Wrist Pain and Numbness in Fingers: Causes and Treatments

Patient Information: 

Mrs. A is an obese, 47years, female

S. (subjective) 

CC (chief complaint)

“Pain in wrist and numbness in fingers.”

HPI :

Patient states that in the past two weeks she has been feeling pain in her wrist and numbness in her index, thumb and middle fingers. She further claims the pain to cause frustration and also caused her to drop her hairstyling tools.

Location: Wrist and Fingers.

Onset: Two weeks ago

Character: Pain in the wrist, tingling, and numbness in the fingers.

Associated signs and symptoms: No associated signs and symptoms recorded.

Timing: During and after her hair styling.

Exacerbating/ relieving factors: Dropping her hairstyling tools.

Severity: 7/10 pain scale

Current Medications : The practitioner has to collect the history of medications she uses, including over the counter, vitamins, and herbal supplements.

Allergies: History needs to be collected about allergies include specific reactions to medications, foods, insects, and environmental factors.

Past Medical History :  Obesity Social History : Hairstyling.

Family History : The practitioner has to collect the medical history of parents, grandparents, siblings, and children.

Review of Systems :

GENERAL: The patient denies fever, fatigue, and chills. The patient denies weight loss. Positive for the weakness of the right hand.

HEENT Eyes: No significant history is given about changes in vision or hearing

Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest discomfort, palpitations, or history of arrhythmias.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY: Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL: No history of syncopal episodes or dizziness. No gait disturbance. No falls or seizure history.

MUSCULOSKELETAL:  Other than right-hand pain, she did not report a history of arthritis, gout, trauma, or fractures.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

Objective. 

Physical exam 

Vital Signs: No vital signs are given in the given case study.

General: The patient is alert, oriented X 3, appears mildly uncomfortable due to pain.

HEENT: No visual, hearing, breathing or throat infections observed. Extraocular movements intact, oronasopharynx is clear.

Neck: Palpate thyroid gland.

Abdomen: Benign, no organomegaly, no suprapubic tenderness.

Musculoskeletal: Look for atrophy of the palm at the base of the thumb. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation.

Diagnostic results :

The carpal tunnel compression test is performed by pressing thumbs over the carpal tunnel and holding pressure for 30 seconds. The onset of pain or paresthesia in the median nerve distribution within 30 seconds is a positive result (Kim, 2011).

Patients should be evaluated for the presence of diminished ability to perceive painful stimuli along the palmar aspect of the index finger compared with the little finger of the affected hand.

The patient should be measured on a single nerve fiber innervating a receptor or group of receptors using Semmes-Weinstein testing which is the most sensitive sensory test for detecting early carpal tunnel syndrome ( Kulkarni, 2016) .

A . 

Differential Diagnoses 

Following our case study, the most prioritized possible diagnosis is the Carpal tunnel syndrome that occurs when the median nerve, which runs from the forearm into the palm, becomes pressed or squeezed at the wrist. Symptoms include burning, tingling, or itching numbness in the palm and the fingers, especially the thumb and the index and middle fingers (Kim, 2011).

Other possible diagnoses include: Cervical radiculopathy that occurs when a nerve root in the cervical spine becomes inflamed or damaged, resulting in a change in neurological functions (Mills, 2017)

Volar radial ganglion characterized by mass near the base of the thumb, above wrist flexion, neck pain, numbness in the thumb and index finger only (Mills, 2017).

Flexor carpi radialis tenosynovitis: it affects the tendons that help flex the wrist and its symptoms include tenderness near the base of the thumb (Kulkarni, 2016).

Lastly is the Carpometacarpal arthritis of thumb: it occurs at the base of the thumb and includes symptoms like joint line pain, radiologic finding, and pain on motion (Vaccaro, 2016).

References 

Kim Edward LeBlanc|Wayne Cestia. (2011, April 15). Carpal Tunnel Syndrome. Retrieved from http://www.aafp.org/afp/2011/0415/p952.html 

Kulkarni, V., & Patil, R. (2016). Stiff Fingers and Wrist.  Textbook of Orthopedics and Trauma (4 Volumes) , 1836-1836. doi:10.5005/jp/books/12869_210 

Mills, K. R. (2017). Neurophysiological examination of the hand and wrist.  Oxford Medicine Online . doi:10.1093/med/9780199550647.003.006011 

Vaccaro, A., Behrend, C., & Chang, A. (2016). Arm Pain, Weakness and Numbness.  Differential Diagnosis in Spine Surgery , 33-33. doi:10.5005/jp/books/12843_4