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.


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";