December 2012 · Vol. 61, No. 12: 726-732Carpal tunnel syndrome—try these diagnostic maneuvers
Physical maneuvers are an essential step in diagnosing carpal tunnel syndrome. This update can help you get up to speed on diagnosis and treatment.
Jennifer
Wipperman,
MD, MPHVia Christi Family Medicine Residency, University of Kansas School of Medicine, Wichita
jennifer.wipperman@viachristi.org Loren
Potter,
DOOrthopedic Hand Surgery, Aurora Medical Group, Oshkosh, Wis
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PRACTICE RECOMMENDATIONS
• Before considering surgery, offer patients with mild-to-moderate carpal tunnel syndrome (CTS) a trial of conservative therapy such as splinting or corticosteroids. A
• Order electrodiagnostic studies (EDS) as needed, to rule out other conditions with a similar presentation, confirm an uncertain diagnosis, and gauge the severity of CTS C, or when surgery is being considered. B
• Recommend carpal tunnel release for patients who have severe CTS or have failed to respond to nonsurgical t0reatment. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
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The authors reported no potential conflict of interest relevant to this article.
CASE Jane K, 52, comes to see you because of discomfort in her right wrist and tingling in her hand. The symptoms began 3 months ago, but have been getting progressively worse, and have started to interfere with her sleep. Ms. K often awakens with “pins and needles” in her hand, and says that she often has the urge to “shake it out.” Her sister has carpal tunnel syndrome (CTS), and Ms. K suspects that she does, too. On exam, you find that Ms. K has a positive Phalen’s and Durkan’s compression test, but normal Tinel’s test. She has normal strength and sensation in her hands. Her neck and upper extremity exam is otherwise unremarkable. You note that her hypothyroidism is well controlled, with a recent thyroid-stimulating hormone level of 1.2 mIU/L.
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