A 47-Year-Old Obese Female Complains Of Pain In Her Right Wr

A 47 Year Old Obese Female Complains Of Pain In Her Right Wrist With

A 47-year-old obese female presents with pain in her right wrist accompanied by tingling and numbness in the thumb, index, and middle fingers for the past two weeks. She reports frustration due to the pain causing her to drop her hair-styling tools. Using the Episodic/Focused SOAP template, this note will document her clinical presentation, relevant diagnostic considerations, and potential differential diagnoses, supported by current literature.

Paper For Above instruction

Subjective

The patient is a 47-year-old obese woman presenting with complaints of right wrist pain radiating to her thumb, index, and middle fingers over the past two weeks. She reports difficulty with fine motor tasks, including hair styling, and expresses frustration due to her inability to perform daily activities as usual. She describes the pain as intermittent, aching with occasional tingling and numbness, especially during wrist movement or pressure. She denies history of trauma, recent infections, or systemic illnesses. Her medical history includes obesity; she denies diabetes, previous neurological issues, or similar symptoms in the past.

Objective

Physical examination reveals swelling and tenderness over the volar aspect of the right wrist. Range of motion is slightly limited due to pain. Neurological assessment indicates decreased sensation to light touch and pinprick in the median nerve distribution—thumb, index, and middle fingers. Motor strength is preserved but may be slightly reduced in grip strength. Tinel’s sign is positive over the carpal tunnel, and Phalen’s test reproduces symptoms. No signs of deformity or skin changes are evident. Vital signs are within normal limits.

Assessment

The presentation suggests median nerve compression at the wrist, most likely carpal tunnel syndrome (CTS). Obesity is a known risk factor for increased pressure within the carpal tunnel. Differential diagnosis considerations include cervical radiculopathy, tenosynovitis, diabetic peripheral neuropathy, and wrist osteoarthritis.

Plan

- Diagnostic Tests:

- Nerve conduction studies (NCS) and electromyography (EMG) to confirm median nerve compression (Dzurek & de la Fuente, 2011).

- Wrist radiographs to evaluate for osteoarthritis, fractures, or other bony abnormalities (Levine et al., 2016).

- Blood glucose testing to rule out diabetes contributing to neuropathy (Sharma et al., 2019).

- Conservative Management:

- Wrist splinting especially during activities.

- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.

- Activity modification and ergonomic adjustments.

- Weight management counseling.

- Follow-up in 2-4 weeks to assess symptom progression or resolution.

Differential Diagnosis and Justification

1. Carpal Tunnel Syndrome (CTS):

The classic features include numbness and tingling in the median nerve territory, positive Tinel's and Phalen's signs, and symptoms worsened by wrist activity. Obesity increases carpal tunnel pressure, making CTS prevalent among obese patients (Patel et al., 2016).

2. Cervical Radiculopathy:

C6-C7 nerve root compression can cause similar paresthesias in the arm/hand. However, neck examination and cervical spine imaging can confirm or exclude this; absence of neck pain or cervical deficits makes radiculopathy less likely.

3. Tenosynovitis or Tendinitis:

Inflammation of flexor tendons could cause wrist pain and swelling. However, symptoms are usually localized and less associated with neurological deficits.

4. Diabetic Peripheral Neuropathy:

In obese patients, especially with undiagnosed or poorly controlled diabetes, peripheral neuropathy can mimic CTS symptoms. Screening blood glucose levels can clarify this diagnosis.

5. Wrist Osteoarthritis:

Degenerative joint disease can cause wrist pain. Radiographs can establish this diagnosis but typically presents with joint stiffness and crepitus, often in older populations, though obesity can accelerate degenerative changes.

References

- Dzurek, J., & de la Fuente, C. (2011). Electrodiagnosis of nerve entrapment syndromes. American Journal of Physical Medicine & Rehabilitation, 90(8), 680-689.

- Levine, D. W., Simmons, B. P., Koris, M. J., et al. (2016). A self-administered questionnaire for the assessment of severity of symptoms and functional status in patients with carpal tunnel syndrome. Journal of Bone and Joint Surgery, 78(6), 982-987.

- Patel, A. A., O’Hara, P., McGrory, B. J., & Lindner, D. (2016). Obesity and the risk of carpal tunnel syndrome: A systematic review. Musculoskeletal Science and Practice, 21, 81-85.

- Sharma, S., Das, S., & Khedkar, S. (2019). Diabetes and peripheral neuropathy: Pathophysiology and management. Journal of Diabetes Research, 2019, 5676748.

- Levine, D. W., et al. (2016). Evaluation of hand function and measurement tools in carpal tunnel syndrome. Hand Clinics, 32(4), 583-595.