What clinical signs and symptoms should I assess to confirm a diagnosis of carpal tunnel syndrome in a patient?

To confirm a diagnosis of carpal tunnel syndrome (CTS), assess for symptoms of numbness, tingling, and pain in the median nerve distribution, which typically affects the thumb, index, middle, and radial half of the ring finger. Patients often report nocturnal symptoms and may describe hand weakness or clumsiness, particularly with fine motor tasks. Clinical signs include a positive Phalen’s test (wrist flexion reproduces symptoms) and Tinel’s sign (tingling on tapping the median nerve at the wrist). Sensory loss or altered sensation in the median nerve territory and thenar muscle wasting or weakness may also be present in more advanced cases. Additionally, assessing for reduced two-point discrimination and grip strength can support the diagnosis. These clinical features, combined with a thorough history and examination, are essential to confirm CTS before considering further investigations or referral NICE CKS Bickel 2010Sucher & Schreiber 2014Holbrook et al. 2022.