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Carpal tunnel syndrome — MCCQE Part 1 MCQ

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EasyNumbness/TinglingCarpal tunnel syndromeMCCQE Part 1

A 46-year-old office worker has nocturnal numbness of the thumb, index and middle fingers reproduced by Phalen manoeuvre, with no neck pain. Which of the following is the most appropriate next step?

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Correct answer: A — Treat with nocturnal wrist splinting and ergonomic modification initially

Treat with nocturnal wrist splinting and ergonomic modification initially is the single best answer because the age, timing, examination findings and investigations in the vignette fit Carpal tunnel syndrome better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian musculoskeletal guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian musculoskeletal guidance