Paresthesias in the hand that cannot be reproduced with median nerve compression tests suggest which condition?

• A. Cubital tunnel syndrome
• B. Thoracic outlet syndrome
• C. C4 nerve root impingement
• D. Reflex sympathetic dystrophy

Answer: (B)

When paresthesias in the hand cannot be reproduced with maneuvers that test the median nerve, the issue isn’t at the carpal tunnel or along the median nerve itself. This points to compression higher up in the brachial plexus as it passes through the thoracic outlet. Thoracic outlet syndrome involves the lower trunk of the brachial plexus (and sometimes vessels) being compressed as the structures traverse the thoracic outlet, so symptoms in the hand can occur in patterns that median-nerve tests at the wrist wouldn’t reproduce. The problem is typically provoked by positions or activities that narrow the outlet, not by carpal tunnel–type testing, which explains why those tests fail to reproduce the paresthesias.