Pain, numbness, and tingling of the hands are increasingly common patient complaints. In this "informed consumer," Internet age, an increasing number of patients will present having self-diagnosed carpal tunnel syndrome. A review of my own patients' charts during a one-week period revealed that 35 percent of new patients had listed "carpal tunnel syndrome" as their presenting complaint. Of those, less than one-half truly had a carpal tunnel syndrome as the major or sole cause of their symptoms. This article will discuss what I believe to be one of the most common mistakes made in the initial assessment and treatment of patients presenting with pain, numbness, and tingling-failure to assess and treat problems of the cervical spine.
We must remember that the patient demographics for carpal tunnel syndrome are also the same as those for cervical spondylosis and cervical radiculopathy. The symptom complex overlaps, and the presence of compression at one level makes the nerve more susceptible to compression at another level. This is the so-called double crush syndrome. It is imperative, therefore, that we begin our examination of the hands (both with regard to history and physical examination) at the neck.
The classic features of night pain, numbness or tingling into the radial digits, and weakness or cramping of the thenar muscles are common to both CTS and cervical pathology. Important additional history includes any history of whiplash injuries or concussions. The patient should be questioned about frequent neck pain or stiffness. A particularly common complaint in cervical spine disease is frequent "trigger points" or "hot spots" in the trapezius region or between the shoulder blades. History concerning alteration in gait patterns, clumsiness of the hands, and problems with bowel or bladder function is critical for ruling out a myelopathic process.