"Tethered" median nerve stress test in chronic carpal tunnel syndrome

Tension of the median nerve produced by simultaneous extension of the supinated wrist and distal interphalangeal joint of the index finger was noted to result in proximal volar forearm pain radiation in patients with chronic carpal tunnel syndrome. This sign was less frequent in patients with a more acute syndrome. Adhesions between the median nerve and the overlying transverse carpal ligament and the development of a pseudoneuroma can individually or together occur in the chronic carpal tunnel syndrome limiting distal nerve excursion of the tethered nerve during simultaneous wrist and index finger extension.