How can I differentiate carpal tunnel syndrome from other conditions that may present with similar symptoms, such as cervical radiculopathy?

To differentiate carpal tunnel syndrome (CTS) from cervical radiculopathy and other conditions with similar symptoms, consider the following clinical and diagnostic features:

• Symptom distribution: CTS typically causes numbness, tingling, and pain in the median nerve distribution of the hand (thumb, index, middle, and radial half of the ring finger), often worsening at night. Cervical radiculopathy symptoms usually follow a dermatomal pattern corresponding to the affected cervical nerve root and may include neck pain radiating to the arm.
• Physical examination: CTS may show positive Tinel’s or Phalen’s tests at the wrist, with sensory changes localized to the median nerve territory. Cervical radiculopathy may present with neck movement restriction, radicular pain, and objective neurological signs such as motor weakness or reflex changes in the affected myotome.
• Diagnostic tests: Nerve conduction studies (NCS) can detect impaired median nerve conduction across the carpal tunnel and help exclude other conditions like radiculopathy or polyneuropathy. However, NCS have moderate sensitivity and specificity and a low positive predictive value; some patients benefit from surgery despite normal NCS results.
• Imaging and specialist referral: If cervical radiculopathy is suspected, especially with objective neurological signs or symptoms persisting beyond 4–6 weeks, MRI is used to confirm nerve root compression. In contrast, CTS diagnosis is primarily clinical, with NCS as an adjunct if diagnosis is uncertain or symptoms persist despite conservative treatment.

Summary: Careful clinical assessment focusing on symptom location, physical signs, and appropriate use of NCS and imaging helps differentiate CTS from cervical radiculopathy. Referral for specialist assessment is advised if diagnosis is unclear, symptoms are severe, progressive, or unresponsive to initial treatment.

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