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Carpal Tunnel Syndrome — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyCarpal Tunnel SyndromeSCE Rheumatology

A 40-year-old office worker has intermittent pain and paraesthesia affecting the thumb, index and middle fingers, particularly at night. Tinel and Phalen tests are positive. There is no persistent sensory loss, thenar weakness or muscle wasting. What is the most appropriate initial non-invasive treatment?

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Correct answer: C — Wrist splinting in a neutral position at night

The correct answer is C. Intermittent nocturnal paraesthesia in the median-nerve distribution, without persistent sensory loss, thenar weakness or wasting, indicates uncomplicated carpal tunnel syndrome suitable for initial non-invasive management. A neutral-position wrist splint worn at night limits wrist flexion and reduces pressure on the median nerve. Nerve- and tendon-gliding exercises have less certain evidence and are not preferred over splinting. Local corticosteroid injection can provide more rapid short-term relief and is reasonable if splinting is ineffective or rapid symptom control is required, but it is invasive. Oral high-dose prednisolone is not routine treatment. Surgical release is appropriate for progressive or severe neurological impairment, or symptoms persisting despite conservative treatment.

Reference: NHS, Carpal tunnel syndrome, treatment section, last reviewed 17 April 2024. https://www.nhs.uk/conditions/carpal-tunnel-syndrome/