There is no consensus reference standard for the diagnosis of<unk> . A combination of described symptoms, clinical findings, and electrophysiological testing may be used. Correct diagnosis involves identifying if symptoms matches the distribution pattern of the median nerve (which does not normally include the 5th digit).<unk>  work up is the most common referral to the electrodiagnostic lab. Historically, diagnosis has been made with the combination of a thorough history and physical examination in conjunction with the use of electrodiagnostic (EDX) testing for confirmation. Additionally, evolving technology has included the use of ultrasonography in the diagnosis of<unk> . However, it is well established that physical exam provocative maneuvers lack both sensitivity and specificity. Furthermore, EDX cannot fully exclude the diagnosis of<unk>  due to the lack of sensitivity. A joint report published by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and the American Academy of Neurology defines practice parameters, standards and guidelines for EDX studies of<unk>  based on an extensive critical literature review. This joint review concluded median and sensory nerve conduction studies are valid and reproducible in a clinical laboratory setting and a clinical diagnosis of<unk>  can be made with a sensitivity greater than 85% and specificity greater than 95%. Given the key role of electrodiagnostic testing in the diagnosis of<unk> , The AANEM has issued evidence-based practice guidelines, both for the diagnosis of<unk> . Numbness in the distribution of the median nerve, nocturnal symptoms, thenar muscle weakness/atrophy, positive Tinel's sign at the<unk><unk> , and abnormal sensory testing such as two-point discrimination have been standardized as clinical diagnostic criteria by consensus panels of experts. Pain may also be a presenting symptom, although less common than sensory disturbances. Electrodiagnostic testing (electromyography and nerve conduction velocity) can objectively verify the median nerve dysfunction. Normal nerve conduction studies, however, do not exclude the diagnosis of<unk> . Clinical assessment by history taking and physical examination can support a diagnosis of<unk> . If clinical suspicion of<unk>  is high, treatment should be initiated despite normal electrodiagnostic testing. Physical exam Although widely used, the presence of a positive Phalen test, Tinel sign, Flick sign, or upper limb nerve test alone is not sufficient for diagnosis. * Phalen's maneuver is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within sixty seconds. The quicker the numbness starts, the more advanced the condition. Phalen's sign is defined as pain or paresthesias in the median-innervated fingers with one minute of wrist flexion. Only this test has been shown to correlate with<unk>  severity when studied prospectively. The test characteristics of Phalen's maneuver have varied across studies ranging from 42 to 85% sensitivity and 54 to 98% specificity. * Tinel's sign is a classic test to detect median nerve irritation. Tinel's sign is performed by lightly tapping the skin over the flexor retinaculum to elicit a sensation of tingling or "pins and needles" in the median nerve distribution. Tinel's sign (pain or paresthesias of the median-innervated fingers with percussion over the median nerve), depending on the study, has 38 to 100% sensitivity and 55 to 100% specificity for the diagnosis of<unk> . * Durkan test,<unk>  compression test, or applying firm pressure to the palm over the nerve for up to 30 seconds to elicit symptoms has also been proposed. * Hand elevation test The hand elevation test is performed by lifting both hands above the head, and if symptoms are reproduced in the median nerve distribution within 2 minutes, considered positive. The hand elevation test has higher sensitivity and specificity than Tinel's test, Phalen's test, and<unk>  compression test. Chi-square statistical analysis has shown the hand elevation test to be as effective, if not better than, Tinel's test, Phalen's test, and<unk>  compression test. As a note, a person with true<unk>  (entrapment of the median nerve within the<unk><unk>  will not have any sensory loss over the thenar eminence (bulge of muscles in the palm of hand and at the base of the thumb). This is because the palmar branch of the median nerve, which innervates that area of the palm, branches off of the median nerve and passes over the<unk><unk> . This feature of the median nerve can help separate<unk>  from thoracic outlet syndrome, or pronator teres syndrome. Other conditions may also be misdiagnosed as<unk> . Thus, if history and physical examination suggest<unk> , patients will sometimes be tested electrodiagnostically with nerve conduction studies and electromyography. The role of confirmatory nerve conduction studies is controversial. The goal of electrodiagnostic testing is to compare the speed of conduction in the median nerve with conduction in other nerves supplying the hand. When the median nerve is compressed, as in<unk> , it will conduct more slowly than normal and more slowly than other nerves. There are many electrodiagnostic tests used to make a diagnosis of<unk> , but the most sensitive, specific, and reliable test is the Combined Sensory Index (also known as the Robinson index). Electrodiagnosis rests upon demonstrating impaired median nerve conduction across the<unk><unk>  in context of normal conduction elsewhere. Compression results in damage to the myelin sheath and manifests as delayed latencies and slowed conduction velocities However, normal electrodiagnostic studies do not preclude the presence of<unk> , as a threshold of nerve injury must be reached before study results become abnormal and cut-off values for abnormality are variable.<unk>  with normal electrodiagnostic tests is very, very mild at worst. Imaging The role of MRI or ultrasound imaging in the diagnosis of<unk>  is unclear. Their routine use is not recommended. MRI has high sensitivity but low specificity to<unk> . High signal intensity would show accumulation of axonal transportation, myelin sheath degeneration or oedema. Differential diagnosis There are few disorders on the differential diagnosis for<unk> . Cervical radiculopathy can be mistaken for<unk>  since it can also cause abnormal or painful sensations in the hands and wrist. In contrast to<unk> , the symptoms of cervical radiculopathy usually begins in the neck and travels down the affected arm and may be worsened by neck movement. Electromyography and imaging of the cervical spine can help to differentiate cervical radiculopathy from<unk>  if the diagnosis is unclear.<unk>  is sometimes applied as a label to anyone with pain, numbness, swelling, or burning in the radial side of the hands or wrists. When pain is the primary symptom,<unk>  is unlikely to be the source of the symptoms. As a whole, the medical community is not currently embracing or accepting trigger point theories due to lack of scientific evidence supporting their effectiveness.
Carpal tunnel syndrome
Radial tunnel syndrome
Ulnar tunnel syndrome
Calpainopathy
Tarsal tunnel syndrome
Sciatica
Median nerve palsy
Anterior interosseous syndrome