Differential Diagnosis
- Single most likely diagnosis
- Carpal Tunnel Syndrome (CTS) exacerbation: The patient's symptoms of numbness and tingling in the right hand and arm, worsening over time, and partial relief with a wrist guard are consistent with an exacerbation of previously diagnosed mild CTS. The symptoms being more pronounced at night and occasional complete numbness in the arm or leg could indicate a progression of the condition.
- Other Likely diagnoses
- Cervical Radiculopathy: The symptoms extending to the shoulder and occasional numbness in the leg could suggest a cervical spine issue, such as a herniated disk or foraminal stenosis, compressing nerve roots.
- Thoracic Outlet Syndrome (TOS): Numbness and tingling in the arm, especially if symptoms worsen at night or with certain positions, could be indicative of TOS, where the nerves and/or blood vessels are compressed between the collarbone and first rib.
- Ulnar Neuropathy: Although less likely given the wrist guard provides some relief, ulnar neuropathy could cause numbness and tingling, particularly if the symptoms are more pronounced in the little and ring fingers.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Multiple Sclerosis (MS): Although less common, MS could present with numbness and tingling in various parts of the body, including the arms and legs. It's crucial to consider MS due to its significant impact on quality of life and the importance of early treatment.
- Spinal Cord Compression: Symptoms such as numbness, tingling, and occasional complete numbness in the arm or leg could indicate spinal cord compression, which is a medical emergency requiring prompt intervention.
- Peripheral Neuropathy due to Systemic Disease: Conditions like diabetes, vitamin deficiencies, or autoimmune diseases can cause peripheral neuropathy, which might present with similar symptoms. Identifying and treating the underlying cause is essential.
- Rare diagnoses
- Brachial Plexitis (Neuralgic Amyotrophy): An inflammatory condition affecting the brachial plexus, which could cause numbness, tingling, and pain in the arm.
- Tumors (e.g., Schwannoma, Neurofibroma): Rarely, tumors compressing nerves could cause the described symptoms. Although uncommon, their potential impact necessitates consideration in a differential diagnosis.