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Carpal tunnel syndrome — SCE Rheumatology MCQ

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HardOsteoarthritis and soft tissue rheumatologyCarpal tunnel syndromeSCE Rheumatology

A patient with carpal tunnel syndrome has persistent numbness, thenar wasting and weak thumb abduction despite splinting. What is the next step?

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Correct answer: C — Nerve-conduction assessment followed by referral for surgical decompression

Thenar weakness or wasting indicates severe median-nerve compromise and warrants expedited assessment for decompression rather than prolonged conservative treatment. Electrodiagnostic testing helps grade severity and exclude an alternative neuropathy.

Reference: NHS England decision aid for carpal tunnel syndrome (Published July 2022): https://www.england.nhs.uk/statistics/wp-content/uploads/2022/07/Making-a-decision-about-carpal-tunnel-syndrome.pdf; NICE CKS: carpal tunnel syndrome — management (Current NICE CKS, accessed 30 July 2026): https://cks.nice.org.uk/topics/carpal-tunnel-syndrome/management/management/