Treatment of Carpal Tunnel Syndrome

A 45 year old woman who works as a professional baker, with a specialty in birthday and wedding cakes, is diagnosed today with carpal tunnel syndrome. Her history of present illness include a four month history of numbness and tingling of the thumb, index and middle finger of her dominant hand. Physical exam reveals normal grip strength and decreased sensation along the median nerve distribution. Thenar atrophy is absent.

Which of the following is the most appropriate next step?

A. referral for carpal tunnel surgical decompression

B. arranging for carpal tunnel corticosteroid injection

C. advice on the use of neutral position wrist splinting

D. obtain a TSH and an A1C

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