Summary
The patient presents with a one-year history of intermittent tingling and numbness in the first three fingers of their right hand, exacerbated by certain activities and positions, such as driving with their hand elevated or sleeping on their right side. The symptoms are relieved by changing position or moving their hand. The patient has a history of repetitive use of their right hand for work and currently uses a computer regularly. They also perform daily tai chi exercises and neck stretches, which they believe have been helpful in managing their symptoms.
Differential Diagnosis
- Single most likely diagnosis:
- Carpal Tunnel Syndrome (CTS): The patient's symptoms of tingling and numbness in the first three fingers of their right hand, particularly when holding their hand up or sleeping with their hand in an elevated position, are classic for CTS. The fact that moving their hand or changing position provides relief also supports this diagnosis.
- Other Likely diagnoses:
- Thoracic Outlet Syndrome (TOS): The patient's symptoms are exacerbated by certain positions, such as driving with their hand elevated, which could suggest TOS. However, the lack of upper back tension or pain makes this diagnosis less likely.
- Ulnar Neuropathy: Although the patient's symptoms primarily affect the first three fingers, ulnar neuropathy could be considered if the symptoms were more pronounced in the fourth and fifth fingers. However, the patient's history of repetitive use of their right hand and the distribution of their symptoms make CTS more likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Cervical Radiculopathy: Although the patient denies neck pain, cervical radiculopathy could cause similar symptoms. It is essential to consider this diagnosis, as it may require urgent attention if there is significant nerve root compression.
- Peripheral Neuropathy: Although the patient denies numbness or tingling in their feet or left hand, peripheral neuropathy could be considered if there is an underlying systemic condition, such as diabetes. However, the patient's symptoms are localized to one hand, making this diagnosis less likely.
- Rare diagnoses:
- Vibration-Induced Neuropathy: The patient's history of using a screwdriver for work could suggest vibration-induced neuropathy. However, this diagnosis is rare and would require further investigation.
- Ganglion Cyst: A ganglion cyst in the wrist could cause compression of the median nerve, leading to symptoms similar to CTS. However, the patient's symptoms are more consistent with CTS, and a ganglion cyst would likely cause more localized pain and swelling.