What is the diagnosis and recommended management for a 60-year-old female patient with a history of diabetes mellitus, urinary incontinence, headaches, hemorrhoids, hypertension, edema, irritable bowel syndrome (IBS), and hyperlipidemia, who presents with gastritis, a buttock abscess, and progressive numbness and tingling in her left hand, particularly affecting the thumb, index, and middle fingers, and who is currently taking ondansetron (Zofran) (ondansetron) and dicyclomine (Bentyl) (dicyclomine)?

From the Guidelines

This patient can return to work as her current symptoms of gastritis have improved, and she is completing antibiotic treatment for a buttock abscess, but she requires further evaluation and management for her progressive numbness and tingling in her left hand. The patient's symptoms of numbness and tingling in her left hand, particularly affecting the thumb, index, and middle fingers, with worsening symptoms when gripping objects and during the morning, are concerning for a possible neuropathy or nerve compression syndrome, such as carpal tunnel syndrome, which is common in patients with diabetes 1. Given her 12-month history of progressive symptoms, it is essential to evaluate her for possible underlying causes, including diabetic neuropathy, and to consider further testing, such as electromyography (EMG) or nerve conduction studies (NCS), to determine the extent of nerve damage. The patient's increased computer use at work over the past 6 months may be a contributing factor to her symptoms, and modifying her work activities or using ergonomic equipment may help alleviate her symptoms. In terms of treatment, medications such as pregabalin, duloxetine, or tapentadol may be considered for the management of diabetic peripheral neuropathy, as recommended by the American Diabetes Association 1. However, as the patient's symptoms are not typical of diabetic neuropathy, and she has no other symptoms of autonomic neuropathy, such as gastroparesis, constipation, or orthostatic hypotension, a more thorough evaluation is necessary to determine the underlying cause of her symptoms. The patient's IBS symptoms are not currently a concern, but if they worsen, second-line treatments, such as tricyclic antidepressants or selective serotonin reuptake inhibitors, may be considered, as recommended by the British Society of Gastroenterology 1. In conclusion, the patient's numbness and tingling symptoms require further evaluation and management, and she should be referred to a specialist, such as a neurologist or a rheumatologist, for further assessment and treatment. Key points to consider in the patient's management include:

• Further evaluation and testing to determine the underlying cause of her numbness and tingling symptoms
• Consideration of medications, such as pregabalin or duloxetine, for the management of neuropathic pain
• Modification of her work activities or use of ergonomic equipment to alleviate her symptoms
• Referral to a specialist, such as a neurologist or a rheumatologist, for further assessment and treatment.

From the Research

Current Concerns and Symptoms

• The patient is a 60-year-old female with a past medical history of diabetes mellitus, urinary incontinence, headaches, hemorrhoids, hypertension, edema, IBS, and hyperlipidemia.
• She was seen in the ER for gastritis and has been prescribed ondansetron (ZOFRAN) and dicyclomine (BENTYL) for nausea and abdominal pain.
• The patient reports feeling better and needs a note to return to work.
• She also reports a 12-month history of progressive numbness and tingling in her left hand, particularly affecting the thumb, index, and middle fingers, which worsens when gripping objects or in the morning 2, 3, 4.

Diagnosis and Management of Carpal Tunnel Syndrome

• Carpal tunnel syndrome is caused by compression of the median nerve as it travels through the carpal tunnel, leading to pain and paresthesias in the distribution of the median nerve 2.
• The patient's symptoms are consistent with carpal tunnel syndrome, and further evaluation with ultrasonography and electrodiagnostic studies may be necessary to confirm the diagnosis 2, 4.
• Conservative treatment options for carpal tunnel syndrome include splinting, corticosteroids, physical therapy, and yoga, while surgical decompression may be necessary for severe cases or those that do not respond to conservative therapy 2, 3, 4.

Gastritis and Other Conditions

• The patient's gastritis is likely related to her recent ER visit and treatment with ondansetron and dicyclomine.
• Atrophic gastritis is a complex syndrome that can arise from H. pylori infection or gastric autoimmunity, and may lead to potentially life-threatening complications such as cancer and anemia 5, 6.
• The patient's buttock abscess and antibiotic treatment are separate from her gastritis and carpal tunnel syndrome, but may be related to her overall health and medical history.