A 45-Year-Old Man Comes to the Office Due to Intermittent

A 45-year-old man comes to the office due to intermittent pain and numbness in the right hand for the last several months.  The symptoms occur primarily at night and occasionally wake the patient.  Shaking the hand or holding it in a dependent position briefly relieves the pain.  He works as a carpenter.  The patient has a 20-pack-year smoking history but does not use alcohol or illicit drugs.  Vital signs are normal.  BMI is 36 kg/m².  Examination shows normal range of motion in the wrists and digits.  Sensation is decreased to pinprick in the thumb and index finger.  Biceps, triceps, and brachioradialis reflexes are normal.  There is no muscle atrophy.  Phalen and Tinel tests do not provoke symptoms.  The remainder of the examination is normal.  Which of the following is the most appropriate next step to confirm the diagnosis in this patient?

A) Chest CT scan
B) MRI of the cervical spine
C) MRI of the wrist
D) Nerve conduction studies
E) X-ray of the hands

Correct Answer:

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