Carpal Tunnel Syndrome: Clinical Features

Carpal Tunnel Syndrome (CTS) is caused by compression of the median nerve as it passes through the carpal tunnel at the wrist. Its clinical features reflect the sensory and motor territory supplied by the median nerve distal to the wrist.

Analysis of Each Statement

• Statement 1: Pain and tingling in hands at night — Correct. Nocturnal exacerbation of pain and paraesthesia is one of the most classic and characteristic symptoms of CTS, typically worsened by wrist flexion during sleep and relieved by shaking the hand ("flick sign").
• Statement 2: Weakness of thumb abduction — Correct. The median nerve innervates the abductor pollicis brevis (part of the thenar/LOAF muscle group). Compression in the carpal tunnel therefore produces weakness of palmar thumb abduction, a key motor sign used clinically to assess median nerve involvement.
• Statement 3: Loss of sensation over lateral half of the palm — Correct. The median nerve supplies sensation to the palmar aspect of the thumb, index, middle, and radial half of the ring finger, along with the adjoining radial (lateral) part of the palm via its palmar cutaneous branch. Sensory loss in CTS is therefore typically described over this lateral half of the palm.
• Statement 4: Atrophy of hypothenar eminence — Incorrect. The hypothenar muscles are supplied by the ulnar nerve, not the median nerve. Atrophy of the hypothenar eminence is a feature of ulnar nerve pathology, not CTS. In CTS, it is the thenar eminence (median-nerve-supplied) that undergoes atrophy in longstanding or severe cases — not the hypothenar eminence.

Conclusion

Statements 1, 2, and 3 correctly describe features of Carpal Tunnel Syndrome, while statement 4 incorrectly attributes an ulnar-nerve-related sign (hypothenar atrophy) to a median nerve disorder. Hence, the correct answer is the option combining 1, 2 and 3.