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Carpal tunnel syndrome — SCE Rheumatology MCQ

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EasyOsteoarthritis and soft tissue rheumatologyCarpal tunnel syndromeSCE Rheumatology

A 42-year-old woman has nocturnal hand paraesthesia affecting thumb, index and middle fingers. Examination shows Tinel and Phalen tests reproduce symptoms. Investigations show thenar strength is mildly reduced. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: D — Night wrist splint

Night wrist splint is the best answer because night wrist splint is the most appropriate next step for carpal tunnel syndrome in this clinical setting. Bisphosphonate therapy is a plausible distractor, but it does not account for the key discriminator in the stem. Urgent antibiotics and Activity modification would be more appropriate in a different clinical pattern or at another point in the pathway, while Start methotrexate with folic acid is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: NICE NG226; NICE CKS musculoskeletal topics