Monday, November 23, 2009

Light at the End

A 45 year old secretary presents with pain and tingling of the thumb, index, middle, and ring fingers. She's noted difficulty writing, pinching, and holding small utensils. She's been under a lot of stress lately at the law firm. Physical exam shows mild flattening of the thenar eminence. The two following tests recreate symptoms:

Challenge: What's the diagnosis and what are the tests shown above?

Both images shown under Fair Use.

3 comments:

Suheil said...

carpal tunnel syndrome.. phalen's test and tinel's sign? i hope that is.. i AM capable of putting my exceptionally large foot into my even bigger mouth...

Stephanie said...

carpal tunnel. tinel's sign is when you tap on the median nerve, eliciting tingling/numbness. phalen's sign is when you hold your hands together, reproducing the tingling, numbness, etc.

Craig Chen said...

You're right!
-
Light at the End

This is carpal tunnel syndrome, median nerve entrapment. The Hoffman-Tinel test involves tapping over the compressed nerve at the wrist; the Phalen maneuver involves having the patient maintain acute wrist flexion for 30-60 seconds. The tests are positive if symptoms are reproduced.

Sources: UpToDate, second image from Sheon, Moskowitz, Goldberg, "Soft Tissue Rheumatic Pain"; www.med.und.nodak.edu.