A 30-year-old Caucasian male comes to your office and complains of pain and numbness in his right wrist and palmar surface of his first three fingers. These symptoms woke him up last night. He is a baker, and rolls dough using repetitive movements, including hyperextension of the wrist and pronation of the forearm. He remembers having several similar episodes of finger numbness before, which resolved completely after a period of rest. His past medical history is otherwise insignificant. Which of the following is the most likely localization of the pathologic process in this patient?

Question

A 30-year-old Caucasian male comes to your office and complains of pain and numbness in his right wrist and palmar surface of his first three fingers.  These symptoms woke him up last night.  He is a baker, and rolls dough using repetitive movements, including hyperextension of the wrist and pronation of the forearm.  He remembers having several similar episodes of finger numbness before, which resolved completely after a period of rest.  His past medical history is otherwise insignificant.  Which of the following is the most likely localization of the pathologic process in this patient?

Quizplus · Accepted Answer

Explanation: The clinical scenario described is suggestive of carpal tunnel syndrome - pain and numbness in the wrist and palmar surface of the first three fingers associated with repetitive movements of the wrist. (Choice A) Median nerve entrapment between the two heads of pronator teres is less common, and usually manifests as pain in the volar forearm, in addition to the symptoms described in this scenario. (Choices C and D) Ulnar nerve involvement is indicated by tingling and numbness of the one-and-half fingers on the ulnar aspect of the hand. (Choice E) The radial nerve is known as 'the great extensor nerve.' Sensory abnormalities during radial nerve involvement are located on the dorsal aspect of the forearm and hand. Educational Objective: Pain and numbness in the wrist and palmar surface of the first three fingers associated with repetitive movements of the wrist is typical for carpal tunnel syndrome.

A 30-Year-Old Caucasian Male Comes to Your Office and Complains of Pain