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Carpal Tunnel Syndrome
History: A 38-year old female was seen by a HR adviser as a management referral
following her repeated short-term absences associated with a three-month history of
wrist pain. For the past 15 years, she has been doing extensive repetitive clerical work.
She complained of mild to moderate pain in the right hand with weakness of the thumb
and numbness and tingling sensation in the digits. There had been instances when
she was dropping heavier objects. She had been losing sleep due to her hand
discomfort. Her GP diagnosed her condition as carpal tunnel syndrome. She is a nonsmoker and drank alcohol occasionally. Her usual exercise is a 30-minute walk to and
from the train station during her commute. There is no history of trauma.
Physical examination: The patient has a BMI of 35 kg/m2
. Phalen’s and Tinel tests
are positive. The thenar prominence has less bulk in the right hand compared with the
left hand. Thumb strength in the right hand is reduced. Opposition in the right hand is
weaker when compared with the left hand.
Laboratory studies: Free T4 and T3 and fasting blood sugar level were normal. While
doing the nerve conduction study, the motor and sensory latency values of the median
nerve are prolonged and the conduction velocity across the palm and wrist is reduced.
Her GP prescribed her with ibuprofen and recommended a wrist splint. She is referred
to a specialist for possible carpal tunnel release.