A 46-year-old administrative assistant complains of pain in the wrist that radiates into the palm and into the fingers. The clinician can test the patient for carpal tunnel syndrome by eliciting which of the following signs?
A. Tinel's sign
B. Apley's sign
C. Finkelstein sign
D. Lhermitte's sign
ANS: A
Carpal tunnel syndrome causes a range of neurological symptoms, including pain, paresthesia, and weakness. Frequently, nighttime pain is an early symptom. There may be a swelling at the wrist related to inactivity or flexion at night. The pain and/or paresthesias typically involve the anterior aspects of wrist, medial palm, and first three digits on the affected hand. However, pain may radiate up the forearm to the shoulder with numbness and tingling along the median nerve. Over time, hand weakness often develops. Pain and paresthesia are often relieved by the patient "shaking" the affected hand in a downward fashion; this is called the flicking sign. A positive Tinel's sign is elicited by tapping on the median nerve at the carpal tunnel, causing pain and tingling along the median nerve. Phalen's maneuver reproduces the pain after 1 minute of wrist flexion against resistance.
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