Mateusz Gładysz FESSH prep

FESSH prep Compressive neuropathies Median nerve — wrist

Carpal tunnel syndrome

Last reviewed v1.0

FESSH-005Compressive neuropathies●○○ basic

Regarding carpal tunnel syndrome (CTS).

  1. 1.CTS is the most common upper-extremity entrapment neuropathy.

  2. 2.Phalen's test is performed by passive wrist extension.

  3. 3.A bifid median nerve can be associated with CTS.

  4. 4.Electrodiagnostic studies are the gold standard for diagnosing CTS.

  5. 5.Surgical treatment is not recommended if there is thenar muscle atrophy.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-005
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. CTS is the most common upper-extremity entrapment neuropathy.

    True

    In the Atroshi southern-Sweden general-population survey of 2,466 responders, the prevalence of clinically and electrophysiologically confirmed CTS was 2.7% (95% CI 2.1–3.4%); CTS is the most prevalent entrapment neuropathy of the upper limb.

    • Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153-158. PMID 10411196

  2. 2. Phalen's test is performed by passive wrist extension.

    False

    The provocative manoeuvre described by Phalen in 1966 is sustained wrist flexion (typically held for 60 seconds), not extension; reproduction or worsening of paraesthesiae in the median distribution constitutes a positive test.

    • Phalen GS. The carpal-tunnel syndrome. Seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. J Bone Joint Surg Am. 1966;48(2):211-228. PMID 5934271

  3. 3. A bifid median nerve can be associated with CTS.

    True

    A bifid median nerve has a reported incidence of approximately 2.8% and a higher cross-sectional area than a non-bifid nerve; in Bagatur and colleagues' series, three patients with four bifid nerves — all associated with a persistent median artery — presented with carpal tunnel syndrome.

    • Bagatur AE, Yalcinkaya M, Atca AO. Bifid median nerve causing carpal tunnel syndrome: MRI and surgical correlation. Orthopedics. 2013;36(4):e451-e456. PMID 23590784

  4. 4. Electrodiagnostic studies are the gold standard for diagnosing CTS.

    False

    Graham's CTS-6 prospective evaluation showed that for patients with a pre-test probability ≥ 0.80 by clinical evaluation, electrodiagnostic testing did not change the post-test probability to a clinically relevant degree; clinical diagnosis with the CTS-6 is sufficient in most patients, and ultrasound (composite sensitivity 77.6%, specificity 86.8% in Fowler's meta-analysis) has emerged as a reasonable alternative confirmatory test.

    • Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008;90(12):2587-2593. PMID 19047703
    • Fowler JR, Gaughan JP, Ilyas AM. The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop Relat Res. 2011;469(4):1089-1094. PMID 20963527

  5. 5. Surgical treatment is not recommended if there is thenar muscle atrophy.

    False

    Thenar atrophy is a marker of severe, established median axonal loss and constitutes an indication for prompt carpal tunnel release rather than a contra-indication; it is recognised in the AAOS evidence-based guideline as a feature of severe CTS for which surgical decompression is recommended.

    • American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. 2016.