A 32-year-old presents with burning in the right wrist and hand; Phalen's test is positive but there is no thenar atrophy. What is the initial management?

• A. Wrist splints
• B. Corticosteroid injection
• C. Surgical referral
• D. Darvocet

Answer: (A)

CTS is suspected when a patient has symptoms of median nerve compression and a positive Phalen’s test. The absence of thenar atrophy suggests this is an early or mild stage, so the first step is to relieve pressure with conservative treatment rather than jumping to surgery.

Wrist splinting, usually at night, keeps the wrist in a neutral or slightly extended position and reduces carpal tunnel pressure during sleep when flexion worsens symptoms. This simple, noninvasive measure can significantly improve symptoms for many patients and avoids risks associated with injections or surgery.

If splinting fails to control symptoms or if there are persistent or progressive motor signs (like thenar weakness or atrophy), corticosteroid injections may be used for temporary relief, and surgical carpal tunnel release is considered for refractory cases. Darvocet isn’t a targeted treatment for CTS and isn’t appropriate as initial management.