Differential Diagnosis
- Single most likely diagnosis
- Carpal Tunnel Syndrome (CTS): This is the most likely diagnosis given the patient's symptoms of pain and numbness in the hand, particularly in the long and index fingers, which are commonly affected in CTS. The nocturnal worsening of symptoms and the relief after changing positions are also characteristic. Minimal atrophy of the thenar muscles and decreased sensation to light touch at the tip of the thumb, index finger, and long finger further support this diagnosis.
- Other Likely diagnoses
- Cervical Radiculopathy: This condition could cause similar symptoms if the nerve roots that contribute to the median nerve (C6 and C7) are affected. However, the absence of neck pain and the specific distribution of numbness make it less likely than CTS.
- Thoracic Outlet Syndrome: This condition involves compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib). It could cause hand numbness but typically involves other symptoms such as neck and shoulder pain, which are not mentioned.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Acute Carpal Tunnel Syndrome due to a space-occupying lesion (e.g., tumor): Although rare, a tumor or other space-occupying lesion in the carpal tunnel could cause CTS symptoms and would be critical to diagnose early.
- Brachial Plexus Neoplasm: A tumor affecting the brachial plexus could cause progressive neurological deficits, including numbness and weakness in the hand.
- Rare diagnoses
- Multifocal Motor Neuropathy: A rare condition characterized by asymmetric muscle wasting and weakness, often with minimal sensory symptoms. It could present with hand weakness and numbness but is much less common.
- Hereditary Neuropathies (e.g., Charcot-Marie-Tooth disease): These are a group of disorders that affect the peripheral nerves, leading to progressive muscle weakness and atrophy. While they could cause hand symptoms, the age of onset and the specific pattern of involvement would be unusual for this patient.