With advanced nerve compression, an aching sensation is persistent and static and may radiate to the forearm and elbow. Activities involving repetitive wrist flexion, such as assembly packing, computer keyboard work, playing a musical instrument, and craftwork, can cause inflammation of the flexor tendon sheath. Trauma of any type, including fractures, can cause edema that can compress the median nerve. Pregnancy or oral contraceptive-related edema can cause compression of the median nerve. The physician who follows the patient after the acute presentation usually orders imaging studies and other tests discussed below.
Plain radiographs are very low-yield.
Ultrasonography shows promise but is currently 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 studies. Volar splint should be placed in neutral position since flexion and extension of the wrist increases carpal intracanal pressure. Initially, night splinting is indicated, with day splinting as needed for comfort.