HELP!!
A conultant has referred a male patient to me with a diagnosis of (R)
carpal Tunnel syndrome. 3 month history. (R) hand dominant.
He has occasional pain in his index finger and lateral border of forearm
precipitating, factor unknown
Cutaneous hypersensitivity of thenar eminence.
Pain on palpation of snuff box.
Pain ++ on palpation at a point where the superficial radial nerve
passes over the radial styloid.
Normal sensation in the rest of the palm, dorsum, fingers and tips.
Full ROM of all fingers and wrist, slight pain on movement and resisted
thumb opposition is painful.
Skin texture is normal L=R.
Skin has a mottled appearance
There is no history of trauma.
Compression/palpation of carpal tunnel has no effect
Tens/icing of carpal tunnel has no effect.
Ultra sound. 1:2. 1Mhz. .25 w/cm to carpal tunnel has no effect.
Tens to carpal tunnel has no effect.
Ultra sound 1:2. 3MHz. .25 w/cm to radial styloid has no effect.
Ultra sound 1:2. 3MHz 1.0 w/cm to radial styloid exacerbates
Tens to area of radial styloid gives relief when in use.
He would appear to be well motivated, has a well paid job which he
cannot afford to lose, but is in danger of doing so due to this problem.
Looks like carpal in some respects but there is cause for doubt, could
it be early RSD, if so does anybody have any effective treatment
regimes.
Your comments and advice would be much appreciated.
regards
Pete Purslow.
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