American Board of Internal Medicine (ABIM) Certification Practice Exam

Patients with carpal tunnel syndrome who have active denervation should undergo what procedure?

1. Physical therapy

2. Decompression surgery

3. Medial nerve injection

4. Wrist splinting

The correct answer is: Decompression surgery

In patients with carpal tunnel syndrome who exhibit signs of active denervation, the most appropriate procedure is decompression surgery. Active denervation indicates that there is significant nerve dysfunction resulting from prolonged compression of the median nerve at the wrist, which can lead to muscle atrophy if not addressed swiftly. Decompression surgery aims to relieve this pressure on the median nerve, restoring normal function and preventing further damage. Immediate surgical intervention is vital when there are clear signs of denervation, evidenced by symptoms such as muscle weakness or atrophy, as conservative treatments may not be sufficient to reverse the damage to the nerve. While options like physical therapy, medial nerve injection, and wrist splinting are often part of the management plan for carpal tunnel syndrome, they are more suitable for cases where patients have not yet developed acute neurological deficits. Upon the identification of active denervation, the priority shifts to surgical decompression to provide rapid relief and promote recovery of nerve function.