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Carpal tunnel syndrome — SCE Rheumatology MCQ

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HardOsteoarthritis and soft tissue rheumatologyCarpal tunnel syndromeSCE Rheumatology

A 60-year-old woman has nocturnal median nerve symptoms without thenar wasting. Examination shows Tinel and Phalen tests are positive. Investigations show nerve conduction studies show mild median neuropathy. What is the most appropriate management?

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Correct answer: C — Use splinting and consider local injection for persistent symptoms

The best answer is “Use splinting and consider local injection for persistent symptoms”. Night wrist splint and local steroid injection if persistent is the best first management step for this non-inflammatory musculoskeletal presentation. The alternatives either over-medicalise a mechanical disorder or expose the patient to disproportionate risk. Education, exercise and function-focused goals are central to osteoarthritis and many soft-tissue syndromes. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

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