Article

The main aspects of positive and differential
diagnosis of carpal tunnel syndrome (CTS) in different clinical situations
encountered in daily practice. Authentic CTS can be discovered
in situations, which alter the usual presentation or therapeutic management. This
is the case for instance in pregnant women or in the elderly subject or with
acute motor forms where CTS discloses a focal intratunnel disorder (neuroma,
lipoma, arterial condition, bone disorder) or a general disease (hereditary
neuropathy, amylosis). In certain situations, the clinical manifestations suggest
a more proximal compression of the medial nerve (round pronator, Struthers
arcade, or superficial flexor) or an inflammatory condition (mononeuritis,
inflammatory demyelinising neuropathy). Locoregional disease may also be
involved, for instance a plexus (thoracobrachial outlet syndrome, post-radiation
plexitis) or radicular condition. The clinical presentation of diffuse
polyneuropathy with initial manifestations involving the upper limb
(ganglioneuropathies, polyradiculoneuritis, small-fiber neuropathies) may also be
misleading. Finally central conditions can sometimes be confused with CTS.
CONCLUSION: A rigorous physical examination and an electroneuromyogram are
determining to avoid diagnostic pitfalls.
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Langue : FRANCAIS