Carpal tunnel syndrome — SCE Rheumatology MCQ

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EasyOsteoarthritis and soft tissue rheumatologyCarpal tunnel syndromeSCE Rheumatology

A 57-year-old woman with hypothyroidism reports intermittent nocturnal tingling and numbness affecting the thumb, index finger and middle finger. Flexing the wrist for 60 seconds reproduces the paraesthesia. Neck examination is normal, and sensation in the little finger is preserved. What is the most likely diagnosis?

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Correct answer: B — Carpal tunnel syndrome

The correct answer is carpal tunnel syndrome, caused by compression of the median nerve at the wrist. The discriminating features are nocturnal paraesthesia in the median digital distribution and reproduction of symptoms by sustained wrist flexion, constituting a positive Phalen test. Hypothyroidism is an associated risk factor. C8 radiculopathy would more typically produce neck or radicular arm symptoms with sensory disturbance extending towards the ulnar hand and may cause myotomal weakness. Ulnar neuropathy principally affects the little finger and ulnar half of the ring finger. Raynaud phenomenon causes episodic, usually cold-triggered digital colour change rather than fixed nerve-distribution paraesthesia. Complex regional pain syndrome requires disproportionate regional pain with autonomic, sensory, sudomotor or motor/trophic abnormalities, none of which are described.

Reference: Hertfordshire and West Essex NHS Clinical Guidance. Carpal Tunnel Syndrome Pathway: Examination and Differential Diagnosis. 2026. https://www.hweclinicalguidance.nhs.uk/all-clinical-areas-documents/download?checksum=6f5d0b423298d083015ad980af13f57d&cid=1628&document=22&field=4