{"id":5874,"date":"2025-04-16T12:01:09","date_gmt":"2025-04-16T20:01:09","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=5874"},"modified":"2026-03-20T14:10:20","modified_gmt":"2026-03-20T22:10:20","slug":"omm-question-of-the-day-tingling-hands","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-tingling-hands","title":{"rendered":"COMLEX OMM\u00ae Question of the Day:\u00a0Tingling hands"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-tingling-hands\/#The_correct_answer_to_todays_OMM%C2%AE_Question_is%E2%80%A6\" >The correct answer to today\u2019s OMM\u00ae Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-tingling-hands\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-tingling-hands\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-tingling-hands\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-tingling-hands\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Osmosis regularly shares an OMM-style practice question to test your medical knowledge<\/em><\/strong>. <strong><em>Can you identify the maneuver likely to reproduce the symptoms of a 47-year-old woman with bilateral tingling in her thumbs and second finger (digit) that worsens in the morning?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 47-year-old woman presents to the clinic with two months of tingling in her hands. The tingling sensation is most prominent in her thumbs and 2<sup>nd<\/sup> digits and is worst when she wakes in the morning. She has unintentionally dropped a few objects over the past two months. She works at a computer for eight hours per day. Her past medical history is significant for type 2 diabetes mellitus. Her medications include insulin glargine, metformin, and pioglitazone. Her vital signs are within normal limits. On physical examination she has decreased sensation on the palmar aspect of her thumb and second digit bilaterally. When placing a sheet of paper between her thumb and second digit, you can easily pull it out from between her fingers. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is <strong>likely <\/strong>to reproduce this patient\u2019s symptoms?\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Percussion at the medial epicondyle<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Placing the thumb inside a closed fist and adducting the wrist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Having the patient flex her wrist against your resistance<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Flexing both wrists and holding the dorsal aspect of both hands against one another<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Nerve conduction study at the axilla<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s OMM\u00ae Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Flexing both wrists and holding the dorsal aspect of both hands against one another<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let\u2019s look at the incorrect answer explanations. Skip to the bottom if you want to learn more about the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Percussion at the medial epicondyle<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale:<\/strong> Percussing the medial epicondyle can detect ulnar nerve neuropathy. Percussion over the carpal tunnel (Tinel sign) would likely reproduce this patient\u2019s symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Placing the thumb inside a closed fist and adducting the wrist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale:<\/strong> This test (Finkelstein test) causes extra strain on the tendons running through the anatomic snuffbox and can detect deQuervain tenosynovitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Having the patient flex her wrist against your resistance<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale: <\/strong>This would cause extra strain on the flexors within the forearm and could help diagnose medial epicondylitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Nerve conduction study at the axilla<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale:<\/strong> This could detect a more proximal neuropathy; however, her symptoms indicate a more distal neuropathy (likely at the carpal tunnel).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Carpal tunnel syndrome is a median nerve neuropathy that occurs due to soft tissue swelling and\/or compression inside of the carpal tunnel, usually due to repetitive motions at the wrist. Diabetes mellitus is also a risk factor. Early symptoms may include numbness and tingling in the median nerve distribution of the palm (thumb to lateral half of 3rd digit). Later symptoms may include weakness in thumb opposition and eventually loss of thenar eminence muscle mass. Tinel sign (percussion over the carpal tunnel) will reproduce the patient\u2019s symptoms. Phalen or reverse Phalen test (flexing wrists and placing dorsal aspects of hands together for 30-60 seconds) will also reproduce the patient\u2019s symptoms.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment of carpal tunnel syndrome starts conservatively and can include osteopathic manipulative treatment. Patients should try activity modification (do less of the repetitive task) and wearing splints at night that gently extend the wrist. If this fails, patients should undergo nerve conduction studies and may eventually need surgical decompression.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"418\" height=\"418\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-5.png\" alt=\"An illustration of both wrists holding the dorsal aspect of both hands against one another.\" class=\"wp-image-5877\" style=\"width:266px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-5.png 418w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-5.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-5.png?resize=300,300 300w\" sizes=\"auto, (max-width: 418px) 100vw, 418px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Carpal tunnel syndrome presents initially with numbness and tingling in the median nerve distribution of the palm. As it progresses, patients develop weakness in thumb opposition. Tinel sign and Phalen test can help confirm the diagnosis.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video: <a href=\"https:\/\/www.osmosis.org\/learn\/Carpal_tunnel_syndrome\">Carpal tunnel syndrome<\/a><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\/do\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2025\/02\/health-sci-mo-ad.png\" alt=\"\" class=\"wp-image-5573\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/02\/health-sci-mo-ad.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/02\/health-sci-mo-ad.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more OMM practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prep for the COMLEX exam with today\u2019s OMM question focused on tingling fingers. Strengthen your clinical assessment skills and prepare effectively for your exam!<\/p>\n","protected":false},"author":204,"featured_media":5878,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,34,16],"tags":[641,150,642,265,643,84,245,645,647,644,646,279],"class_list":["post-5874","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-omm","category-do","tag-carpal-tunnel-syndrome","tag-clinical-practice","tag-diagnostic-tests","tag-healthcare-training","tag-median-nerve","tag-medical-education","tag-nursing-education","tag-omm","tag-osteopathic","tag-osteopathic-medicine","tag-osteopathy","tag-patient-assessment"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>COMLEX OMM\u00ae Question of the Day:\u00a0Tingling hands - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-tingling-hands\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"COMLEX OMM\u00ae Question of the Day:\u00a0Tingling hands - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prep for the COMLEX exam with today\u2019s OMM question focused on tingling fingers. 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