woman with pain and tingling in her hands
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A 32 year-old previously healthy woman comes to clinic for pain and tingling in her hands for several
months. It began on the right as tingling in the hand and aching in the forearm. For the past month, she
has had minor tingling in the left hand. On further questioning, you find out the symptoms began at night,
but are more persistent in her right hand during the day. She sometimes awakens with the symptoms
and shakes her hands to make them go away. She has never had symptoms like this before.
Neurologic examination shows normal tone and reflexes, with subtle decreased pinprick in the lateral
three digits on palmar surface of the right hand.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?
woman with pain and tingling in her hands
Case 18
A 32 year-old previously healthy woman comes to clinic for pain and tingling in her hands for several
months. It began on the right as tingling in the hand and aching in the forearm. For the past month, she
has had minor tingling in the left hand. On further questioning, you find out the symptoms began at night,
but are more persistent in her right hand during the day. She sometimes awakens with the symptoms
and shakes her hands to make them go away. She has never had symptoms like this before.
Neurologic examination shows normal tone and reflexes, with subtle decreased pinprick in the lateral
three digits on palmar surface of the right hand.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?
woman with pain and tingling in her hands
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