MSK-06 · Wrist, Carpal Bones, Carpal Tunnel, and DeQuervain

Wrist, Carpal Bones, Carpal Tunnel, and DeQuervain. Part of the Musculoskeletal series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: carpal tunnel syndrome and de Quervain tenosynovitis, which we will cover next, are frequently driven by true active inflammatory tenosynovitis. — Correct: Idiopathic carpal tunnel syndrome is not inflammatory tenosynovitis; specimens show non-inflammatory fibrosis, oedema, and vascular proliferation. It is a compressive mononeuropathy, not an inflammatory condition. (2) In the audio: They recur at a massive 80% rate after simple needle aspiration, but the recurrence drops dramatically to around 10%, — Correct: Recurrence after simple aspiration runs roughly 50 to 75 percent, pooled near 60 percent, and rises with the length of follow-up, so short series report lower numbers. Nothing published reports 90 percent. Excision of the cyst with its stalk brings recurrence to about 20 percent, not 10. (3) In the audio: is statistically the most sensitive bedside — Correct: No single provocative test is reliably the most sensitive for carpal tunnel syndrome. Phalen and Durkan compression perform comparably, at pooled sensitivities of roughly 0.57 to 0.70 each, and both are more sensitive than Tinel, which is the most specific of the three. The original 87 percent figure for the compression test was never replicated; independent testing with the same gauge found 0.36. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MSK-06.