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Traumatic and Occupational Injuries

A 35-year-old woman works as a keyboard operator and must type for 6 hours per day. Over the course of a few months she has developed pain in her wrists (right worse than left), as well as some paresthesias into the lateral palmar aspect of her hands. There is no atrophy. Conservative treatment for her condition consists of which of the following?

a. Exploratory surgery

b. Wrist splints

c. Hydrocodone

d. Shoulder sling

e. Back brace

The answer is b. Pressure on the volar aspect of the wrist may produce recurrent injuries to the carpal tunnel through which the median nerve runs. The injury characteristically produces pain and paresthesias in the hand over the distribution of the sensory component of the median nerve. This sensory distribution extends over the palmar surface of the thumb and first four digits, with the fourth digit supplied on one side by the median nerve and on the other side by the ulnar nerve. Median nerve injuries are consequently said to split the fourth digit on sensory examinations. With carpal tunnel compression of the median nerve, the sensory disturbance may be incapacitating. Subsequently, weakness and atrophy may develop in the muscles that are innervated by the median nerve. The abductor pollicis brevis may be severely involved late in the progression of the disorder. Treatment options for carpal tunnel syndrome include avoiding aggravating factors, splints, and surgical procedures. The role of surgery is not clearly defined, but many experts agree that progressive cases or those with motor involvement should often consider surgical nerve release.

A 28-year-old police officer has been generally healthy except for mild, easily controlled hypertension. He sustains a gunshot wound to the upper arm. This type of trauma may cause partial damage to the median nerve that may leave the patient with which of the following?

a. Easily provoked pain in the hand

b. Weakness on wrist extension

c. Atrophy in the first dorsal interosseous muscle

d. Numbness over the fifth digit

e. Radial deviation of the hand

The answer is a. Trauma to nerves in the extremities may give rise to causalgia, a disturbance in sensory perception characterized by hypesthesia, dysesthesia, and allodynia. Hypesthesia is a decrease in the accurate perception of stimuli. Dysesthesia is persistent discomfort, which in the situation described is likely to be an unremitting burning pain. Allodynia is the perception of pain with the application of ...

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