ABSTRACT
Clinical Presentation Patients with CTS typically report intermittent pain and paresthesias in the me
dian nerve distribution of the hand, comprising the thumb, index finger, middle finger, and radial half of the ring finger. Sensation in the thenar area of the palm tends to be unaffected, due to the fact that this area of the hand is innervated by the palmar cutaneous branch of the median nerve which “branches” off of the median nerve proximal to the carpal tunnel. Symptoms generally progress gradually over a period of months to years, and they are typically worse at night. These nighttime paresthesias are a classic symptom of a patient with CTS, which is attributable to the tendency for the wrist to flex during sleep. Symptoms may also be aggravated during the day by activities for which the wrist is flexed or extended for prolonged periods, or when the hands are vibrated, such as when holding a steering wheel.
