Paraesthesia
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7352.1501 (Published 22 June 2002) Cite this as: BMJ 2002;324:1501
This article has a correction. Please see:
- Badal Pal (badal.pal@smuht.nwest.nhs.uk), consultant rheumatologist
- Withington Hospital, Room 10, Home 4, Manchester M20 2LR
A woman of 45 comes to you with tingling (“pins and needles”) and numbness in the fingers and hands. It has been getting gradually worse for about three months.
Phalen's investigations for paraesthesia in fingers and hand
If you suspect:
Carpal tunnel syndrome—Do Phalen's test (positive if holding the wrist in flexion for 20 seconds or more reproduces the patient's symptoms) and refer for nerve conduction tests
Ulnar nerve palsy—Refer for nerve conduction tests
Raynaud's phenomenon—Test blood for rheumatoid and antinuclear factors
Other systemic disease—Depending on the findings on neurological examination, consider checking for hypothyroidism (plasma thyroid stimulating hormone and thyroxine); diabetes (dipstick testing for glycosuria, random serum glucose, fasting serum glucose); rheumatoid arthritis and other connective tissue disorders (serum rheumatoid and antinuclear factors); alcohol related disease (liver function tests, full blood screen); renal disease (urine and blood biochemistry); vitamin …