Dhaka MRCP Course

Carpal tunnel syndrome (CTS), a common case in station 5 (brief clinical consultation) in PACES. Know the examiner's expectation

(1) Consider other causes of hand pain/paresthesia which are common in this station like arthritis/Takayasu's disease/Raynaud's

(2) Exclude polyneuropathy (ask about paresthesia in the feet as well)

(3) Sensory examination (especially pinprick), confirm sensory changes in the distribution of median nerve (check both side of ring finger also as this one has supply from both median and ulnar nerve)

(4) Motor examination (especially check power of abductor policis brevis/thumb abduction)

(5) Try to elicit Tinel's sign (use correct method)

(6) Ask aboout neck pain (as cervical spondylosis is a common cause of hand paresthesia in practice)

(7) Explore underlying cause of CTS (hypothyroidism, work-related/typing, though CTS is commonly idiopathic)

(8) Investigations: NCS, wrist ultrasound, TSH, FT4

(9) Management: analgesic (gabapentin/pregabalin), wrist splint, local corticosteroid, carpal tunnel release surgery if progressive/motor weakness

Dr Md Mahiuddin Ahmed MRCP (UK)
Facilitator in concise academy & mrcp centre, dhaka, Bangladesh
email: [email protected]