Carpal tunnel syndrome (CTS) is commonly seen by general practitioners and often presents with neurologic symptoms of nocturnal pain and paresthesia along the median nerve distribution. Approximately 20% of patients also present with cutaneous findings (ulcerations, blistering, sclerodactyly, nail dystrophy) characterizing a severe form called necrotic CTS. Necrotic CTS can also be associated with bone changes (acro-osteolysis). In the author's practice, combined nail and skin findings are not an uncommon presentation of CTS, although this form remains overlooked and underreported in the dermatological textbooks and studies. This manuscript aims to review the literature on CTS cases, with a specific focus on using associated nail findings as diagnostic clues. The literature review along with a few additional recent cases from the author's practice demonstrate that CTS is frequently accompanied by a variety of nail changes including koilonychia, longitudinal fissuring, Beau's lines, onychomadesis, melanonychia, nail thickening, hyperkeratosis, and ischemic ulcerations with paronychia. Furthermore, when these changes are limited to the second and third fingernails, they should prompt the diagnosis of CTS. Once suspected, diagnostic evaluation is not difficult and surgical management can resolve cutaneous findings and prevent irreversible changes such as acro-osteolysis.

腕管综合症（CTS）在普通医生中很常见，并且通常表现出夜间疼痛和感觉异常的神经症状，沿着中位神经分布。大约20％的患者还表现出皮肤病征（溃疡，水疱，硬化，指甲营养不良），表现为一种严重的形式，称为坏死性CTS。坏死的CTS也可能与骨骼变化有关（肢端溶骨）。在作者的实践中，尽管皮肤科教科书和研究仍然忽略了这种形式，但结合了指甲和皮肤的发现并不是CTS的常见表现。该手稿旨在回顾有关CTS病例的文献，特别侧重于使用相关的指甲发现作为诊断线索。文献综述以及来自作者的其他一些近期案例 实践证明，CTS经常伴有各种指甲变化，包括角膜结节，纵向裂痕，Beau's纹，甲癣，黑色素瘤，指甲增厚，角化过度和甲状旁腺缺血性溃疡。此外，当这些变化仅限于第二和第三指甲时，它们应提示CTS的诊断。一旦被怀疑，诊断评估就不难了，手术管理可以解决皮肤病的发现并防止不可逆的变化，例如肢端骨溶解。当这些变化仅限于第二和第三只指甲时，应提示CTS的诊断。一旦被怀疑，诊断评估就不难了，手术管理可以解决皮肤病的发现并防止不可逆的变化，例如肢端骨溶解。当这些变化仅限于第二和第三只指甲时，应提示CTS的诊断。一旦被怀疑，诊断评估就不难了，手术管理可以解决皮肤病的发现并防止不可逆的变化，例如肢端骨溶解。