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Carpal Tunnel Syndrome

Tingling 2

Step 1: View clinicals

A 68 year old woman presents with progressive numbness, tingling and a burning sensation over the outer aspect of her left palm for 3 months, which now radiates to the forearm. On several occasions, she was woken up at night by the pain. There is no history of trauma. She was diagnosed with diabetes 8 years ago, which is well controlled on Metformin.

Step 2: Order all relevant investigations

Fasting Plasma Glucose

The fasting plasma glucose level is 100 mg/dl (normal: < 110)

Serum TSH

The serum TSH level is 3.8 mU/L (0.4 - 4.5)

Nerve Conduction Studies(NCS)

The left median nerve shows increased latency in both sensory and motor modalities. Action potential amplitudes and velocities are normal. The left ulnar nerve, and right median and ulnar nerves show normal findings.

Nerve Biopsy

You realize that a nerve biopsy is probably not indicated.

Step 3: Select appropriate management

Wrist Splint
Vitamin B6
Surgical Decompression
Corticosteroid Injections

Score: ★★☆