QuestionSBA
QuestionChoice
These are classical findings of carpal tunnel syndrome, the compression of the median nerve within the carpal tunnel. Altered sensation in the distribution of the median nerve is the most common finding, which becomes worse at night as it is common to sleep with flexed wrists, which increases pressure on the nerve.

Pregnancy is a risk factor for carpal tunnel syndrome. Weakness of the abductor pollicis brevis can occur as this muscle is supplied by the median nerve. Light percussion of the median nerve just proximal to the flexor retinaculum will elicit paraesthesia in carpal tunnel syndrome, which is known as a positive Tinel’s sign. Severe carpal tunnel syndrome can also cause paralysis and wasting of the thenar eminence.
10004526
a
Carpal tunnel syndrome
QuestionChoice
Palsy of the median nerve, for example at the elbow, would likely result in these findings plus an inability to pronate the forearm, weak wrist flexion and ulnar deviation of the wrist.
10004529
d
Median nerve palsy
QuestionChoice
Scaphoid fracture is mostly caused by a traumatic injury, most commonly a fall onto an outstretched hand. This usually presents with pain along the radial aspect of the wrist, at the base of the thumb and in the anatomical snuffbox, with an associated loss of grip strength. Typical signs include pain worsening on longitudinal compression of the thumb, wrist joint effusion (especially in acute presentations), and pain on ulnar deviation of the wrist.
10004527
b
Scaphoid fracture
QuestionChoice
Ulnar nerve palsy results in a characteristic ‘claw hand’ deformity. The ulnar nerve innervates most intrinsic muscles of the hand (apart from the thenar eminence and the lateral two lumbricals), therefore its damage results in hyperextension of the metacarpophalangeal joints and flexion of the 4th and 5th digit interphalangeal joints. Wasting and paralysis of the hypothenar eminence and other intrinsic hand muscles innervated by the ulnar nerve would also be seen. Sensory loss or changes would be in the ulnar distribution (palmar and dorsal aspects of the medial 1.5 digits).
10004528
c
Ulnar nerve palsy
QuestionChoice
This is caused by compression of a particular nerve root (e.g. C5) as it leaves the spinal cord. Typical symptoms of cervical radiculopathy include pain corresponding to a particular dermatome and muscle weakness corresponding to a particular myotome. The symptoms, in this case, are not associated with either of these, but with the distribution of a particular peripheral nerve, the median nerve. Paraesthesia in cervical radiculopathy is also usually provoked by particular neck movements.
10004530
e
Cervical radiculopathy
Concept
Chapter
2693
3858
Carpal tunnel syndrome
Topic
145
Orthopaedics
13452
A 36-year-old pregnant woman presents with ‘pins and needles’ in her thumb, index and middle fingers, and across the lateral aspect of her palm, which becomes worse at night. Upon examination, she has weak thumb abduction and Tinel’s sign is positive.

Which of the following is the most likely diagnosis?
a