It is Carpal Tunnel Syndrome or a mimicker

14 Aug 2023

Carpal tunnel is a common condition that occurs in approximately two to three per cent of the general population. Women are more likely to experience the condition than men and the average age of patients is generally 40 to 50 years. 

Globally, there is a worrying trend of misdiagnosis of those with carpal tunnel syndrome. In the United States, 10 per cent of patients with carpal tunnel are misdiagnosed. When extrapolated to Australia, this equates to potentially 20,000 patients a year being managed with an incorrect diagnosis. 

Symptoms of carpal tunnel

The symptoms of carpal tunnel can be very similar to that for cervical radiculopathy, ulnar/cubital tunnel syndrome, pronator syndrome or AIN compressive neuropathy to name a few.

It can be difficult to differentiate between carpal tunnel, other compressive neuropathies and some medical pathologies causing a peripheral neuropathy. 

The classic symptoms of carpal tunnel include: 

• Numbness and tingling in the median nerve distribution
• Night time numbness
• Weakness and/or atrophy of the thenar musculature
• Positive Tinel sign
• Positive Phalen test
• Loss of two-point discrimination

Investigation and diagnosis

There are different investigations that can supplement your clinical examination to ensure that the diagnosis is accurate. These include:

• USS - measure the size of the median nerve in the carpal tunnel 
• MRI - increased signal and size of the median nerve
• EMG/NCS – differentiates between mild/moderate/severe carpal tunnel. Can differentiate between cervical radiculopathy and carpal tunnel. 

As an orthopaedic surgeon, my preferred investigation is an EMG/NCS as it is very useful pre-operatively to guide patient prognosis and being able to counsel patients on any longer term residual symptoms they may continue to experience post-surgery. 

Importantly, it can also rule out other potential causes of carpal tunnel type symptoms. 

Management of carpal tunnel syndrome

Management of carpal tunnel syndrome depends on the severity and duration of the symptoms. It can vary from modifying activities, wearing a splint, cortisone injection or surgery. 

The team at Perth Carpal Tunnel Clinic includes Neurologist Dr Sameer Saleem who performs NCS/EMG onsite, Upper Limb Orthopaedic Surgeon Dr Wael Chiri who provides a consultation to review all investigations and clinically assess patients, and Flex Physiotherapy who can develop comfortable night time splints, if required. 

One referral is all that is required to have your patients adequately assessed and managed for their neuropathy. 

Referrals

Do not hesitate to email or call the Perth Carpal Tunnel Clinic on 08 6245 5535 or [email protected]. Alternatively, visit Perth Carpal Tunnel Clinic to send a referral directly.