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Question

Difficulty: EasyPhysical Examination Findings

A 42-year-old administrative assistant schedules a clinic visit due to a three-month history of right-hand numbness and tingling that often awakens him at night. During the assessment, the physician taps gently over the volar surface of the patient's right wrist. This action immediately reproduces a shock-like sensation radiating into the palmar aspect of the thumb, index, and middle fingers. Which of the following conditions is most strongly suggested by this specific examination finding?

  1. Median nerve compression at the transverse carpal ligamentAnswer
  2. B
    Ulnar nerve entrapment at the cubital tunnel
  3. C
    Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons
  4. D
    Compression of the C6 spinal nerve root at the neural foramen
  5. E
    Brachial plexus compression within the interscalene triangle

Answer

Median nerve compression at the transverse carpal ligament
The correct answer identifies median nerve compression at the transverse carpal ligament (carpal tunnel syndrome). The clinical scenario describes Tinel's sign. Tapping over the median nerve at the volar crease of the wrist, which reproduces a tingling or shock-like sensation in the median nerve distribution (thumb, index, and middle fingers), is a classic and highly specific physical examination finding for this diagnosis.

Step-by-Step Solution

1
Identify the chief complaint and its anatomical location.
The patient has numbness and tingling in the right hand, specifically affecting the thumb, index, and middle fingers.
This symptom distribution maps precisely to the sensory territory of the median nerve.
2
Analyze the physical examination maneuver described in the vignette.
The physician taps the volar aspect of the wrist, reproducing the sensory symptoms.
This describes the Tinel sign, a provocative test used to identify nerve irritability or entrapment at a specific anatomical site.
3
Synthesize the findings to confirm the diagnosis.
A positive Tinel sign over the volar wrist combined with median nerve sensory symptoms confirms median nerve entrapment.
This constellation of clinical findings is diagnostic for carpal tunnel syndrome, where the median nerve is compressed by the transverse carpal ligament.

Key Concept

Tinel's sign (percussion over the volar wrist reproducing median nerve distribution symptoms) is a highly specific physical examination finding for carpal tunnel syndrome (median nerve compression at the transverse carpal ligament).
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Topics

Physical Examination Findings

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