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Path: utzoo!decvax!mcnc!bch
From: bch@mcnc.UUCP
Newsgroups: net.med
Subject: Re: Medical Puzzle #10
Message-ID: <1179@alvin.mcnc.UUCP>
Date: Tue, 25-Feb-86 17:23:40 EST
Article-I.D.: alvin.1179
Posted: Tue Feb 25 17:23:40 1986
Date-Received: Thu, 27-Feb-86 03:43:31 EST
References: <2271@aecom.UUCP>
Reply-To: bch@alvin.UUCP (Byron C. Howes)
Distribution: na
Organization: North Carolina Educational Computing Service
Lines: 37
Summary: 

In article <2271@aecom.UUCP> werner@aecom.UUCP (Craig Werner) writes:
>
>	A 52-yr old housewife comes in with two complaints. Over the past few 
>months, she had dropped 7 dishes, and had to switch to washing dishes with
>her left hand, at which point the china breakage stopped. She also said that
>she had trouble holding a pencil while writing, and dropped it repeatedly.
>(Oh yes, she is right-handed.)
>	She also has another symptom, but hasn't noticed it. Additionally,
>there are findings you can elicit on physical exam. To tell you which would
>give away the answer.
>
>	What is the most likely diagnosis?

Having had this particular affliction I'd say this was an example of
Carpal Tunnel Syndrome.  The symptom she hasn't noticed yet would be
numbness of the thumb, index, middle and half of the ring finger on the
right hand and/or shooting pains in the right arm and shoulder.  

There are several things that can show up on a physical exam.  A reflex
test on a nerve on the underside of the wrist (I forget the name, but
Craig surely will supply it) shows a heightened response which *feels*
like an electric shock.  The definitive test is something called a
Nerve Conduction Velocity Test in which the time of traversal of nerve
impulses up the arm is measured.  This particular test is second in
irritation only to the Chinese Water Torture.  Finally, and most
curiously, Carpal Tunnel patients often complain of dryness and flaking
of the skin on the first three fingers of the afflicted hands.  The
reduction of sensation due to the compression of the nerve in the
wrist results in a decrease in perspiration and lubrication of the skin.

My surgeon took great pride in demonstrating this in the presurgical
conference.

-- 

						Byron C. Howes
				      ...!{decvax,akgua}!mcnc!ecsvax!bch