D: How may I help you?

P: Um I'm here because I've had some numbness in my right hand and uh doesn't seem to be going going away, so I thought I should get it checked out by you. 

D: Yeah, certainly so, so when did this exactly start? 

P: Um so it's been pretty gradual, I would say over the past month or two months um is when I first noticed it, but the numbness is definitely worse now than it was at the start.

D: OK, and uh where is this um the pain and numbness, where are you feeling it exactly?

P: Um it's particular, it's the worst on my thumb and index finger.

D: OK, do you feel it on your ring finger or uh, or sorry or your middle finger?

P: Um there is a little bit on my middle and ring finger, but it's like it's very very mild.

D: OK. Uh, and uh, like how long, is, are the symptoms constant or or are they intermittent?

P: Um I would say it's somewhat constant, but it's worse when um when I'm trying to like hold the steering wheel or using my phone, or you know, reading a book.

D: OK, I see, and um is there anything that you do uh at those times, to try to help get the symptoms to go away?

P: Um I guess I like shake out my hand um or yeah, try to put pressure on those numb, numb areas.

D: OK, does flicking the the wrist or anything like that, does it help?

P: Uh maybe slightly.

D: OK. And uh like how would you describe the the pains in your hand, like dull, achy, sharp?

P: I would say the pain is more like a tingling sensation. Um so I guess the tingling is is like a sharp feeling, um I wouldn't call it so much pain as I would just like tingling and numbness.

D: OK. OK, and uh is is there anything, so you mentioned sort of the driving and using your phone, are there any other activities that make it worse?

P: Recently I found it's hard for me to hold things um in my right hand, so like if I'm trying to open up a jar um like it's hard for me to hold it, and sometimes I find uh like it'll just fall out of my hand.

D: OK, so you're like dropping items and stuff?

P: Mhmm, yes.

D: OK, and do you feel any, uh, like the numbness or tingling, does it radiate anywhere? Like to your forearm or up into your like upper arm or shoulder?

P: Uh no, I don't think so. No. 

D: OK. And do you have any neck pain?

P: No.

D: OK, and have you had any trauma or injuries to your wrist or hand?

P: No, nothing that I can think of.

D: Alright. Um and, have you had any weight loss recently?

P: No. 

D: How about any fevers or chills?

P: No. 

D: Have you had any night sweats?

P: No. 

D: OK, have you had any changes to vision or hearing? 

P: No.

D: How about other senses like any changes to your sense of smell or sense of taste?

P: No.

D: Alright, have you had a runny nose or felt congested? 

P: Uh no.

D: Alright, have you had a sore throat or a cough, perhaps?

P: No.

D: Alright, have you had any shortness of breath?

P: No. 

D: Have you had any chest pain or feeling like you're uh like feeling like you have heart palpitations? 

P: No.

D: OK. Have you had any lightheadedness or dizziness? 

P: Uh no. 

D: Alright, and have you had any nausea or vomiting?

P: No. 

D: How about any abdominal pain? 

P: No.

D: Alright, how about any urinary problems?

P: Uh no.

D: Have you had any changes to your bowel movements like diarrhea, constipation?

P: No.

D: OK, and have you had any changes to your hair or nails? 

P: No.

D: And any skin rashes or um anything like that?

P: No. 

D: Alright, and uh have you had any other pains in your joints or any joint swelling?

P: No. 

D: OK. Uh, and have you been diagnosed with any medical conditions before?

P: No, not that I can think of, yeah no, when I was younger I had like childhood asthma but nothing since.

D: OK, do you use any inhalers now?

P: No, not for a long time.

D: OK, do you take any other medications?

P: No. 

D: OK, um and how about, do you have any allergies?

P: No.

D: OK, and have you had any surgeries or hospitalizations? 

P: Uh no.

D: OK. Um and, uh, could you tell me a little bit about uh where you're living and who you're living with?

P: So um I live with my boyfriend and we live in a rented basement apartment downtown.

D: OK. Um and are you working currently, or are you in school?

P: Um I am a grad student.

D: OK, excellent, and um do you smoke cigarettes? 

P: I don't.

D: OK, and uh do you drink alcohol?

P: Um I'll have a glass of wine once a week.

D: Alright. Um and do you use any recreational drugs?

P: Uh no.

D: OK. And in the family, uh, are there any, is there a history of like hypothyroidism or other autoimmune conditions?

P: Um there's rheumatoid arthritis in the family, but that's about it.

D: OK, um but you don't have any other joint swelling or pains, right?

P: No.

D: OK. Uh, and so next I would like to just um uh do a physical exam, and for the first part I'll ask you to just have a look at the hand and wrist and, are you seeing any swelling, erythema or redness or like any muscle wasting or or atrophy?

P: Um so, in my right hand, um I guess the you know the fleshy part of your thumb just above your wrist, um that seems to be um I guess atrophied compared to my left hand.

D: OK so, OK, so the muscle bulk is um reduced there. 

P: Mhmm.

D: OK, and are you feeling any temperature changes, like does the, any areas of the hand or wrist feel warm or hot?

P: Um no.

D: Alright. Um and are there any areas if you uh palpate that cause pain, like over the wrist or any of the joints?

P: No pain. Um yeah, no pain.

D: Alright, um and, are you able to uh flex and extend your wrist?

P: Uh yeah I can do that.

D: Alright, and and how about making a fist and and then also extending your fingers back out?

P: That hurts, or like that causes the tingling.

D: OK, um are there any any issues with like moving your elbow or your shoulder?

P: No.

D: OK, and if you take your opposite hand, um with just your uh kind of pointer finger and middle finger and just really tap, um right near the wrist crease called the Tinel's test, you tap there. Do you feel any reproduction of symptoms?

P: Yeah, that that causes the tingling.

D: OK, so you're positive Tinel's test, and um if you kind of place your wrist so that um like the backs of your hands are facing each other so that your wrists are flexed downwards and your um, your wrists are flexed and your fingers are pointing towards the ground and you just hold that position for a period of time. Um do you feel any pain?

P: Uh I guess a little bit of tingling.

D: OK, so that would be a positive Phalen's test as well. Um and range of motion of the neck, do you have any problems with that or any pain there?

P: No. 

D: OK. Um I think that was everything I wanted to ask about and check on the exam. Did you have any questions for me?

P: Um no, no questions. Thank you so much.

D: Alright, you're welcome, yeah, so it sounds like this could be uh carpal tunnel syndrome and uh so we we may depending on uh kind of like nerve studies to confirm the diagnosis, and um things that you can do in the meantime would be to use like a splint or um yeah, try to use like nighttime splints and activity modification as well.

P: OK, yeah, that sounds good.