- Overuse Syndromes:
- include muscle pain, tendinitis, fibrositis, epicondylitis, & psychological conditions that may contribute to disability;
- Ulnar Neuropathy:
- is considered since no more than half pts w CTS carpal tunnel syndrome can reliably report location of their paresthesias;
- Vascular Pathology:
- Anatomic Diff Dx:
- Cervical Root Impingement
- combination of nerve entrapment & radiculopathy (
C6-
C7) is not uncommon & is sometimes referred to as double crush syndrome;
- radiculopathy is identified by occurrence of proximal radiation of pain above shoulder, paresthesias with coughing or sneezing, or pattern of motor or sensory
disturbances beyond distribution of median nerve;
- correct diagnosis is established by noting the function of the muscles innervated by
C6-
C7 portions of radial nerve (ie function of wrist extensors and triceps);
- in addition, w/ thenar atrophy, consider the diagnosis of
T1 radiculopathy;
- dx is made by noting the function of the muscles innervated by the
T1 portion of the
ulnar nerve (hypothenar and interossei muscles);
- Thoracic Outlet Syndrome
- Compression at Ligament of Struthers:
- the ligament of Struthers is a band of fibrous tissue which connects the supra-condylar bone spur (present in a minority of patients) to the medial
epicondyle of the humerus;
- compression at this level will cause atrophy of forearm flexors as well as the thenar muscles;
- Pronator Teres Syndrome
- compression in forearm either between heads of
pronator teres or under the superficialis arcade;
- typically there is pain in median nerve distribution & Tinel's sign in the mid to upper forearm;
-
AIN may also become compressed, w/ finding of loss of the teminal flexion of the thumb and index finger;
- if there is thenar atrophy and loss of
AIN muscles (FPL, FDP, P.Q.), then CTS is unlikely;
- also consider
FPL rupture;
- Median Artery
- in majority of cases, median nerve artery ends w many branches in FDS muscle, proximal to wrist level;
- in about 1-2% of pts, it participates in palmar circulation;
- ref:
Can simple release relieve symptoms of carpal tunnel syndrome caused by a persistent median artery? Clinical experience.
- CMC arthritis: (see:
radial sided wrist pain)
- Other:
-
Myopathic Disorders
Carpal tunnel syndrome. Diagnostic and prognostic value of the tourniquet test.
Year Book: A New Diagnostic Test for Carpal Tunnel Syndrome. Durkan-JA. Original Article: J Bone Joint Surg. 1991. 73-A. pp 535-538.
"Life" above the neck: brain tumour presenting as carpal tunnel syndrome.
