A 40-year-old woman presents with complaints of burning and tingling sensations in the left hand for several months. She relates that she has been frequently awakened at night by aching pain in the same hand. Pain is elicited by extreme dorsiflexion of the wrist. Most likely diagnosis?
The symptomatology is classic for carpal tunnel syndrome, which is a form of neuropathy resulting from anatomic compression of the median nerve. Pain, tingling sensations, and hypoesthesia in the distribution of the median nerve are the cardinal manifestations. These often undergo exacerbations at nighttime. A shock-like pain upon percussion on the volar aspect of the wrist (Tinel sign) is an additional characteristic sign. Carpal tunnel syndrome is most often idiopathic, but may represent a manifestation of underlying disorders such as rheumatoid arthritis, sarcoidosis, amyloidosis, acromegaly, and leukemia. Carpal tunnel syndrome may be confused with angina pectoris when located on the left side. However, angina pectoris typically manifests with physical or emotional stress and very rarely results in pain limited to the hand. Dupuytren contracture is a relatively common disorder characterized by fibrous thickening of the palmar fascia. Contracture and nodule formation ensue. This condition is most common in Caucasian men over 50. Fibrositis also known as fibromyalgia, refers to a poorly understood syndrome of widespread musculoskeletal pain associated with tenderness in multiple trigger points. Fatigue, headache, and numbness are also common. Women between 20 and 50 years of age are most commonly affected. Neck, shoulders, low back and hips are usually involved. Reflex sympathetic dystrophy describes a syndrome of pain and swelling of one extremity (most commonly a hand), associated with skin atrophy. It is thought to be secondary to vasomotor instability. Sometimes, it follows injuries to the shoulder (shoulder-hand variant).
Angina pectoris
Carpal tunnel syndrome
Dupuytren contracture
Fibrositis