Your pregnant patient is at 8 weeks' gestation and complains of pain that radiates from the wrist into the fingers in the right hand. She is a computer programmer and uses a keyboard daily for 6 hours or more. The clinician should:

Question

A. Ask the person to place dorsal surfaces of hands together to check for Phalen's sign
B. Teach the patient that carpal tunnel syndrome is common during pregnancy
C. Tap the patient's right wrist to try to elicit tingling in the fingers for Tinel's sign
D. All of the above

Answer 1

ANS: D
Carpal tunnel syndrome results from compression of the median nerve in the carpal tunnel, which results in paresthesias or weakness of the thumb, index, and middle fingers (Viera, 2003). Carpal tunnel syndrome occurs in 20% to 60% of pregnant women and often causes these women to awake with burning, numbness, and tingling in the median nerve distribution (Padua et al., 2001; Weimer et al., 2002). However, these symptoms usually tend to occur during the last trimester. Tinel's sign and Phalen's test should be performed. Upper extremity, grip, and finger strength should be assessed along with the ability to oppose the thumb to the fingers. An evaluation for thenar atrophy and dry skin on the thumb as well as index and middle fingers (median nerve distribution) should be completed. The size and shape of joints, skin color, pulses, and capillary refill should be noted.