D: What brings you in?

P: I've um I've been having this numbness and tingling and I guess kind of burning sensation that well uh it's been happening more often in my uh left hand.

D: On your left hand, OK. And sorry when did you say this started?

P: Uh it's been going on for probably four or five months um.

D: OK.

P: Yeah, it first uh it would only bug me for a couple of minutes at a time and I could kind of shake my hand out, like flick like flick my wrist and um and it would go away after a few minutes. But now I'm starting to get uh like symptoms at night sometimes as well.

D: OK, so um it's gotten worse then, you said over the past few weeks?

P: Yeah it has. 

D: OK um and is it always there? Is it persistent or does it come and go?

P: It comes and goes.

D: OK and what makes it better or worse?

P: Uh better uh I've tried some um Advil um and Tylenol and it's kind of the, hasn't done much um for the pain really, uh I think only the thing that kind of helps it is just not using it as much, um yeah. 

D: Yeah, alright, um have you tried any like cold compresses, um topical creams? Anything like that?

P: No.

D: No, OK. And uhm if you were to describe the quality of how it feels like, does it does it, is it painful, is it tender, or is it just numb and tingling, kind of like when your foot goes to sleep?

P: Uh I guess I have, it is a bit painful as well, yeah. I have um like a burning kind of pain.

D: OK and 1 to 10, 10 being the worst pain ever, how bad is this pain?

P: Uh when it gets to its worst, I would say about a 6.

D: OK, OK. Um and have you ever experienced this before or is this kind of like the first time you're experiencing this?

P: Yeah, this is the first uh really like over these last three months, the first time I've been experiencing it, I think uh the first time that it started it started to wake me up at night though has been like about a couple of weeks ago.

D: Oh I see, OK. Um alright and do you feel like your symptoms are getting worse over the past few weeks or is it kind of the same?

P: Uh over these past couple of weeks, about the same. It's woken me up uh like two or three times at night.

D: OK, alright and do you have any numbness or tingling elsewhere on your body?

P: No, it's just um just kind of the the outside of my hand here, it's really only the first like 3 fingers.

D: OK, first three fingers so your um thumb, index finger and uh middle finger? Or your pinky to middle finger?

P: Yeah, it's just the uh my thumb index finger and ring finger.

D: And ring finger, OK.

P: And maybe just like a little bit of the um like of the ring finger too, but not all of it.

D: OK, um alright, so um any weakness in your arms or do you feel like you can still use your arms OK?

P: Uh yeah I haven't had any, uh, any muscle um weakness, I guess I may be a bit more clumsy um with uh with my left hand like I've dropped a few things, I've had it, a little bit more difficult time like opening jars or like car doors and stuff like that.

D: OK, OK, and any confusion or memory loss?

P: No.

D: Headaches?

P: No.

D: OK, um how about weight loss?

P: No, I haven't had any weight loss.

D: Uh fevers or chills?

P: No.

D: Uh rashes? 

P: No rashes.

D: Changes in your vision, hearing, smell or taste?

P: No, that's been normal.

D: OK, how about um a cough?

P: Uh no, I haven't had a cough.

D: OK, um wheezing or shortness of breath?

P: Nope, neither of those.

D: OK. Chest pain or heart palpitations?

P: Um nope, I haven't had that. 

D: OK, how about um changes in your bowel movements?

P: Uh nope, I haven't had any diarrhea and no no constipation and no blood either.

D: OK, good. Any nausea or vomiting?

P: No I haven't had any of that.

D: OK, any changes in your voiding? 

P: Uh, no I I um haven't had any problems with urination.

D: OK, um are you otherwise healthy? Do you have any longstanding medical conditions?

P: Um I have hypothyroidism, so I take um like uh thyroxine for that and um I am overweight as well, or in obesity class one I think.

D: OK, and um do you take any medications for the hypothyroid? 

P: Yeah I do, I take um I take uh Synthroid, I think.

D: OK, alright, and are you on any weight loss medications?

P: No, I've just been trying to uh change diet around when I can and um and trying to um exercise a bit more, but uh it's been it's been tough, especially now with my wrist or my hand bugging me.

D: Yeah, for sure. Um alright, and then are you up to date with your immunizations?

P: I am, yeah and I get the flu shot every year. 

D: OK, that's good. Um and have you had any hospitalizations or surgeries in the past? 

P: Um I, I, no, I haven't had anything like that.

D: No, OK. Um any allergies?

P: Uh no allergies. 

D: OK, family history of lung or heart conditions?

P: Um my grandfather had a stroke when he was in his uh 70s, um and my dad has high cholesterol.

D: Have you been worked up for all of that? Like high blood pressure, diabetes, cholesterol?

P: Uh yeah, I think my family doctor checked a few years ago, but I've been healthy besides this um uh this this pain um so maybe that, yeah maybe that could be investigated as well.

D: OK, um any neural, neurological, or musculoskeletal issues in the family?

P: Um I think osteoarthritis, a few few people have that.

D: OK, um how about autoimmune conditions?

P: Uh no, I think I'm the only one with the thyroid.

D: OK, um how about cancers?

P: Uh no cancer.

D: No cancers, OK. Um alright and then, do you smoke?

P: I do, yeah, I smoke about um 5 to 10 cigarettes per day. 

D: OK, and um for how long have you been doing that?

P: Uh probably yeah about the last 10 years, it was kind of around when I started working um in the warehouse here, um yeah.

D: OK, and have you ever thought about quitting?

P: I have, yeah I've tried, it's just such uh I mean people just go out and I mean have their coffee and cigarettes and it's sort of a social thing while at work, it it's kind of what people do so, I have been trying to cut down though.

D: OK, OK, that's good. If you need any resources, we have some that we can refer you to. Um and do you consume marijuana in any form?

P: Um no, I don't.

D: No, OK. Any recreational drugs.

P: Um nope, I don't use anything like that.

D: OK, how about alcohol? Do you drink? 

P: Um I'll have wine every once in awhile on the weekends, maybe maybe a drink per week, something like that.

D: OK, um and have you been in contact with anyone sick recently?

P: Uh no, I don't believe so.

D: OK, how about travel? 

P: No, I've been I've been at home and and just going to work.

D: OK. Um and and where do you live and who do you live with?

P: So I live with my husband and our two daughters and we live and we live in a house.

D: OK, um any concerns for STI's?

P: No, I'm just um, I've been monogamous with my partner now for uh over 10 years and um no concerns for uh an STI at this time.

D: OK, alright good, um so now we're just going to move on to the physical exam part um of this interview. Um so I'm going to get you to look at both your arms, hands, and wrists, um side by side. Does your left one seem at all more red, swollen, uh or hot.

P: No, no symptoms like that.

D: No, OK. And um do you, does that one seem to be more atrophied or are there any deformities or skin changes on that one? 

P: Um maybe uh a little less muscle bulk on the, like where my thumb is. 

D: OK, OK. Um and then I'm gonna get you to palpate certain areas of that arm. So let's start um at the top, when you when you press down on your shoulder blades or just at the very top of your um arm where your, or at the very top where your arm connects to your shoulder, does it hurt over there?

P: No, no pain there.

D: OK. So no pain on the acromion process or the scapula. Um any pain where your biceps are?

P: No.

D: No, OK. How about at your elbows?

P: Uh no pain at the elbows and full, I can move my elbows and shoulders, uh no problem either. And my neck doesn't hurt at all either, I can move my neck around.

D: How about when you um palpate your wrists, both sides, medial and lateral?

P: Uh, yeah no, no pain if I'm just pressing or palpating the wrist.

D: OK. Um and I'm going to get you to um straighten out your arm and flex at your shoulder and extend at your shoulder, does that hurt?

P: No.

D: How about when you flex your elbow and extend your elbow?

P: No.

D: Um how about when you flex your wrist and extend your wrist?

P: No.

D: OK, so I'm going to do a special test for something called carpal tunnel syndrome. Um so um I'm gonna get you to straighten out your left arm again um and right where um alright, how do we do this? OK, so with your right hand or with your yeah, with your right index finger and middle finger, you're going to tap um just below uh where the bulk of your thumb muscles are um connecting to your wrist. I'm just going to get you to tap that area. Do you feel tingling like an electric shock sensation in your hand or anything like that.

P: I do, yeah.

D: You do, OK, so that's a positive Tinel's sign. Um and then we're going to do one more test, so I'm going to, OK so make like a prayer motion with your hands like um putting your 2 palms together and then um and then instead invert your hand so that the outer parts are touching and your fingers are pointing towards the ground.

P: OK.

D: So kind of like upside down but with your outer parts of your hands touching. Um and then I'm going to get you to uh just hold your arms like that um for about 60 seconds. Do you feel any tingling, numbness, or pain in those fingers?

P: Yeah, I get a bit of uh numbness and tingling when when I do that.

D: OK, so that's a positive Phalen's sign test. Um alright, so that brings me to the end of um this interview, did you have any questions or concerns, anything that you wanted to bring up?

P: Uh just wondering about um what this could be.

D: Oh yeah, so um it seems like you have something called carpal tunnel syndrome. Um and that is, it's pretty common um so it can be caused by um a lot of things, but basically your median nerve runs through your forearm into your wrist, and anything that squeezes or irritates that median nerve can lead to carpal tunnel syndrome, um and some things include um like repetitive movements at work, um obesity, um any nerve damaging conditions like diabetes, um inflammatory conditions, but mostly just like workplace factors can can do it, um especially if you're working with like vibrating tools or on an assembly line that requires like repetitive and prolonged flexing of the wrist. Um so uh diagnosis, we just do that through like symptoms, physical exam, um we don't really need to do any imaging at this at this point. And to treat it um basically work modification, so taking frequent breaks, uh not doing those repetitive movements um as often um and then you can do things at home, like apply cold packs. Um and then we also have some like non-surgical treatments where we can uh splint, we can put like a wrist splint um while you sleep to relieve those nighttime symptoms. Uh you can take some NSAIDs to relieve pain, um and if those don't work, we can try corticosteroids, um and if that doesn't work, then we can also discuss surgery sometime down the line. Does that sound OK?

P: It does, yeah, thank you.

D: Yeah no problem.