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ICD-9-CM Code

  • 354.0 Carpal tunnel syndrome

ICD-10-CM Codes

  • G56.01 Carpal tunnel syndrome, right upper limb

  • G56.02 Carpal tunnel syndrome, left upper limb

Preferred Practice Patterns1

Key Features


  • Entrapment neuropathy of the median nerve within the carpal tunnel of the wrist

  • Signs and symptoms typical of neuropathy, including

    • Pain,

    • Paresthesias

    • Loss of sensation

    • Later loss of muscle function

  • Symptoms are seen in the distribution of the median nerve in the hand

Essentials of Diagnosis

  • Pain, paresthesias, and sensory loss perceived on radial side of the palm and the palmar side of thumb, index, middle, and radial side of the ring fingers

  • Pain may radiate up to the elbow, shoulder, neck

  • Waking from pain at night is hallmark of this condition2

  • In advanced cases, motor dysfunction in thenar muscles may occur, characterized by weakness, atrophy, loss of coordination

General Considerations

  • In entrapment neuropathy, nerve becomes compressed, causing ischemic damage to the nerve

  • The carpal tunnel is a constrained area at the wrist bounded by the carpal bones and the transverse carpal ligament (flexor retinaculum)

  • The median nerve and 9 flexor tendons pass through the carpal tunnel

  • Pathomechanics involve decreased size of the tunnel or increased volume of the contents, causing compression on median nerve

  • Often associated with repetitive motions or sustained position of the wrist and hand

  • Unrelieved compression of the nerve results in neurapraxia with segmental demyelination further ischemic damage results in axonotmesis and wallerian degeneration


  • Incidence: 3.5 cases per 1,000 in general population

  • Prevalence: 2.1%

  • Most common entrapment neuropathy

  • More common in women than men (70% of cases are female)

  • 2.5 times more common in obese individuals

  • Most common among people aged 30 to 60 years

  • Nearly one-half of cases will experience bilateral symptoms

Clinical Findings

Signs and Symptoms

  • First symptom is usually pain or paresthesias; most commonly with gradual onset

  • Pain complaints include numbness (most common), tingling, burning

  • Pain or numbness waking the patient at night is very common

  • Pain is experienced in distribution of the median nerve in the hand, though may radiate up to elbow, shoulder, or neck

  • Tenderness to percussion or pressure over the carpal tunnel

  • Pain may be worse with extreme wrist flexion or extension

  • Sensory loss may follow early symptom of pain

  • Motor involvement (weakness, loss of coordination, atrophy) may follow in more advanced cases

Functional Implications

  • Pain with wrist movements

  • Difficulty with grasping and manipulation activities

  • Dropping items ...

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