werner@aecom.UUCP (Craig Werner) (02/19/86)
<<<>>>
This is a real quicky. It's neat. It's quick. I like it.
A 52-yr old housewife comes in with two complaints. Over the past few
months, she had dropped 7 dishes, and had to switch to washing dishes with
her left hand, at which point the china breakage stopped. She also said that
she had trouble holding a pencil while writing, and dropped it repeatedly.
(Oh yes, she is right-handed.)
She also has another symptom, but hasn't noticed it. Additionally,
there are findings you can elicit on physical exam. To tell you which would
give away the answer.
What is the most likely diagnosis?
--
Craig Werner
!philabs!aecom!werner
"Well, do you see the spaghetti?"bch@mcnc.UUCP (02/26/86)
In article <2271@aecom.UUCP> werner@aecom.UUCP (Craig Werner) writes: > > A 52-yr old housewife comes in with two complaints. Over the past few >months, she had dropped 7 dishes, and had to switch to washing dishes with >her left hand, at which point the china breakage stopped. She also said that >she had trouble holding a pencil while writing, and dropped it repeatedly. >(Oh yes, she is right-handed.) > She also has another symptom, but hasn't noticed it. Additionally, >there are findings you can elicit on physical exam. To tell you which would >give away the answer. > > What is the most likely diagnosis? Having had this particular affliction I'd say this was an example of Carpal Tunnel Syndrome. The symptom she hasn't noticed yet would be numbness of the thumb, index, middle and half of the ring finger on the right hand and/or shooting pains in the right arm and shoulder. There are several things that can show up on a physical exam. A reflex test on a nerve on the underside of the wrist (I forget the name, but Craig surely will supply it) shows a heightened response which *feels* like an electric shock. The definitive test is something called a Nerve Conduction Velocity Test in which the time of traversal of nerve impulses up the arm is measured. This particular test is second in irritation only to the Chinese Water Torture. Finally, and most curiously, Carpal Tunnel patients often complain of dryness and flaking of the skin on the first three fingers of the afflicted hands. The reduction of sensation due to the compression of the nerve in the wrist results in a decrease in perspiration and lubrication of the skin. My surgeon took great pride in demonstrating this in the presurgical conference. -- Byron C. Howes ...!{decvax,akgua}!mcnc!ecsvax!bch
dr@ski.UUCP (David Robins) (02/27/86)
> <<<>>> > This is a real quicky. It's neat. It's quick. I like it. > > A 52-yr old housewife comes in with two complaints. Over the past few > months, she had dropped 7 dishes, and had to switch to washing dishes with > her left hand, at which point the china breakage stopped. She also said that > she had trouble holding a pencil while writing, and dropped it repeatedly. > (Oh yes, she is right-handed.) > She also has another symptom, but hasn't noticed it. Additionally, > there are findings you can elicit on physical exam. To tell you which would > give away the answer. > > What is the most likely diagnosis? > -- > > Craig Werner > !philabs!aecom!werner > "Well, do you see the spaghetti?" Most likely diagnosis is CARPAL TUNNEL SYNDROME. This is basically a fibrosis of the ligaments over the wrist-bones where the nerves to the hand pass through. It is aggravated by certain manual activities, and mau lead to weakness of thumb adduction, so the pinching grip is weakened. The other symptom is probably numbness and tingling in the hand on awakening, I believe, which may be caused by buildup of fluid during the night causing increased pressure. Treatment is conservative, but surgical treatment is to cut the tight ligaments. -- ==================================================================== David Robins, M.D. Smith-Kettlewell Institute of Visual Sciences 2232 Webster St; San Francisco CA 94115 415/561-1705 {ihnp4,qantel,dual}!ptsfa!ski!dr The opinions expressed herein do not reflect the opinion of the Institute!