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A 45-year-old man presents with a three-month history of unilateral symptoms in his right wrist and hand. He first noticed a palpable nodule over the volar aspect of his wrist about three months ago. The nodule would become painful after weekends of heavy drinking at which time he noticed tingling sensation in his index and middle fingers. He notes that ibuprofen has helped improve the pain in the past. On clinical examination, he has a palpable, nontender, solid nodule over the volar aspect of his wrist. He has no motor or sensory deficits and negative carpal tunnel provocative tests. An axial CT and MRI image are provided in figures A and B. What would be the most appropriate next step in the management of his symptoms?
Fine needle aspiration
Establish a tissue diagnosis and referral to a rheumatologist
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A healthy 50-year-old secretary is about to undergo an open carpal tunnel release. Which of the following peri-operative steps will have the greatest influence on minimizing the risk of a surgical site infection in this patient?
Administration of cefazolin within 1 hour before incision
Administration of cefazolin within 1 hour before incision followed by 5 days of cephalexin post-op
Cleanse with bacitracin solution immediately before skin incision
Standard sterilization and prepping
Administration of one dose of cephalexin within 1 hour before incision
A 44-year-old male factory worker presents with a 7-month history of pain and paresthesias involving the palmar aspect of the left thumb, index finger, long finger, and the radial half of the ring finger. He reports that this often occurs at night when trying to go to sleep. He has a history of anemia and obstructive sleep apnea. Percussion over the volar wrist crease produces electric sensation distally in the hand and wrist flexion with the elbow in extension produces thumb paresthesias within 18 seconds. Figure A demonstrates a radiograph of the left hand. A sensory nerve conduction velocity test shows a distal sensory latency of 5.7 ms. Which of the following is the most appropriate next step in management?
Phonophoresis and 6-week course of Vitamin B6 (pyridoxine)
Occupational therapy with wrist massage and activity modification
1-month course of nonsteroidal anti-inflammatory drugs [NSAIDs] and physical therapy
1-month course of bumetanide, smoking cessation, and physical therapy
All of the following are contents of the carpal tunnel EXCEPT:
Flexor pollicis longus (FPL)
Flexor digitorum sublimis (FDS)
Flexor digitorum profundus (FDP)
Flexor carpi radialis (FCR)
All of the following can be found on the electromyography (EMG) portion of an electrodiagnostic study during the evaluation of a patient with carpal tunnel syndrome EXCEPT:
Fibrillations at rest
Positive sharp waves
Decreased motor recruitment
Increased insertional activity
Increased distal sensory latency
A 50-year-old woman is diagnosed with carpal tunnel syndrome. She is prescribed a cock-up wrist splint at 30 degrees of extension to wear at night. This splint has what effect on the carpal tunnel?
Decreases carpal tunnel pressure
Increases carpal tunnel pressure
No effect on carpal tunnel pressure
Enlarges the carpal tunnel volume
Improves nerve conduction studies
All of the following are predictive findings for correctly diagnosing carpal tunnel syndrome EXCEPT:
Abnormal hand diagram
Abnormal Semmes-Weinstein testing in wrist-neutral position
Positive median nerve compression test (Durkan's sign)
Presence of night pain
Loss of small digit adduction (Wartenberg sign)
Approximately what percentage of pre-operative grip strength would be expected 3 months after carpal tunnel release?
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HPI - slowly progressive swelling of insidious onset over rt wrist and palm, dull aching with paresthesia over radial three fingers on domestic activity. associated history anorexia weight loss and low grade fever off and on.
What is the most likely diagnosis?