Neuropathy in both hands and wrists

The patient is a 61-year-old female who presents with a complaint of pins and needles, burning, tingling and numbness in both hands. On April 9, 2012, she was in a cruise and was receiving a massage. After the massage, she noticed a sensation in her fingers that started with the left hand and now is in both hands. She has tried chiropractic manipulation which did help with the problem, but after the chiropractic manipulation was finished the problems started to worsen again. She denies any kind of interventional therapies and also the use of any kind of medication for this condition. She describes her pain as follows. Duration is constant. The intensity of the pain ranges from 9/10 to 3/10. Radiation distribution: Pain is mostly located at the tip of her fingers and the wrist and sometimes does radiate up into the arm as far as the forearm. Aggravating factors: Mostly is aggregated during her sleep likely due to movement. Alleviating factors: Chiropractic manipulation has helped. Description of the pain: Pins and needles, tingling, and numbness.

ASSESSMENT:
1. Neuropathy in both hands and wrists.
2. Possible carpal tunnel syndrome.
3. Possible foraminal stenosis of the cervical level versus herniated cervical disc.

RECOMMENDATIONS:
1. I discussed with the patient the possible diagnoses that include the possibility of entrapment of the nerve either at the level of the wrist, ulnar, or the cervical spine.
2. Cervical MRI to rule out foraminal stenosis versus spinal stenosis versus herniated disc versus any other pathology.
3. EMG of the upper extremities along with nerve conduction study was ordered to determine the presence of radiculopathy versus neuropathy.
4. Follow-up after the patient has these testing done.

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