Patients frequently present with symptoms they describe as “carpal tunnel syndrome.” When a patient complains of this syndrome, I often use a modified paper clip to test 2-point discrimination in all digits. An inability to discriminate between the 2 pointed ends of the paper clip when these are pressed against the skin suggests nerve damage—which would be a late finding of carpal tunnel syndrome. This simple test, along with the Phalen maneuver and Tinel sign, can help confirm more severe cases. The diagnosis is suspect if the patient describes symptoms in the fifth digit.
—— Nathan Hitzeman, MD
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