Question

a 35 year old pregnant patient complains of numbness and tingling in the left thumb, index finger, and middle finger. symptoms come and go and wake her up at nights. she often shakes her hand to get sensation back. which of the following is most likely true regarding this patient? a) diabetes due to high sugar intake during the pregnancy b) thoracic outlet syndrome due to compression of the subclavian vein c) ulnar nerve palsy due to compression at the elbow d) carpal tunnel syndrome due to increased tunnel pressure

Explanation:

Carpal tunnel syndrome is characterized by numbness and tingling in the thumb, index, and middle fingers (median nerve distribution). Symptoms often worsen at night (as in this case) and can be relieved by shaking the hand. During pregnancy, fluid retention can increase pressure in the carpal tunnel.

• Diabetes (option a) typically causes more widespread or bilateral symmetric neuropathy, not just in the median nerve distribution.
• Thoracic outlet syndrome (option b) usually presents with symptoms related to vascular (if subclavian vein compression) like swelling, cyanosis, or neurological symptoms (if brachial plexus involvement) but not specifically in the median nerve - thumb, index, middle finger pattern.
• Ulnar nerve palsy (option c) would affect the ring and little fingers (ulnar nerve distribution), not the thumb, index, and middle fingers.

Answer:

d) Carpal tunnel syndrome due to increased tunnel pressure