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Carpal Tunnel in RA — SCE Rheumatology MCQ

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HardSoft Tissue RheumatologyCarpal Tunnel in RASCE Rheumatology

A woman with active rheumatoid wrist synovitis develops nocturnal thumb, index and middle-finger paraesthesia with thenar weakness. What mechanism best explains the neuropathy?

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Correct answer: E — Median-nerve compression from flexor tenosynovitis within the carpal tunnel

The best answer is “Median-nerve compression from flexor tenosynovitis within the carpal tunnel”. Rheumatoid wrist synovitis and flexor tenosynovitis can reduce carpal-tunnel space and compress the median nerve, producing the described sensory distribution and thenar weakness. Ulnar and radial lesions have different distributions, cervical myelopathy is not restricted to a median pattern, and small-fibre neuropathy does not usually cause focal thenar weakness.

Reference: NICE CKS carpal tunnel syndrome: https://cks.nice.org.uk/topics/carpal-tunnel-syndrome/