Practice Exam 5 Question

[michaela main]

For the below question, I am confused why the correct answer is carpal tunnel, because if there was thenar eminence sensory involvement couldn’t we assume it was likely not carpal tunnel, as that portion of the median nerve is spared as it innervates prior to passing through the carpal tunnel? Wouldn’t the more correct answer be thoracic outlet syndrome as it is higher in the chain? Thank you!

CASE 1 (question 1 of 4)

A 29-year-old IT consultant presents to your clinic with complaints of cervical pain. She states the symptoms have been ongoing for approximately 6 months. She rates the neck pain as mild but states the pain in her right arm is moderate and at times severe. She reports intermittent numbness and tingling in the thumb, index finger, and lateral forearm. These symptoms are exacerbated by her work and tend to be worse at night. Her neck pain is exacerbated with sitting, turning her head to the right, and working at the computer. She reports suffering a “stinger” to the right shoulder during a high school field hockey game, but otherwise her past medical history is unremarkable. Physical examination reveals a forward head and rounded shoulder posture. Cervical range of motion is within normal limits with the exception of painful end-range limitations into flexion and right rotation. Myotomal testing is 5/5, except right wrist extension was 4/5 and right grip strength was 75% of left grip strength. Dermatome testing revealed diminished sensation to light touch at the right thenar eminence and 1st and 2nd fingers on the palmar surface. Reflexes were 2+. Spurling’s test was negative.

Based on the information provided in this case, what are the two most likely diagnoses?

a. C6 radiculopathy or thoracic outlet syndrome
b. C5 radiculopathy or carpal tunnel syndrome
c. C5 radiculopathy or thoracic outlet syndrome
d. C6 radiculopathy or carpal tunnel syndrome

The patient has some of the classic signs of carpal tunnel syndrome: hand weakness, numbness tingling in hand (median nerve distribution), increased pain at night. This patient also has symptoms suggestive of C6 nerve root irritation.

[Kristin Hallberg]

This was a tricky one…
*Based on the times symptoms are more present (night and with computer work) – more suggesting carpal tunnel.
* The sensory findings (including thenar eminence) could still be caused by C6 radiculopathy
* TOS most commonly effects lower cervical nerves and no mention of shoulder/upper arm pain

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