Morning Quiz ☕️ 

A 43-year-old woman presents to the clinic with:

• Pain and tingling in the first three digits of both hands (thumb, index, middle fingers, and radial half of the ring finger).

• Symptoms are worse at night, sometimes disrupting sleep.

• No leg symptoms.

Relevant Medical History

• Chronic kidney disease (CKD) due to IgA nephropathy.

• Currently on hemodialysis.

Physical Examination Findings

• Diminished sensation in both hands over:

  • Palmar aspect of the thumb, index, and middle fingers.

  • Radial half of the ring finger

Question

Which of the following is the most likely underlying mechanism of this patient's current symptoms?

Options:
A. Endomysial inflammatory infiltration
B. Endoneural arteriole hyalinization
C. Endoneural multifocal demyelination
D. Mutations of a muscle structural protein gene
E. Nerve compression within an anatomic compartment

Correct Answer 🎯: E. Nerve compression within an anatomic compartment

⚙️

Chronic Kidney Disease (CKD)

⬇

Uremic toxin accumulation + Chronic inflammation

⬇

β2-microglobulin buildup

⬇

Deposition in periarticular tissues + synovium

⬇

Dialysis-related Amyloidosis

⬇

Amyloid deposition in transverse carpal ligament

⬇

Thickening & ↓ flexibility of ligament

⬇

Compression of median nerve within carpal tunnel (anatomic compartment)

⬇

↓ Axonal transport + Ischemia to median nerve fibers

⬇

Sensory impairment in median nerve distribution

⬇

Pain + tingling in thumb, index, middle, radial ½ of ring finger

⬇

Worse at night (wrist flexion during sleep ↑ compression)

⬇

Bilateral symptoms (due to systemic process, e.g. dialysis amyloid)

🧠 Classic for Carpal Tunnel Syndrome

Differential Table ⚖️

Visual Cheat Chart 📈 

Practice Questions ⏳️ 

Most Importantly Solve UWorld Questions with IDs:

1059, 1694, 11683, 1264, 15727

Stay Hungry, Stay Curious!

Your Brother in This Struggle

Dr. Shoaib Ahmad