A patient presents with numbness and tingling in the index and long fingers and nocturnal hand pain; Tinel's sign is positive bilaterally. What is the most appropriate initial intervention?

• A. Referral for physical therapy
• B. Volar wrist splints
• C. Triamcinolone injections bilaterally at the base of the long finger
• D. Referral for surgical release

Answer: (B)

This situation reflects carpal tunnel syndrome, where the median nerve is compressed at the wrist. Numbness and tingling in the index and middle fingers, along with nocturnal hand pain, plus a positive Tinel’s sign at the wrist, point to this diagnosis. The best first move is to use a volar wrist splint in a neutral position, worn at night.

Wrist splinting helps because during sleep the wrist often flexes or extends, which narrows the carpal tunnel and increases pressure on the median nerve. Keeping the wrist in a neutral position reduces intratunnel pressure, lowers nerve irritation, and can improve symptoms without any invasive procedures. It’s a safe, nonoperative, and cost-effective initial therapy for mild-to-moderate CTS.

If symptoms persist or worsen despite splinting—especially if there is thenar weakness or ongoing numbness—the next steps typically involve more targeted interventions such as corticosteroid injections or surgical release. Physical therapy can be helpful as an adjunct, but splinting is the cornerstone of initial management.