Differential diagnoses for CTS include the following:
Carpometacarpal arthritis of the thumb: Pain is localized, and grind test results are positive. Diagnosis is confirmed by radiologic findings.
Cervical radiculopathy (C6): Neck pain radiates to the fingers with numbness. Only the thumb and index finger are involved.
de Quervain tenosynovitis: Tenderness is observed at the distal radial styloid process.
Peripheral neuropathy: Bilateral symptoms are observed. The lower extremities are probably involved, as well as additional findings beyond the respective neuropathy.
Wrist arthritis: Wrist motion is painful, and radiographic findings are diagnostic.
Raynaud syndrome: The fingers change color, precipitated by cold exposure.
Ulnar compressive neuropathy: Paresthesias of the fourth and fifth fingers are observed. The Tinel sign is positive. Compression testing at the elbow or wrist canal confirms the diagnosis.
CTS is diagnosed by clinical findings. The use of electrophysiologic tools to determine disease extent and prognosis is necessary only in selected cases. These selected cases are probably candidates for surgical intervention. Electrophysiologic studies have a sensitivity of 56%-85% and a specificity of 94%-99% for CTS.
Radiographic studies are useful when anatomical abnormalities (eg, associated bone fracture, rheumatologic damage) are suspected. Ultrasonography may be used not only as a diagnostic tool but also as guidance for local steroid injection. MRI is not routinely used because the imaging features are frequently nonspecific and histologic examination is required to establish the final diagnosis. In addition, the cost of the test limits its use. In some cases, it is valuable after surgery.
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