Carpal Tunnel Syndrome — MCQs

10 questions

A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms hanging from the bed. Which of the following options correctly describes his condition and the test used to assess it?

Carpal tunnel syndrome is due to compression of -

A 56-year-old female presents with nocturnal pain in the right thumb, index, and middle fingers for the past 3 months. All of the following provocative tests can be performed except:

Not seen in carpal tunnel syndrome is:

Median nerve injury at the wrist is commonly tested by.

Which of the following is NOT a symptom of carpal tunnel syndrome?

Identify the true statement regarding the clinical examination given in the image:

The most commonly involved nerve in lunate dislocation is -

Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Q10

A 45-year-old woman presents with burning pain and numbness in the wrist and hand. Tinel's sign is positive. What is the most likely diagnosis?

Carpal Tunnel Syndrome Indian Medical PG Practice Questions and MCQs

Question 1: A patient at the orthopedics OPD complains of troubled sleep at night due to numbness and tingling sensation involving his lateral 3 digits. His symptoms are relieved as he lays his arms hanging from the bed. Which of the following options correctly describes his condition and the test used to assess it?

A. Guyon's canal syndrome, Froment's test
B. Carpal tunnel syndrome, Froment's test
C. Guyon's canal syndrome, Durkan's test
D. Carpal tunnel syndrome, Durkan's test (Correct Answer)

Explanation: ***Carpal tunnel syndrome, Durkan's test*** - The symptoms of **numbness and tingling** in the **lateral 3 digits** (thumb, index, middle, and radial half of the ring finger) are classic for **carpal tunnel syndrome (CTS)**, caused by compression of the **median nerve**. Relief with hanging the arm is due to gravity reducing swelling and pressure. - **Durkan's test** (or **median nerve compression test**) is highly specific for CTS. It involves direct pressure over the carpal tunnel, reproducing symptoms within 30 seconds. *Guyon's canal syndrome, Froment's test* - **Guyon's canal syndrome** involves compression of the **ulnar nerve** at the wrist, primarily affecting the **little finger** and the **ulnar half of the ring finger**, not the lateral 3 digits. - **Froment's test** assesses **ulnar nerve palsy** by observing the strength of adductor pollicis during a pinch grip, which is unrelated to median nerve compression. *Carpal tunnel syndrome, Froment's test* - While **carpal tunnel syndrome** is correctly identified based on the symptoms, **Froment's test** is not used to assess it. - As mentioned, Froment's test evaluates **ulnar nerve function**, particularly the adductor pollicis muscle. *Guyon's canal syndrome, Durkan's test* - The symptoms described (lateral 3 digits) are inconsistent with **Guyon's canal syndrome**, which affects the ulnar nerve distribution. - Although **Durkan's test** is appropriate for carpal tunnel syndrome, the diagnosis for Guyon's canal syndrome is incorrect.

Question 2: Carpal tunnel syndrome is due to compression of -

A. Median nerve (Correct Answer)
B. Radial nerve
C. Ulnar nerve
D. Palmar branch of the Ulnar nerve

Explanation: ***Median nerve*** - **Carpal tunnel syndrome** is a condition caused by the compression of the **median nerve** as it passes through the confined space of the carpal tunnel in the wrist. - Symptoms include numbness, tingling, and weakness in the thumb, index finger, middle finger, and the radial half of the ring finger, correlating with the median nerve's sensory and motor innervation. *Radial nerve* - The **radial nerve** is primarily responsible for innervation of the extensor muscles of the forearm and hand, and sensation over the back of the hand. - Compression of the radial nerve typically causes symptoms like **wrist drop** or sensory deficits on the dorsal aspect of the hand, which are not characteristic of carpal tunnel syndrome. *Ulnar nerve* - The **ulnar nerve** provides innervation to the little finger and the ulnar half of the ring finger, as well as some intrinsic hand muscles. - Compression of the ulnar nerve (e.g., in **Guyon's canal** or at the elbow in **cubital tunnel syndrome**) results in sensory or motor deficits in its distribution, distinctly different from carpal tunnel syndrome. *Palmar branch of the Ulnar nerve* - The **palmar branch of the ulnar nerve** is a superficial sensory branch of the ulnar nerve that innervates the skin over the hypothenar eminence. - Compression of this specific branch would cause isolated sensory changes in the hypothenar region, not the characteristic distribution seen in carpal tunnel syndrome.

Question 3: A 56-year-old female presents with nocturnal pain in the right thumb, index, and middle fingers for the past 3 months. All of the following provocative tests can be performed except:

A. Phalen's test
B. Tourniquet test
C. Finkelstein's test (Correct Answer)
D. Tinel sign

Explanation: ***Finkelstein's test*** - **Finkelstein's test** is used to diagnose **De Quervain's tenosynovitis**, which involves inflammation of the tendons on the thumb side of the wrist. - The patient's symptoms (nocturnal pain in the thumb, index, and middle fingers) are classic for **carpal tunnel syndrome (CTS)**, not De Quervain's. *Phalen's test* - **Phalen's test** is a provocative test for **carpal tunnel syndrome (CTS)**, where the patient forcefully flexes their wrists for 60 seconds. - A positive result, indicated by numbness or tingling in the median nerve distribution, supports a diagnosis of CTS. *Tourniquet test* - While not as commonly used as Phalen's or Tinel's, the **tourniquet test** (or **pressure test**) can provoke symptoms of **carpal tunnel syndrome (CTS)** by applying pressure to the median nerve. - It involves applying a blood pressure cuff to compress the wrist above the carpal tunnel, which can elicit median nerve symptoms. *Tinel sign* - The **Tinel sign** is a classic test for **carpal tunnel syndrome (CTS)**, performed by tapping directly over the median nerve at the wrist. - A positive sign is indicated by tingling or shock-like sensations radiating into the thumb, index, and middle fingers.

Question 4: Not seen in carpal tunnel syndrome is:

A. Pain of medial 3 fingers
B. Ape thumb deformity
C. Symptoms worsen at night
D. Sensory loss on lateral 3½ of palm (Correct Answer)

Explanation: ***Sensory loss on lateral 3½ of palm*** - In **carpal tunnel syndrome**, sensory loss typically affects the **lateral 3½ digits** (thumb, index, middle, and radial half of the ring finger) and the corresponding palm *distal to the wrist crease*. The palm *proximal to the wrist crease* is spared because its sensation is supplied by the **palmar cutaneous branch of the median nerve**, which originates proximal to the carpal tunnel. - Therefore, **sensory loss on the lateral 3½ of the palm *before the wrist crease*** is not characteristic of carpal tunnel syndrome, as this area is innervated by the palmar cutaneous branch which passes *outside* the carpal tunnel. The wording implies a broader palmar involvement, which would be inconsistent. *Pain of medial 3 fingers* - This is a common and characteristic symptom of carpal tunnel syndrome, as the **median nerve** innervates the lateral side of the hand, including the thumb, index, middle, and radial half of the ring finger. - Patients often describe **numbness, tingling, and pain** radiating into these fingers, particularly during activities that involve sustained wrist flexion or extension. *Ape thumb deformity* - This deformity is a sign of **chronic, severe median nerve compression** in carpal tunnel syndrome, leading to atrophy of the **thenar muscles** (abductor pollicis brevis, opponens pollicis, and superficial head of flexor pollicis brevis). - The thumb becomes **adducted and externally rotated**, lying in the same plane as the other fingers, resembling an ape's thumb. *Symptoms worsen at night* - This is a classic presentation of carpal tunnel syndrome, often due to **fluid accumulation** in the wrist and prolonged wrist flexion during sleep. - Patients frequently report being **woken up by numbness and pain** in their hands, requiring them to shake or move their hands for relief.

Question 5: Median nerve injury at the wrist is commonly tested by.

A. Contraction of abductor pollicis brevis (Correct Answer)
B. Loss of sensation on palm
C. Loss of sensation on ring finger
D. Contraction of flexor pollicis brevis

Explanation: ***Contraction of abductor pollicis brevis*** - The **abductor pollicis brevis (APB)** is primarily innervated by the **median nerve**, and its motor function is often the **first to be affected** and is a reliable test for median nerve integrity at the wrist. - Testing the **abduction of the thumb** against resistance (often called the "OK" sign or simply checking for strength) directly assesses the function of the APB and therefore the median nerve. *Contraction of flexor pollicis brevis* - The **flexor pollicis brevis (FPB)** has a **dual innervation**; its superficial head is supplied by the median nerve, but its deep head is often supplied by the ulnar nerve. - This dual innervation makes its contraction an unreliable isolated test for median nerve injury, as ulnar nerve compensation might mask a median nerve deficit. *Loss of sensation on palm* - While the median nerve supplies sensation to the radial side of the palm, an injury at the wrist, specifically within the **carpal tunnel**, typically spares the palmar cutaneous branch. - The **palmar cutaneous branch** of the median nerve arises proximal to the carpal tunnel and provides sensation to the thenar eminence and central palm, so its sensation is often preserved even with significant carpal tunnel syndrome. *Loss of sensation on ring finger* - The **ring finger** receives sensory innervation from both the **median nerve** (radial half) and the **ulnar nerve** (ulnar half). - Therefore, isolated loss of sensation on the ring finger would not be a definitive test for median nerve injury alone, as it requires assessment of both nerve distributions.

Question 6: Which of the following is NOT a symptom of carpal tunnel syndrome?

A. Phalen's sign
B. Pain & paraesthesia of wrist
C. Tinel sign
D. Ulnar nerve dysfunction (Correct Answer)

Explanation: ***Ulnar nerve dysfunction*** - Carpal tunnel syndrome specifically involves compression of the **median nerve**, not the ulnar nerve. - Symptoms related to the median nerve include numbness and tingling in the **thumb, index, middle, and radial half of the ring finger**, along with **thenar muscle wasting**. *Tinel sign* - The **Tinel sign** is a common physical examination finding in carpal tunnel syndrome, elicited by tapping over the **median nerve** at the wrist. - A positive sign involves tingling or electric shock-like sensations in the **median nerve distribution**. *Phalen's sign* - **Phalen's sign** is another classic physical maneuver used to diagnose carpal tunnel syndrome, where exaggerated wrist flexion for 60 seconds reproduces symptoms. - This maneuver increases pressure within the **carpal tunnel**, exacerbating median nerve compression. *Pain & paraesthesia of wrist* - **Pain and paraesthesia (numbness and tingling)** in the wrist and hand are hallmark symptoms of carpal tunnel syndrome. - These symptoms are often worse at night or with repetitive hand movements, reflecting **median nerve irritation**.

Question 7: Identify the true statement regarding the clinical examination given in the image:

A. Wrist is held in forced flexion for 60 sec eliciting pain (Correct Answer)
B. Wrist is held in forced extension for 60 sec
C. Wrist is held in forced flexion for 45 sec eliciting pain
D. Wrist is held in forced extension for 45 sec

Explanation: ***Wrist is held in forced flexion for 60 sec eliciting pain*** - The image depicts **Phalen's test**, used to diagnose **carpal tunnel syndrome**. In this test, the patient's wrists are held in maximal sustained **flexion** for 30-60 seconds. - The reproduction of **tingling or pain** in the median nerve distribution (thumb, index, middle, and radial half of the ring finger) within this time frame indicates a positive test. *Wrist is held in forced extension for 60 sec* - Holding the wrist in **forced extension** for 60 seconds describes **reverse Phalen's test**, not the standard Phalen's test shown. - While reverse Phalen's test also assesses for **carpal tunnel syndrome**, it typically involves holding the wrists in **extension**. *Wrist is held in forced flexion for 45 sec eliciting pain* - While **flexion** is correct for Phalen's test, the standard duration is up to **60 seconds**, not specifically 45 seconds to determine a positive result. - Pain should be elicited within this timeframe, but the 45-second duration is not the most accurate statement regarding the full range of the test's timing. *Wrist is held in forced extension for 45 sec* - This option incorrectly states **forced extension** rather than flexion for Phalen's test, and the specific duration of 45 seconds is not universally cited as the definitive endpoint for a positive result. - **Forced extension** is part of the reverse Phalen's maneuver, not the test shown.

Question 8: The most commonly involved nerve in lunate dislocation is -

A. Ulnar nerve
B. Median nerve (Correct Answer)
C. Posterior interosseous
D. Anterior interosseous

Explanation: ***Median nerve*** - In a **lunate dislocation**, the lunate bone dislocates anteriorly and rotates. This displaced lunate can directly compress the **median nerve** within the carpal tunnel, which lies just anterior to it. - Compression of the median nerve leads to symptoms of **carpal tunnel syndrome**, including numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar nerve* - The **ulnar nerve** passes through Guyon's canal, which is located more medially and is generally not directly compressed by an isolated lunate dislocation. - While other wrist injuries can affect the ulnar nerve, it is not the most common nerve involved in lunate dislocation. *Posterior interosseous* - The **posterior interosseous nerve** is a branch of the radial nerve and supplies muscles in the posterior compartment of the forearm; it is located away from the carpal bones and is very rarely affected by lunate dislocation. - Injury to this nerve typically results in wrist drop or issues with finger extension. *Anterior interosseous* - The **anterior interosseous nerve** is a branch of the median nerve that supplies deep flexor muscles in the forearm; it also lies away from the direct path of a dislocated lunate. - Injury to this nerve leads to an inability to make the "ok" sign due to paralysis of the flexor pollicis longus and flexor digitorum profundus to the index finger.

Question 9: Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

A. Ulnar
B. Median nerve (Correct Answer)
C. Radial nerve
D. Median & ulnar nerve

Explanation: ***Median nerve*** - The **lunate bone** dislocates volarly into the **carpal tunnel**, directly compressing the median nerve which passes through this space. - This compression leads to symptoms typical of **carpal tunnel syndrome**, such as numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar* - The **ulnar nerve** passes outside the carpal tunnel, through Guyon's canal, and is therefore not typically affected by injuries within the carpal tunnel itself. - Compression of the ulnar nerve would result in symptoms in the little finger and ulnar half of the ring finger, which are not the primary symptoms associated with lunate dislocation. *Radial nerve* - The **radial nerve** primarily innervates the dorsal aspect of the hand and travels more superficially in the forearm, not through the carpal tunnel. - Injuries to the radial nerve usually result from fractures of the humerus or direct trauma to the forearm, not lunate dislocation. *Median & ulnar nerve* - While both nerves can be affected by severe, generalized trauma to the wrist, a classic lunate dislocation specifically targets the **median nerve** within the carpal tunnel. - Concurrent ulnar nerve involvement is less common and would suggest additional or more extensive injury beyond a simple lunate dislocation affecting the carpal tunnel.

Question 10: A 45-year-old woman presents with burning pain and numbness in the wrist and hand. Tinel's sign is positive. What is the most likely diagnosis?

A. Radial nerve palsy
B. Cubital tunnel syndrome
C. Carpal tunnel syndrome (Correct Answer)
D. Thoracic outlet syndrome

Explanation: ***Carpal tunnel syndrome*** - **Burning pain**, **numbness** in the hand, and a **positive Tinel's sign** at the wrist are classic symptoms of median nerve compression within the carpal tunnel [1]. - The median nerve supplies sensation to the thumb, index, middle, and radial half of the ring finger, which is where symptoms are typically experienced [1]. *Radial nerve palsy* - This condition affects the **radial nerve**, causing **wrist drop** and sensory loss over the posterior forearm and dorsum of the hand [1]. - It does not typically present with burning pain or numbness in the distribution described. *Cubital tunnel syndrome* - Involves compression of the **ulnar nerve** at the elbow, leading to numbness and tingling in the **little finger** and ulnar half of the ring finger [1]. - While it can cause burning pain, the anatomical distribution of symptoms is distinct from the patient's presentation. *Thoracic outlet syndrome* - Results from compression of neurovascular structures in the **thoracic outlet**, causing varied symptoms such as pain, numbness, and weakness in the arm and hand [2]. - A positive Tinel's sign at the wrist is not a characteristic finding, and the symptom distribution is often broader or less specific to a single nerve.

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