Linda has been a secretary for 25 years. She is now experiencing numbness, pain, and coldness in her hands and fingers. Describe the physical examination that can determine her condition.
a.Flex the wrist as far as possible and watch for symptoms.
b.Rotate the wrist in a circle and listen for snapping sounds.
c.Pull the thumb and little finger together while the fingers are pointing upward.
d. Push middle finger backward until pain occurs.
The correct answer and explanation is:
The correct answer is a. Flex the wrist as far as possible and watch for symptoms.
This physical examination is commonly used to assess for Carpal Tunnel Syndrome (CTS), a condition that Linda may be experiencing, given her symptoms of numbness, pain, and coldness in the hands and fingers. CTS is typically caused by pressure on the median nerve as it passes through the carpal tunnel in the wrist. Over the years, repetitive movements, such as those often associated with secretarial work (typing, writing, or using a mouse), can lead to the thickening of tendons or inflammation in the tunnel, putting pressure on the median nerve.
To test for Carpal Tunnel Syndrome, the wrist is flexed as far as possible in a maneuver called the Phalen’s test. In this test, Linda would be asked to press the backs of her hands together, fingers pointing downward, and hold the position for 30 to 60 seconds. If she experiences symptoms such as tingling, numbness, or pain in the fingers, this is indicative of median nerve compression, supporting the diagnosis of CTS.
The other options are not directly related to testing for Carpal Tunnel Syndrome:
- b. Rotate the wrist in a circle and listen for snapping sounds: This could be related to joint issues or tendinitis but is not a standard test for CTS.
- c. Pull the thumb and little finger together while the fingers are pointing upward: This is not a diagnostic maneuver for CTS and is unrelated to the condition.
- d. Push middle finger backward until pain occurs: This may test for issues related to tendon or joint strain, but it is not specific for diagnosing CTS.
In summary, the Phalen’s test (flexing the wrist as far as possible) is a key method for assessing the presence of Carpal Tunnel Syndrome and is the most relevant examination for Linda’s condition.