Symptoms may be reproduced by volar wrist
percussion (Tinel sign), sustained wrist flexion (Phalen sign), or wrist
extension (palmar prayer sign). Occurring in the context of familial
aggregation and excluding secondary causes such as trauma, local edema
(during pregnancy), tissue infiltration (myxedema, mucopolysaccharidosis,
mucolipidosis, sarcoidosis, amyloidosis), or inflammatory tenosynovitis
(rheumatoid arthritis, gout, systemic lupus erythematosus). Thickened
transverse carpal ligament and digital flexor tenosynovitis are observed.
Familial carpal tunnel syndrome is described in related persons suffering
from amyloidosis, mucopolysaccharidosis, and mucolipidosis.