Review Question - QID 103296

The patient's history, examination, and nerve conduction velocity tests (normal distal sensory latency is <3.5 ms) are consistent with carpal tunnel syndrome.

Carpal Tunnel Syndrome is a common neuropathy affecting the peripheral median nerve caused by compression within the carpal tunnel. Repeated activity involving wrist flexion leads to edema within the carpal tunnel and compression of the median nerve. Patients with certain underlying conditions such as diabetes, hypothyroidism, rheumatoid arthritis, and chronic kidney disease on dialysis are especially prone to developing carpal tunnel syndrome. It is characterized by pain and paresthesias of the palm involving the wrist and/or volar aspect of the thumb, index finger, long finger, and the radial half of the ring finger. The patient often has feelings of clumsiness and weakness. Night pain and hypesthesia are also common. Chronic carpal tunnel syndrome may lead to thenar muscle atrophy. Diagnosis is often made clinically, but nerve conduction studies may be performed if the diagnosis is uncertain. Management consists of bracing and rest from repeated activity, as well as surgical management for cases refractory to conservative management.

Osiak et. al review the diagnosis and management of carpal tunnel syndrome. They note the classic clinical presentation of pain and paresthesias in the median nerve distribution. They further discuss strategies for management.

Incorrect Answers:
Answer 2: Cervical myelopathy would likely present with symptoms involving an entire nerve root distribution (e.g C6 or C7 distribution). This patient has symptoms affecting the median nerve distribution. In addition, neck pain would be expected

Answer 3: Cubital tunnel syndrome results from increased pressure on the ulnar nerve at the medial epicondyle, and would result in symptoms in the ulnar nerve distribution (e.g. 4th and 5th digits, hypothenar eminence).

Answer 4: Multiple sclerosis may cause hand numbness. However, this patient's age and sex are atypical for multiple sclerosis. In addition, other symptoms such as urinary incontinence, numbness, or weakness elsewhere would expected.

Answer 5: Ulnar tunnel syndrome may cause hand numbness, but symptoms would be in the ulnar nerve distribution.

Bullet Summary:
Carpal tunnel syndrome presents with pain and paresthesias in the median nerve distribution.