CC:

 Left third digit numbness and wrist pain.

HX: 

This 44 y/o LHM presented with a one month history of numbness and pain of the left middle finger and wrist. The numbness began in the left middle finger and gradually progressed over the course of a day to involve his wrist as well. Within a few days he developed pain in his wrist. He had been working as a cook and cut fish for prolonged periods of time. This activity exacerbated his symptoms. He denied any bowel/bladder difficulties, neck pain, or weakness. He had no history of neck injury.

SHX/FHX:

 1-2 ppd Cigarettes. Married. Off work for two weeks due to complaints.

EXAM: 

Vital signs unremarkable.

MS:

 A & O to person, place, time. Fluent speech without dysarthria.

CN II-XII: 

Unremarkable,MOTOR:

 5/5 throughout, including intrinsic muscles of hands. No atrophy or abnormal muscle tone.

SENSORY:

 Decreased PP in third digit of left hand only (palmar and dorsal sides).

STATION/GAIT/COORD:

 Unremarkable.

REFLEXES: 

1+ throughout, plantar responses were downgoing bilaterally.

GEN EXAM: 

Unremarkable.

Tinel's manuever elicited pain and numbness on the left. Phalens sign present on the left.

CLINICAL IMPRESSION: 

Left Carpal Tunnel Syndrome,EMG/NCV: 

Unremarkable.

MRI C-spine, 12/1/92: Congenitally small spinal canal is present. Superimposed on this is mild spondylosis and disc bulge at C6-7, C5-6, C4-5, and C3-4. There is moderate central spinal stenosis at C3-4. Intervertebral foramina at these levels appear widely patent.

COURSE:

 The MRI findings did not correlate with the clinical findings and history. The patient was placed on Elavil and was subsequently lost to follow-up.