1st April 2022

A 52-year-old woman with a 5-year history of rheumatoid arthritis presents to the GP

A 52-year-old woman with a 5-year history of rheumatoid arthritis presents to the GP complaining of “tingling” in her thumb, index and middle finger of her right hand. This began spontaneously 2 weeks ago and was not associated with trauma or change in activity. She notices it particularly in the night and tries to shake her hand for relief. On examination, grip strength and thumb abduction is weak and tapping the patient’s right wrist reproduces the symptoms. All other aspects of neurological examination are unremarkable. 

Which of the following is the most likely cause?

Select the SINGLE most appropriate option from the list below. Select ONE option only.