American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common first-line treatment for mild to moderate carpal tunnel syndrome without weakness?

1. Physical therapy

2. Occupational therapy

3. Nocturnal splinting

4. All of the above

The correct answer is: All of the above

In the management of mild to moderate carpal tunnel syndrome, especially in cases without weakness, various approaches can be effectively utilized, and each of the options presented plays a role in treatment. Nocturnal splinting is often a first-line treatment because it helps to keep the wrist in a neutral position, reducing pressure on the median nerve during sleep. This non-invasive method can alleviate symptoms such as numbness and tingling that are characteristic of carpal tunnel syndrome. Physical therapy may involve specific exercises and modalities to improve wrist and hand function, enhance flexibility, and support recovery. Although physical therapy can be beneficial, it typically complements other treatments rather than serving as the sole first-line solution. Occupational therapy focuses on modifying activities to prevent repetitive strain and improve ergonomics in daily tasks. This approach is important for addressing the underlying causes of symptoms in day-to-day life and can include education on proper wrist positioning during activities. Since all these treatment modalities—nocturnal splinting, physical therapy, and occupational therapy—can be employed effectively to manage mild to moderate carpal tunnel syndrome and are often recommended in conjunction, it is accurate to identify that all of these methods are legitimate first-line treatments depending on the individual patient's situation and preferences. Thus,