Classic and probable symptom patterns are more likely to have electrodiagnosis of CTS than other presentations. CTS is unlikely if no symptoms are present in digits 1,2, or 3. Symptoms are most often bilateral, insidious in onset, and progressive in nature. With advanced nerve compression, an aching sensation is persistent and static and may radiate to the forearm and elbow. The physician who follows the patient after the acute presentation usually orders the imaging studies and other tests discussed below.
Plain radiographs are very low-yield.
Ultrasonography shows promise but is still experimental. They are most helpful in the determination of the site and severity of nerve compression. Clinically symptomatic CTS may have normal nerve conduction findings. A volar splint should be placed in neutral position because flexion and extension of the wrist increases carpal intracanal pressure. Initially, night splinting is indicated, with day splinting as needed for comfort.