Review Question - QID 3688

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Carpal Tunnel Syndrome Treatment Nonoperative QID: 3688 (OBQ11.265)

QID 3688 (Type "3688" in App Search)

A 44-year-old male factory worker presents with a 7-month history of pain and paresthesias involving the palmar aspect of the left thumb, index finger, long finger, and the radial half of the ring finger. He reports that this often occurs at night when trying to go to sleep. He has a history of anemia and obstructive sleep apnea. Percussion over the volar wrist crease produces electric sensation distally in the hand and wrist flexion with the elbow in extension produces thumb paresthesias within 18 seconds. Figure A demonstrates a radiograph of the left hand. A sensory nerve conduction velocity test shows a distal sensory latency of 5.7 ms. Which of the following is the most appropriate next step in management?

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Phonophoresis and 6-week course of Vitamin B6 (pyridoxine)

46/3934

Occupational therapy with wrist massage and activity modification

12%

483/3934

Wrist splinting

78%

3074/3934

1-month course of nonsteroidal anti-inflammatory drugs [NSAIDs] and physical therapy

244/3934

1-month course of bumetanide, smoking cessation, and physical therapy

41/3934

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The patients history, examination, and nerve conduction velocity tests (normal distal sensory latency is <3.5 ms) are consistent with carpal tunnel syndrome. There is Level 1 and 2 evidence supporting local steroid injection or splinting for the nonoperative treatment of carpal tunnel syndrome. Phonophoresis, Vitamin B6 (pyridoxine), heat therapy, bumetanide, and physical therapy are not considered the most appropriate options for carpal tunnel syndrome management.

The AAOS clinical guidelines for carpal tunnel syndrome consist of 9 clinical recommendations supported with a grading of the recommendation and levels of evidence for the literature contributing to the recommendation.

The use of neutral wrist splints for carpal tunnel syndrome is most useful for improving night-time symptoms. However wrist splinting is most functional at 30 degrees of extension, and the neutral splints can be functionally limiting when used during productive daytime hours.