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Typical Case Overview

History:

·         Occupational repetitive wrist motion - microtrauma - from hammering, typing, sewing, or assembly line work.

·         No major, overt trauma to the wrist - no macrotrauma.

Warning Signs - Complaints by the Patient:

·         Pain in the arm, wrist and hand - location and intensity may vary.

·         Decreased sensation of the hand - may tingle or feel numb.

·         Weak grip - may fumble or drop objects.

·         Tenderness along the median nerve into the hand when the underside of the wrist is tapped sharply (Tinel's test)

Numbness or tingling of hands when wrists are bent downward at 90 degrees for more than 30 seconds (Phalen's test)

Professional Examination:

·         Observe the hand for natural symmetry and color.

·         Check for muscle atrophy - wasting of the thumb muscle (th enar eminence).

·         Check active and passive ranges of motion of the neck, arm, wrist and hand.

·         Check sensation, especially the area supplied by the median nerve - index and middle finger.

·         Check deep tendon reflexes of the biceps, brachioradialis and triceps.

·         Check for myofascial adhesions and trigger points in the neck, back, shoulder, arm, forearm, and hand.

·         Check for pain with pressure on the side of the neck ("doorbell sign").

·         Perform tests for carpal tunnel: Phalen's and Tinel's tests.

·         Perform grip strength tests - manual or dynamometer.

·         Order appropriate blood chemistry tests if arthritis is suspected.

·         Order x-rays of neck and wrist if necessary.

·         Request nerve conduction velocity tests (sensory and motor latency) if case is severe.