Do I Have Carpal Tunnel Syndrome or is it Something Else? How to Sort it Out

By Lakeview Physio
Pain Management
June 20, 2022

If you think you may have nerve compression in your arms, please see a qualified medical professional, such as a registered physiotherapist, who can help you sort it out.

Carpal Tunnel Syndrome (CTS) is caused by compression of a nerve at the wrist (median nerve).  A tunnel is formed by the bones of the wrist and a sheet of tissue over top.  The median nerve travels through this tunnel.  The nerve can be compressed in this tunnel for numerous reasons.  CTS is very common.

Very occasionally (7-10%) of the time the median nerve can be compressed in other areas further up in the forearm. The term “proximal median nerve entrapment” (PMNE) includes all the other areas in the forearm where the median nerve can get compressed. This is where things get confusing.

Here are a few tips that will hopefully help sort it out.  

  1. With carpal tunnel syndrome (median nerve compression at the wrist) you will often experience:
    • Numbness, tingling, pain in the thumb, index, middle and ½ of the ring finger.
    • Above symptoms are worse at night or when the wrist is bent.
    • Symptoms are sometimes relieved by shaking your hands.
    • The pad at the base of your thumb (thenar eminence) may get smaller.
    • You may have some weakness and clumsiness in your hand.
  2. With proximal median nerve entrapment (median nerve entrapment above the wrist):
    • There are a couple of areas that are very very rare to get compression: pure anterior interosseous nerve compression and compression by Struthers ligament. Let’s not worry about the terms or details of these areas for now as they rarely happen.
    • Compression of the median nerve close to the elbow either by a muscle called pronator teres or at the laceratus fibrosus (tissue coming off the biceps tendon close to the elbow) are more common.
    • It can be a bit tricky to differentiate between the two areas as they both present with similar signs and symptoms:
      • Pain in the forearm
      • Numbness and tingling at the base of the thumb instead of the first 3 ½ fingers. Numbness and tingling are less common with PMNE than CTS.
      • Clumsiness of the hand
      • Loss of key grip
      • Difficulty making an ok sign with thumb and index finger
      • Symptoms are not worse at night.
    • Sometimes the only way to differentiate where the nerve is compressed is by a very careful assessment by a medical practitioner and some specialized tests.

In summary, the most common area for the median nerve to be compressed is at the wrist, followed occasionally by compression in tissues near the elbow.  It is important to note that there are other things that may be going on that can complicate the picture like: neck problems, hypersensitive nervous system, hormonal issues etc. 

If you think you may have nerve compression in your arms, please see a qualified medical professional, such as a registered physiotherapist, who can help you sort it out.


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Hagert E. Clinical diagnosis and wide-awake surgical treatment of proximal median nerve entrapment at the elbow: a prospective study. Hand (N Y). 2013, 8: 41–6.

Marcus R Bair, Michael T Gross, Jennifer R Cooke, Carla H Hill. Differential Diagnosis and Intervention of Proximal Median Nerve Entrapment: A Resident's Case Problem. J Orthop Sports Phys Ther . 2016 Sep;46(9):800-8

Mia Erickson, Marsha Lawrence, Caroline W Stegink Jansen, Diane Coker, Peter Amadio, Carla Clear. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome. J Orthop Sports Phys Ther . 2019 May;49(5): CPG1-CPG85.

Tang JB. Median nerve compression: lacertus syndrome versus superficialis-pronator syndrome. J Hand Surg Eur. 2021, 46: 1017-22


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