Can you make the diagnosis?

Carrie has been waking up at night with a burning sensation in her thumb and fingers.  Her forearms are aching, and she has a tingling sensation in both of her hands.   She has tried taking Advil and changing her sleeping position, but it seems to be getting worse.

Carrie is otherwise a fairly health person  She is about 20 pounds overweight but has been exercising and dieting.

What is causing Carrie’s pain?

  1.  She is having a heart attack
  2.  She is sleeping on her arms and compressing the nerves
  3.  Carpal tunnel syndrome
  4.  Arthritis


If you guessed 3.  Carpal tunnel syndrome, you are right!

Carpal tunnel syndrome is caused by compression of the median nerve as it travels through the wrist.  Symptoms are pain, numbness, and tingling in the fingers, with aching and pain up the arm.

Carpal tunnel syndrome can cause weakness of the hand and loss of dexterity.  Risk factors include obesity, repetitive wrist work, pregnancy, and family history.

Carpal tunnel syndrome can be diagnosed by physical examination, and can be confirmed with electrodiagnostic tests.

Carpal tunnel syndrome is treated by wearing wrist splints and steroid injections, but sometimes surgery is necessary to decompress the nerve.

Heart attacks can cause arm pain, but also typically have associated symptoms such as chest, neck or jaw pain.  Sleeping on the arm can cause numbness, but it would be unusual to have symptoms on both sides.  Arthritis can cause joint pain, but does not typically cause numbness or tingling.



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