American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for severe carpal tunnel syndrome?

1. Continuous splinting

2. Glucocorticoid injection

3. Neural decompression surgery

4. Oral glucocorticoids

The correct answer is: Neural decompression surgery

The first-line treatment for severe carpal tunnel syndrome is neural decompression surgery. Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through the carpal tunnel in the wrist, leading to symptoms such as pain, numbness, and weakness in the hand and fingers. In cases of severe carpal tunnel syndrome, where conservative treatments such as splinting and injections have not alleviated symptoms or when there is significant motor weakness or atrophy, surgical intervention becomes necessary. Neural decompression surgery typically involves cutting the transverse carpal ligament to relieve pressure on the median nerve. This surgical approach has been shown to provide quick and lasting relief from symptoms, making it the most effective option for patients with severe manifestations of the condition. Other treatments like continuous splinting, glucocorticoid injections, and oral glucocorticoids may be beneficial for mild to moderate cases or as initial conservative measures, but they do not address the underlying anatomical issue that causes severe symptoms. Therefore, for severe cases, surgical treatment is the recommended and most effective first-line approach.