I wanted to share a case I had at the clinic today. I thought it would be a good learning experience for those of you who are students or for those who are just graduating.
Essentially, I had a 35 year old female complaining of bilateral hand pain whom was previously diagnosed with carpal tunnel syndrome.
She said her pain has been going on for approximately 4 to 6 months. She does a lot of cleaning and her pain is aggravated while she is at work. It’s for this reason they were diagnosing her with carpal tunnel syndrome.
But, her symptoms weren’t getting any better so they were thinking of getting nerve conduction studies. Anyway, she comes into our clinic today, and I ask a little more about her discomfort.
She says, “every time I go into the freezer at work, my hand pain gets worse”. So, I ask exactly where the pain is and she says it’s over the fingertips.
It’s not the entire hand and it doesn’t follow the median nerve distribution – instead it’s on the fingertips. I ask if she’s having any pain right now and she said yes.
So, I exam her fingertips and they were completely white. The patient also states that over the last couple of weeks, she’s noticed the pain progress to her toes as well.
By now, you may be well aware, this is not carpal tunnel – this is Raynaud’s phenomenon. The pain here is commonly aggravated by cold exposure – for her it’s going into the freezer. She just had blood work done and everything came back normal. So, the only thing we did was order an ANA because Raynaud’s is associated with autoimmune processes, such as lupus or scleroderma.
I started her on nifedipine and we will see her back in a few weeks.
A very important point: it’s not so important that you spend 20-30 minutes with your patient. Instead, it’s important that you spend quality time with your patient – making sure you are present, asking the right questions, and performing a physical exam. Even if you’re only there for 2, 3, or 5 minutes – make the time count.