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Waking Up With Hand Pain Sensitive Indication For Carpal Tunnel Syndrome

Waking up from sleep at night because of pain in the hand is a more sensitive test for carpal tunnel syndrome than two more common and widely studied tests.

Research on 188 patients (346 affected hands) with carpal tunnel syndrome, confirmed with electrophysiologic diagnosis, found that a past medical history of awakening with severe pain at night was a more sensitive test than Phalen test or Tinel's sign.

A history of waking up was present in 163 (86.7 percent) of the patients, whereas the Phalen test was found in only 63 percent of hands, and Tinel's sign was found in only 59 percent.

The researchers found that waking up at night with pain from CTS, the commonest entrapment neuropathy, was correlated positively with a positive Phalen test, as well as the presence of the syndrome in both hands. But, there was no statistically significant link with the duration of symptoms of CTS, the intensity of symptoms or the presence of Tinel's sign.

The researchers behind the study, from the faculty of neurology at Gaziantep University , say the pain of CTS is usually worse at night, but that there have been few studies to assess the diagnostic value awakening against the common clinical tests.

In Tinel's sign, percussion leads to tingling sensations. In Phalen's test, the patient puts the wrist under pressure for a minute or so which pinches the median nerve.
Arthroplasty Arthroscopic Surgery 2002; 13(1): 10-14. "Comparison of Awakening From Sleep with Phalen Test And Tinel's Sign in Patients with Carpal Tunnel Syndrome"

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