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Pain in the forearm 01

Topic: Adult

Created on Saturday, April 18 2009 by jdmiles

Last modified on Saturday, April 18 2009.

A 25 year-old woman presents complaining of pain and tingling in her right arm. The pain is in her wrist, forearm, and elbow. The tingling is in her thumb and index finger. She says it's been going on for about 4 weeks, and getting worse. It frequently wakes her up at night. When it does, she shakes it out, and after a few minutes it feels better. She is diabetic, has hypothyroidism, and is 9 months pregnant. She works as a cashier. Which of the following is this patient's most likely diagnosis?

A) Motor neuron disease

B) Peripheral neuropathy

C) Ulnar mononeuropathy at the elbow

D) Median mononeuropathy at the wrist

E) Ulnar mononeuropathy at the wrist

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This question was created on April 18, 2009 by jdmiles.
This question was last modified on April 18, 2009.

ANSWERS AND EXPLANATIONS

A) Motor neuron disease

This answer is incorrect.

This patient's history are very suggestive of a median mononeuropathy at the wrist (Carpal Tunnel Syndrome or CTS). CTS frequently presents as pain in the hand, wrist, forearm, elbow, and even the proximal upper extremity. Paresthesias (e.g., tingling) in the thumb, index, and middle fingers are also very characteristic of CTS, although patients may often complain of pain in all fingers. The symptoms are often worse at night, and frequently awaken patients from a sound sleep. Motions which involve the wrist may also worsen the symptoms; common examples are holding a book, using a telephone, and holding the steering wheel while driving.
This patient's complaints are not suggestive of motor neuron disease. (See References)

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B) Peripheral neuropathy

This answer is incorrect.

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C) Ulnar mononeuropathy at the elbow

This answer is incorrect.

This patient's history are very suggestive of a median mononeuropathy at the wrist (Carpal Tunnel Syndrome or CTS). CTS frequently presents as pain in the hand, wrist, forearm, elbow, and even the proximal upper extremity. Paresthesias (e.g., tingling) in the thumb, index, and middle fingers are also very characteristic of CTS, although patients may often complain of pain in all fingers. The symptoms are often worse at night, and frequently awaken patients from a sound sleep. Motions which involve the wrist may also worsen the symptoms; common examples are holding a book, using a telephone, and holding the steering wheel while driving.
Ulnar mononeuropathy at the elbow is less common than CTS, and does not present with these symptoms. Ulnar mononeuropathy would more likely present with paresthesias in the 4th and 5th fingers. (See References)

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D) Median mononeuropathy at the wrist

This answer is correct.

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E) Ulnar mononeuropathy at the wrist

This answer is incorrect.

This patient's history are very suggestive of a median mononeuropathy at the wrist (Carpal Tunnel Syndrome or CTS). CTS frequently presents as pain in the hand, wrist, forearm, elbow, and even the proximal upper extremity. Paresthesias (e.g., tingling) in the thumb, index, and middle fingers are also very characteristic of CTS, although patients may often complain of pain in all fingers. The symptoms are often worse at night, and frequently awaken patients from a sound sleep. Motions which involve the wrist may also worsen the symptoms; common examples are holding a book, using a telephone, and holding the steering wheel while driving.
Ulnar mononeuropathy at the elbow is less common than CTS, and does not present with these symptoms. Ulnar mononeuropathy would more likely present with paresthesias in the 4th and 5th fingers. (See References)

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References:

1. Preston, D.C., and Shapiro, B.E. (2005). Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations, 2nd Edition. Elsevier, Philadelphia. (ISBN:075067492X)

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adult
Pain in the forearm 01
Question ID: 041809069
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 04/18/2009
Modified: 04/18/2009
Estimated Permutations: 1200