WBR0242

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::A 65 year old women comes to see you at the office with complaints of right wrist pain for the past 3 months. She has numbness and tingling sensation in the first two fingers and her symptoms increase with activities requiring prolonged flexion or extension of the wrist. Her other medical problems are hypothyroidism, diabetes, chronic renal failure, coronary heart disease, hypertension and osteoporosis. A clinical diagnosis of carpel tunnel syndrome is made. Which is the most appropriate initial approach to manage her symptoms?]]
Answer A	AnswerA::Observation and tight sugar control
Answer A Explanation	AnswerAExp::'''Incorrect''' : Tight blood glucose control does not relive CTS symptoms.
Answer B	AnswerB::Oral prednisone
Answer B Explanation	[[AnswerBExp::Incorrect : Oral prednisone produces short term relief; however it is not the appropriate line of action in this patient.]]
Answer C	AnswerC::Steroid injection into carpel tunnel
Answer C Explanation	[[AnswerCExp::Incorrect : Injection of glucocorticoids into the region of the carpal tunnel is intended to reduce tissue inflammation and aid recovery. Its value relative to conservative treatment (eg, splinting) has been controversial.]]
Answer D	AnswerD::Continuous wrist splint
Answer D Explanation	[[AnswerDExp::Correct : A wrist splint or brace maintains the wrist in a neutral position, thus preventing prolonged flexion or extension of the wrist. Splinting may limit activities that raise pressure within the carpal tunnel or reduce its cross sectional area. Splinting is generally thought to be effective in reducing CTS symptoms, and it may delay or eliminate the need for surgery in mildly symptomatic patients. Hence this is the correct option.]]
Answer E	AnswerE::Surgical release of the ligament
Answer E Explanation	AnswerEExp::'''Incorrect''' : Surgical treatment of CTS appears to be more effective than splinting. It is usually indicated when conservative measures fail.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Carpel tunnel syndrome (CTS) is a clinical diagnosis. The diagnosis is suspected when the characteristic symptoms and signs are present. The most important of these are nocturnal pain or paresthesia in the distribution of the median nerve. Many options are available for the treatment of patients with carpal tunnel syndrome (CTS) and the modality chosen depends on the severity of nerve dysfunction (ie, mild, moderate, or severe). The specific choice of therapy will also vary according to patient preference and availability. For patients with mild to moderate CTS, conservative therapy is generally considered to be a reasonable first option with successful outcomes ranging from 20 to 93 percent. Conservative options include splinting, oral glucocorticoid or injections, ultrasound, nerve-gliding exercises, and yoga. Combined therapy may be more effective than the use of any single modality Educational Objective: References: ]]
Approved	Approved::Yes
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