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Carpal tunnel syndrome — SCE Rheumatology MCQ

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HardOsteoarthritis and Soft Tissue RheumatologyCarpal tunnel syndromeSCE Rheumatology

A 49-year-old woman with rheumatoid arthritis has nocturnal paraesthesia affecting the thumb, index and middle fingers. Symptoms are reproduced by wrist flexion. Thenar strength is slightly reduced. The clinician wants to grade severity before considering decompression. What is the most appropriate investigation?

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Correct answer: C — Nerve conduction studies

The best answer is “Nerve conduction studies”. Nerve conduction studies most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Temporal artery ultrasound, after safety review”, “Synovial fluid crystal analysis”, “DEXA scan, within a rheumatology pathway”, “Anti-dsDNA titre, after safety review”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG100 rheumatoid arthritis in adults: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations