A 40-year-old woman presents with numbness of the thumb, index, and middle fingers that worsens at night, relieved by shaking the hand (Flick sign positive). Tinel's sign is positive at the wrist. Electrodiagnostic studies confirm carpal tunnel syndrome. She failed 3 months of splinting and a steroid injection. The next appropriate management is:

• A Repeat steroid injection and continue conservative management
• B Ulnar nerve decompression at Guyon's canal
• C Cervical spine MRI to rule out C6 radiculopathy before any intervention
• D Open or endoscopic carpal tunnel release (division of flexor retinaculum) ✓

Explanation

After failed conservative management (3+ months of splinting and corticosteroid injection), surgical carpal tunnel release is indicated. Both open and endoscopic techniques divide the transverse carpal ligament (flexor retinaculum) to decompress the median nerve. The Flick sign (shaking the hand relieves symptoms) is highly specific for CTS. Ulnar nerve decompression at Guyon's canal treats ulnar neuropathy affecting ring and little fingers — not appropriate here. Cervical MRI for C6 radiculopathy is indicated when clinical features are ambiguous; with confirmed electrodiagnostic CTS and failed conservative treatment, surgery is the next step.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.