Loss of grip
Besides autonomic function and sensory function, the median nerve also carries a few motor fibers and contributes to gripping and specific hand movements. These patients often feel weakness in their hands or lose their grip without realizing it.
- Sensory distribution: When evaluating these symptoms, it is essential to locate the pain’s sensory distribution. It is located in the palmar aspect of the hand and distributed in the first to the fourth fingers of the hand, usually the fifth finger and surrounding areas. This is where sensory and autonomic symptoms are mostly reported.
- More symptoms in the dominant hand: The dominant hand is more often affected by carpal tunnel syndrome than the other hand. The condition can be bilateral, too, but patients often describe more severe symptoms in their dominant hand, even in bilateral carpal tunnel syndrome.
- Worsening at night: The pain sensation, tingling, and numbness are usually exacerbated at night and when patients are actively using their grip or doing repetitive movements with their hands.
- Improvements by shaking the wrist: Many patients describe that shaking their wrists makes them feel an improvement in their symptoms.
- Hoffmann-Tinel sign: This sign is elicited in the physical exam by doctors. They locate the median nerve and tap on the skin where the median nerve is running. This prompts a sensation of tingling in the hands.
- Phalen sign: This is another sign used by doctors during their physical exam. They will ask the patient to flex or extend the wrist for 60 seconds. When they do, they start feeling tingling in the hands. The flexion or extension should be complete for the exam to be accurate.
- Square wrist sign: This exam is elementary and only requires measuring the wrist width and the wrist thickness. After that, doctors calculate the thickness to wrist ratio. When it is greater than 0.7, the diagnosis of carpal tunnel syndrome is more likely.