seen, it suggests a long-standing condition. Early diagnosis is key—don’t let this muscle waste away.
Patients can compare the affected hand with the unaffected one, or compare it with someone's hand to detect atrophy.

Phalen's test is performed by flexing the wrist for 60 seconds. This increases pressure within the carpal tunnel and can reproduce symptoms. If positive, the patient will feel numbness and tingling in the hand and wrist.

Tinel’s sign is another test. Light tapping over the median nerve at the carpal tunnel causes radiating paresthesia into the thumb, index, and middle fingers. A positive test indicates median nerve irritation.

Durkan’s compression test is the most sensitive. The examiner applies firm pressure over the median nerve in the carpal tunnel for 30 seconds. If this reproduces the patient's symptoms—such as numbness, tingling, or pain—it is considered a positive test.

If the patient has at least three of these six clinical findings, the likelihood of carpal tunnel syndrome is high.

Although self-diagnosis may be possible, it is essential to consult a physician for a formal and accurate diagnosis and to initiate proper treatment. Because several conditions can mimic carpal tunnel syndrome.

Double crush syndrome is one such example—carpal tunnel syndrome may coexist with another lesion along the course of the median nerve.

Cervical disc herniation, especially at C5–C6, can cause symptoms that resemble carpal tunnel syndrome. While the sensory distribution may seem similar, a physician’s clinical exam may reveal the herniated disc as the true cause.

Pronator teres syndrome, a proximal median nerve entrapment, is another mimicker. In this condition, the palmar cutaneous branch of the median nerve—which supplies sensation to the thenar eminence—is affected.

In carpal tunnel syndrome, the radial aspect of the palm retains sensation. In contrast, patients with pronator teres syndrome typically experience loss of sensation over the radial aspect of the palm.

Martin-Gruber anastomosis, a connection between the median and ulnar nerves in the proximal forearm, can also cause unusual exam findings and make diagnosis less straightforward.
Quizzes
1. Which nerve is compressed in carpal tunnel syndrome?
Answer: Median nerve
A) Ulnar nerve
B) Radial nerve
C) Median nerve
D) Musculocutaneous nerve
Explanation: The median nerve passes through the carpal tunnel and is the nerve affected in carpal tunnel syndrome.
2. Which fingers are typically affected in carpal tunnel syndrome?
Answer: Thumb, index, and middle fingers
A) Thumb, index, middle
B) Ring and small
C) Thumb, index, and middle fingers
D) Small and ring fingers only
Explanation: Carpal tunnel syndrome affects the median nerve distribution—thumb, index, and middle fingers.
3. Which finger is NOT involved in carpal tunnel syndrome?
Answer: Small (pinky)
Explanation: The small finger is innervated by the ulnar nerve and is not affected in CTS.