Carpal tunnel syndrome: a practical review
Katz RT
American Family Physician. 1994 May 1;49:1371­9, 1385­6: Issue: 6
Carpal tunnel syndrome is the commonest focal entrapment syndrome. Forceful repetitive activity and vibration may be important workplace risk factors for carpal tunnel syndrome. Although systematic study has suggested that carpal tunnel syndrome is work­related, no clear "dose­response" curve has been found between the amount or severity of work and the incidence or severity of the syndrome. Nocturnal pain is a hallmark of the syndrome, and Phalen's test, the carpal compression test and the Tinel's sign are useful indicators of the diagnosis. The most commonly used confirmatory test is the nerve conduction study (NCS), with or without electromyography. Many cases are treated successfully with simple ergonomic modifications, splinting and steroid injections. In addition to traditional open procedures, carpal tunnel release may be performed endoscopically. 

Once motor symptoms start or one sees muscle wasting, please proceed straight to confirmation of diagnosis by NCS and then surgery if confirmed.

The shaded area is the usual area of discomfor in Carpal Tunnel Syndrome. The pain may be felt as high as the elbow.