Poster 43

Setting: Outpatient rehabilitation clinic. Patient: A 47-year-old man with a history of polio and paralysis of his right arm. Case Description: The patient complained of numbness and tingling in his left hand both with activity and at night. His 2-point discrimination was 3 to 4mm, grasp strength was 70lb, lateral pinch was 22lb, and tip pinch was 15lb. Nerve conduction studies (NCSs) revealed an absent left median sensory nerve action potential (SNAP) and a prolonged motor nerve action potential (MNAP) equal to 6.1ms with a normal amplitude. The patient refused electromyography and was diagnosed with median neuropathy at the wrist, which appeared to be severe given the limited testing. A surgical consultation was recommended, but the patient refused, and conservative treatment was initiated. Treatment included lifestyle modifications, anti-inflammatory medications, vitamin B supplements, and a nocturnal wrist splint. He also began to use voice-activated software, speakerphone, large grip pen, and reduced-tension car steering. Assessment/Results: A repeat NCS was done at 6-month follow-up and it showed significant improvement of his left median neuropathy. The SNAP was present but prolonged at 4.7ms (normal