A 57 year old woman presents to her family physician complaining of numbness and tingling in her right thumb, index and long finger for the past four weeks. She repos that she wakes up in the middle of the night with these symptoms and needs to shake her hands to "wake" them up. She denies numbness or tingling in her other hand or either leg. She has no neck or upper arm pain. On physical examination, her symptoms are reproduced by Tinel testing. Her symptoms are also exacerbated by hyperflexion of the wrist. There is decreased sensation over the palmar aspects of the thumb, index and middle fingers. There is no apparent motor weakness. Which of the following is the most likely diagnosis?
The patient's symptoms are classic for carpal tunnel syndrome. Carpal tunnel syndrome is the most common compressive neuropathy in the upper extremity. It is caused by compression of the median nerve in the carpal tunnel. The median nerve provides sensation to the palmar side of the thumb, index finger, long finger and radial half of the ring finger. The floor of the tunnel is formed by the carpal bones; the roof is formed by the transverse carpal ligament.A patient with a C5 nerve cervical nerve root compression would have weakness in their deltoids and biceps with sensory changes in the lateral arm.Cubital tunnel syndrome is compression of the ulnar nerve at the elbow. Symptoms include pain and paresthesias over the medial forearm and hand as well as weakness in the ulnar nerve distribution.Radial tunnel syndrome is compression of a branch of the radial nerve at the forearm. It is a pain-only problem without motor or sensory changes.
C5 cervical nerve root compression
Carpal tunnel syndrome
Cubital tunnel syndrome
Radial tunnel syndrome