CASE STUDY 1

Patient A is a woman, 54 years of age, who has been employed for 17 years in the manufacturing industry. She has missed little work and continues to perform her regular duties, which include spending many hours each day at an assembly station. Patient A also spends time each day at her home computer. The patient presents to her physician's office with chronic pain, tingling, and numbness in her right hand and wrist as well as pain, tingling, and numbness in her neck and shoulders. Patient A indicates that she is unable to take anti-inflammatory medication due to a peptic ulcer and that she has had no success alleviating symptoms with other medications. She also reports a history of hypertension and recent-onset arthritis.

Comments and rationale : Patient A ' s gender, age, medical history, and symptoms are positive risk factors for carpal tunnel syndrome. A physical examination including laboratory tests and imaging should be conducted to confirm the medical history of hypertension and rheumatoid arthritis.

Phalen's maneuver is performed and reveals significant weakness in Patient A's right hand. Ultrasound and a two-part EDX study are ordered, which confirm the initial diagnosis of carpal tunnel syndrome. A single cortisone injection at the right wrist is recommended while the patient considers further treatment options. The injection provides Patient A with temporary symptom relief (for four weeks). The patient then elects to undergo outpatient endoscopic carpal tunnel release. Postoperative instructions include no computer or other repetitive hand use for a minimum of four weeks. The patient demonstrates significant symptom improvement three weeks postoperatively and reports being pain-free six weeks postoperatively. Patient A relates that she is able to cook and play tennis with no related pain. A follow-up examination at one year shows no recurrence of symptoms.