Numbness/paresthesias of the first three and a half digits with decreased grip strength indicate which condition?

• A. Carpal tunnel syndrome
• B. Cubital tunnel syndrome
• C. Thoracic outlet syndrome
• D. De Quervain's tenosynovitis

Answer: (A)

This pattern is classic for compression of the median nerve at the wrist (carpal tunnel syndrome). The median nerve supplies sensation to the thumb, index, middle, and the radial half of the ring finger, so numbness or paresthesias in those first three and a half digits fits this distribution. It also innervates the thenar muscles (via the recurrent branch), so weakness or decreased grip strength reflects thenar muscle involvement, leading to weaker grasp and pinch.

Why the other options don’t fit as well: compression at the elbow (cubital tunnel) would affect the ulnar nerve distribution (little finger and the medial half of the ring finger) and cause different hand weakness. Thoracic outlet syndrome can involve vascular or broader neurogenic symptoms in the arm but typically isn’t limited to the median nerve’s sensory pattern. De Quervain’s tenosynovitis presents with focal radial-side wrist pain and tendon symptoms around the first dorsal compartment, not numbness of the digits.