Pain, paresthesia, and numbness in distribution of median nerve
Palmar aspect of thumb, index, middle, and radial aspect of ring finger
Awakening at night with burning pain and tingling in hand
Palmar aspect of thumb, index, middle, and radial aspect of ring finger
Sensation testing
Most specific - splitting of 4th digit in which medial aspect of 4th digit normal and lateral aspect abnormal
Most sensitive - abnormal sensation of distal palmar tip of 2nd digit
LOAF muscle weakness as compared to other hand - Lumbricals, with thumb Opposition, Abduction, Flexion
Tinel sign - poorly sensitive and specific
Tapping on palmar aspect of wrist reuslts in electric shock sensation shooting into hand
SN 0.50 and SP 0.77
Phalen maneuver
Holding wrists in flexion for 60 seconds evokes or worsens symptoms
SN 0.68 and SP 0.73
Durkan sign
Manual compression of<unk><unk>  reproduces symptoms after 30 seconds
SN 0.64 and SP 0.83
More sensitive and specific than Tinel and Phalen in earlier studies
Hand Elevation Test
Performed by having patient elevated both hands above the head
Positive if paresthesia, numbness, or dull pain felt within two minutes
SN 0.87 and SP 0.89
May see atrophy of thenar eminence in advanced cases
Most specific - splitting of 4th digit in which medial aspect of 4th digit normal and lateral aspect abnormal
Most sensitive - abnormal sensation of distal palmar tip of 2nd digit
Tapping on palmar aspect of wrist reuslts in electric shock sensation shooting into hand
SN 0.50 and SP 0.77
Holding wrists in flexion for 60 seconds evokes or worsens symptoms
SN 0.68 and SP 0.73
Manual compression of<unk><unk>  reproduces symptoms after 30 seconds
SN 0.64 and SP 0.83
More sensitive and specific than Tinel and Phalen in earlier studies
Performed by having patient elevated both hands above the head
Positive if paresthesia, numbness, or dull pain felt within two minutes
SN 0.87 and SP 0.89
Carpal tunnel syndrome
Spinal cord lesion
Anterior interosseous neuropathy
Cervical radicular pain
Posterior interosseous neuropathy
Thoracic outlet syndrome
Cauda equina syndrome
Multiple Sclerosis 