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Carpal tunnel syndrome — USMLE Step 3 MCQ

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EasyAmbulatory Medicine / Primary CareCarpal tunnel syndromeUSMLE Step 3

A 39-year-old administrative assistant has nocturnal numbness and tingling of the thumb, index, and middle fingers. Symptoms improve when she shakes her hand. Examination shows decreased sensation over the palmar thumb and positive Phalen test. Thenar strength is preserved. Which of the following is the most likely diagnosis?

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Correct answer: A — Carpal tunnel syndrome

Median nerve compression at the wrist causes nocturnal paresthesias in the radial three and a half digits and positive provocative testing.

Reference: AAOS carpal tunnel syndrome guidance: https://www.aaos.org/