A patient with paresthesias on the palmar surface of the thumb, index, and middle fingers and a positive Tinel’s sign at the wrist most likely has compression of which nerve?

A patient with paresthesias on the palmar surface of the thumb, index, and middle fingers and a positive Tinel’s sign at the wrist most likely has compression of which nerve?

• A. Ulnar nerve compression distal to the elbow
• B. Tenosynovitis of abductor pollicis longus
• C. Median nerve compression at the wrist
• D. Thoracic outlet syndrome

Answer: (C)

Paresthesias in the palmar surface of the thumb, index, and middle fingers with a positive Tinel’s sign at the wrist point to compression of the median nerve at the carpal tunnel. The median nerve supplies sensation to the lateral palm and the palmar surfaces of those digits, so irritation or compression there produces the described sensory pattern. Tinel’s sign at the wrist—tapping over the carpal tunnel provoking tingling—further supports carpal tunnel syndrome due to median nerve compression. If the problem were ulnar nerve compression, symptoms would appear in the little finger and ulnar half of the ring finger, not the thumb through middle fingers. Tenosynovitis of the abductor pollicis longus would cause focal wrist tendon pain rather than a median-nerve sensory distribution, and thoracic outlet syndrome typically yields broader upper-extremity symptoms that aren’t limited to the median nerve’s palm and digits.

Paresthesias in the palmar surface of the thumb, index, and middle fingers with a positive Tinel’s sign at the wrist point to compression of the median nerve at the carpal tunnel. The median nerve supplies sensation to the lateral palm and the palmar surfaces of those digits, so irritation or compression there produces the described sensory pattern. Tinel’s sign at the wrist—tapping over the carpal tunnel provoking tingling—further supports carpal tunnel syndrome due to median nerve compression. If the problem were ulnar nerve compression, symptoms would appear in the little finger and ulnar half of the ring finger, not the thumb through middle fingers. Tenosynovitis of the abductor pollicis longus would cause focal wrist tendon pain rather than a median-nerve sensory distribution, and thoracic outlet syndrome typically yields broader upper-extremity symptoms that aren’t limited to the median nerve’s palm and digits.