A carpenter presents with numbness of the thumb, index finger, and long finger for 6 months, worse at night and with prolonged gripping. Phalen's test is positive at 30 seconds. Nerve conduction velocity study shows prolonged median nerve distal motor latency of 5.2 ms (normal <4.5 ms) across the carpal tunnel. First-line treatment is:

• A Immediate surgical carpal tunnel release (open or endoscopic)
• B Local corticosteroid injection into the carpal tunnel
• C Physiotherapy and ultrasound therapy to the wrist
• D Neutral wrist splinting (especially at night) and activity modification for 6–12 weeks ✓

Explanation

For mild-to-moderate carpal tunnel syndrome without thenar wasting or fixed neurological deficit, neutral wrist splinting (maintaining the wrist in neutral position, especially nocturnally) is the recommended first-line treatment and reduces nocturnal pressure on the median nerve. Corticosteroid injection is effective for temporary relief and useful when splinting fails, before surgery is considered. Surgery is indicated for thenar atrophy, severe neurophysiology (absent SNAP or CMAP), or failure of 3 months of conservative management.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.