Answer:USMLE step 2 Mcq 53:A 34 woman complains of an aching left wrist pain that radiates into the forearm


Correct Answer: D
Carpal tunnel syndrome (tardy median palsy) results from compression of the median nerve within the carpal tunnel. It occurs most often in patients between 30 and 60 years old and is five times more common in women than in men Paresthesia over the sensory distribution of the median nerve is the most frequent symptom; it occurs more often in women and frequently causes the patient to awaken several hours after getting to sleep with burning and numbness of the hand that is relieved by exercise. The Tinel sign also may be demonstrated in most patients by percussing the median nerve at the wrist. Atrophy to some degree of the median-innervated thenar muscles has been reported in about half of the patients treated by operation. Acute flexion of the wrist for 60 seconds (Phalen test) in some but not all patients or strenuous use of the hand increases the paresthesia. Application of a blood pressure cuff on the upper arm sufficient to produce venous distention may initiate the symptoms


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