Carpal tunnel syndrome — CCFP MCQ

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EasyMusculoskeletal and sportsCarpal tunnel syndromeCCFP

A 44-year-old administrative assistant has nocturnal numbness and tingling in the thumb, index and middle fingers. Symptoms improve when she shakes her hand. Phalen test is positive and there is no thenar wasting. What is the most likely diagnosis?

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Correct answer: C — Carpal tunnel syndrome

This patient has carpal tunnel syndrome. The combination of nocturnal paresthesia in the median nerve distribution (thumb, index, middle fingers), symptom relief with hand shaking (flick sign), and a positive Phalen test establishes the diagnosis clinically. CTS is diagnosed on the basis of characteristic history and physical findings; electrodiagnostic testing is optional in straightforward cases. The absence of thenar wasting rules out advanced motor compromise but does not exclude CTS. Ulnar neuropathy would affect the ring and little fingers. Cervical myelopathy is bilateral and lacks nocturnal awakening or relief with hand shaking. De Quervain tenosynovitis presents with radial wrist pain, not paresthesia. Raynaud phenomenon is a vasomotor disorder, not a compressive neuropathy.

Reference: Canadian Family Physician. 'Treatments for carpal tunnel syndrome.' Vol. 53, No. 7, July 2007. https://www.cfp.ca/content/53/7/1186; and PubMed. 'Sensitivity and Specificity of Examination Maneuvers for Carpal Tunnel Syndrome: A Meta-Analysis.' July 2023. https://pubmed.ncbi.nlm.nih.gov/37621797/