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Carpal Tunnel Syndrome – Surgical Indication — SCE Neurology MCQ

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EasyPeripheral Neuropathy & NeuromuscularCarpal Tunnel Syndrome – Surgical IndicationSCE Neurology

A 35-year-old man presents with numbness and weakness in his right hand. Examination shows wasting of the right thenar muscles, weakness of thumb opposition and abduction, and reduced sensation over the palmar aspect of the lateral 3.5 fingers. Tinel's sign is positive at the wrist. NCS show prolonged distal motor latency of the right median nerve at the wrist with slowed sensory conduction velocity across the wrist. What is the management for this moderate-to-severe carpal tunnel syndrome?

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Correct answer: B — Surgical decompression (carpal tunnel release)

For moderate-to-severe carpal tunnel syndrome with thenar wasting and weakness (indicating axonal loss), surgical decompression (carpal tunnel release) is the recommended treatment per NICE guidelines. Wrist splinting and steroid injections are appropriate for mild CTS. Once thenar wasting has developed, conservative measures are unlikely to reverse the neurological deficit, and delayed surgery risks permanent median nerve damage. A: Splinting is insufficient for moderate-severe CTS. B: Steroid injection provides temporary relief but does not address structural compression with axonal loss. D: Oral steroids are not recommended. E: Physiotherapy alone is insufficient.

Reference: NICE CG156 Carpal Tunnel Syndrome (withdrawn but principles maintained in CKS); AANEM CTS Practice Parameters