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Differential Diagnosis of Carpal Tunnel Syndrome

- see carpal tunnel syndrome

- Overuse Syndromes:
       - include muscle pain, tendinitis, fibrositis, epicondylitis, & psychological conditions that may contribute to disability;

- 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:
          - ligament of Struthers is a band of fibrous tissue which connects the supra-condylar bone spur (present in a minority of patients) to 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
    - Ulnar Neuropathy:
          - is considered since no more than half pts w CTS carpal tunnel syndrome can reliably report location of their paresthesias; 
          - see ulnar nerve and cubital tunnel syndrome

    - CMC arthritis: (see: radial sided wrist pain

- Other:
    - Myopathic Disorders
    - Peripheral Neuropathy

[Carpal tunnel syndrome. Diagnostic and prognostic value of the tourniquet test.]

Year Book: A New Diagnostic Test for Carpal Tunnel Syndrome.    

"Life" above the neck: brain tumour presenting as carpal tunnel syndrome.

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