Tingling hand? Think carpal tunnel every time.

Some diagnoses get all the glory. Leg pain?… think sciatica.  Headache at the forehead?… think sinus infection.  Hand tingling/pain?… think carpal tunnel syndrome (CTS).  And if you’ve used a computer, then it must be CTS.

With no further need for sarcasm (while it is April 1st), let us discuss the importance of a doctor’s diagnostic skepticism.

Two colleagues and I recently displayed a scientific poster at the Association of Chiropractic Colleges Research Agenda Conference. The poster described a unique case of bilateral ulnar and median nerve compression syndrome that developed during a 100 mile bicycle ride. The patient had tingling and weakness in both hands and was previously diagnosed with CTS.  A careful examination revealed muscle weakness and skin numbness consistent with compression injury to the ulnar nerve just past the tunnel of Guyon and compression injury to the median nerve at the carpal tunnel.  (You can highlight any of the above anatomical terms, right click, and select “search Google.”)  Basically, the splint for CTS that she was previously prescribed to reduce the pressure on the median nerve was irritating further the ulnar nerve.

For me, this case highlights the importance of a meticulous examination, even when a patients symptoms seem to indicate a common problem.

 

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One Response to Tingling hand? Think carpal tunnel every time.

  1. Brad April 1, 2011 at 10:33 am #

    For more information of examiner bias and diagnostic error, read Dr. Charles Pilcher’s post on KevinMD.com http://bit.ly/eUOxnF

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