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From: dr@ski.UUCP (David Robins)
Newsgroups: net.med
Subject: Re: Medical Puzzle #10
Message-ID: <232@ski.UUCP>
Date: Wed, 26-Feb-86 21:25:43 EST
Article-I.D.: ski.232
Posted: Wed Feb 26 21:25:43 1986
Date-Received: Fri, 28-Feb-86 03:40:38 EST
References: <2271@aecom.UUCP>
Distribution: na
Organization: Smith-Kettlewell Institute, S.F., CA.
Lines: 39

> <<<>>>
> 	This is a real quicky. It's neat. It's quick. I like it.
> 
> 	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?
> -- 
> 
> 				Craig Werner
> 				!philabs!aecom!werner
>                           "Well, do you see the spaghetti?"

Most likely diagnosis is CARPAL TUNNEL SYNDROME.

This is basically a fibrosis of the ligaments over the wrist-bones where
the nerves to the hand pass through.  It is aggravated by certain manual
activities, and mau lead to weakness of thumb adduction, so the pinching
grip is weakened.  The other symptom is probably numbness and tingling
in the hand on awakening, I believe, which may be caused by buildup of
fluid during the night causing increased pressure.

Treatment is conservative, but surgical treatment is to cut the tight ligaments.

-- 
====================================================================
David Robins, M.D. 
Smith-Kettlewell Institute of Visual Sciences
2232 Webster St; San Francisco CA 94115
415/561-1705
			{ihnp4,qantel,dual}!ptsfa!ski!dr

The opinions expressed herein do not reflect the opinion of the Institute!