American Board of Internal Medicine (ABIM) Certification Practice Exam

What would indicate a need for surgical intervention in a patient with carpal tunnel syndrome?

1. Initial mild symptoms

2. Inability to perform daily activities

3. Complete resolution of symptoms

4. Short symptom duration

The correct answer is: Inability to perform daily activities

In carpal tunnel syndrome, surgical intervention is generally indicated when conservative measures have failed and the patient's quality of life is severely affected. The inability to perform daily activities due to the symptoms is a significant reason to consider surgery. This inability stems from the debilitating nature of the condition, which may lead to persistent pain, numbness, and weakness in the hand and wrist. When these symptoms prevent a patient from completing essential tasks, surgery becomes a necessary option to alleviate the pressure on the median nerve and restore function. Other options suggest either mild symptoms, resolved symptoms, or a brief duration of symptoms, which are typically managed with non-surgical treatments such as splinting, medications, or physical therapy. Hence, they do not warrant surgical intervention at that time. The key factor leading to surgery is the impact on daily functionality, underscoring the importance of quality of life in determining treatment strategies for carpal tunnel syndrome.