The key symptom of brachialgia paraesthetica nocturna (Lat.), in which the hand or hands go numb at night, especially during the early hours of the morning, coupled with pain in the forearm, is absolutely classic of this condition.

X-rays are generally of little diagnostic benefit, although they do have their place in the differential diagnosis of other simultaneous painful conditions affecting the hand.

High-resolution ultrasound allows the width of the bony carpal tunnel and any cystic changes in the area of the carpal tunnel to be assessed.

There is no indication for an MRI scan.

Neurological examination is strongly recommended: a definitive diagnosis of carpal tunnel syndrome can only be made following specialist neurological examination and must have been made before surgery can be considered. Only careful examination with arm nerve conduction studies (ENG) will allow the entrapment of nerves in the hand to be clearly distinguished from other orthopaedic conditions such as disc problems affecting the cervical spine.