Carpal Tunnel Syndrome Examination

Since carpal tunnel syndrome seems to be a favourite among musculoskeletal teaching, it is a good idea to know how to recognise these patients.

In the examination of the hand, you should want to focus on:

  • Inspection
    • Thenar atrophy (abductor pollicis brevis)
  • Tests
    • Abduction of the thumb against resistance
    • Check that the patient can hold thumb against the little finger against resistance (i.e. you try and break the connection between them) – this tests thumb opposition
    • Tinel’s test – tap over the median nerve (anterior wrist) with a tendon hammer.  If symptoms worsen, test is positive.
    • Phalen’s test– ask the patient to make an inverse prayer sign (i.e. wrist flexion) for 30-60 secs.  If symptoms appear/worsen during this time, test is positive.
    • Two-point discrimination can be a useful test too- using an opened out paper clip, ask the patient to close their eyes and map out the distance the patient can distinguish two points.
    • Check particularly the region of skin supplied by the median nerve, namely the radial half of the hand (thumb, first finger, second finger and lateral half of third/ring finger, with corresponding palm)

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