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Tingling sensation in the palm - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1722 Questions
User :   A person has tingling sensation in his right palm for about two weeks. He has a trouble conng the movement of his thumb and rotating his right hand at wrist. Also, he had difficult time at the gym gasping the chin-up bar. The person has developed a “click” in his shoulder. Four months earlier the person got in a bike accident (he fall on his right shoulder and wrist). So he suffers concussion from the bike accident. The person has no clavicular pain but does experience a sharp pain in the shoulder region when reaching to grab a chin-up bar. What can it be?
Doctor :   Hi,
Doctor :   Dr XXX here
User :   Hi
Doctor :   please give me a minute to read your post
User :   I wrote the situation
Doctor :   Is the pain since the accident ?
User :   yes
Doctor :   how is the pain in the shoulder on rotating the shoulder ?
User :   he feel the pain too, but it is more at the wrist
Doctor :   well, i do not doubt any joint dislocation in the shoulder but a mild ligamental sprain
Doctor :   Has he got Xray of the wrist ?
User :   no
Doctor :   i suggest to get an xray of the wrist , as the dislocation in the carpal bones may not present with severe pain at once but mild pain for long
User :   can it be the median nerve injured?
Doctor :   and the tingling sensation would be due to compression of the nerve in the wrist which is more likely to be due to displaced carpal bones
Doctor :   May i know whether the tingling sensation is all over the hand or restricted to few fingers , if so which fingers ?
User :   Also, the person is retaining fluid in his right hand
Doctor :   ya , that could happen due to vascular injuries or as a indirect effect of nerve compression ( sympathetic effect )
User :   the sensation is in his palm
Doctor :   the whole of the palm ?
User :   yes
Doctor :   then the median nerve involvement should be considered
User :   he has the pain in the shoulder region only when he is reaching upwards
Doctor :   yes, that could happen when the rotator cuff ( ligament ) is sprained , it will be self limiting
User :   ok
Doctor :   i suggest you to get an xray of the wrist and present it top an orthopedician , if dislocated carpal bones , he reduce the dislocation and advice immobilisation
User :   what is the source of tingling?
Doctor :   nerve compression , its paraesthesia
User :   what are the other methods of determining the problem?
Doctor :   the best and gold standard is xray
Doctor :   also you can go for ENMG if the dislocation in the xray is confirmed to study the nerve conduction
User :   what other methods are there or would be good in this situation?
Doctor :   consult a neurologist too, after the test , where he would examine the nerve functioning physically
Doctor :   by examining the sensory , motor and reflexes
User :   ok. From what you have red, what the most plausible diagnosis would be?
Doctor :   Carpal bone dislocation or carpal tunnel syndrome
User :   I thought that with carpal tunnel only median nerve would be affected but this seams like ulnar nerve can be affected too.
Doctor :   may i know the reason y you think ulnar nerve involved ?
User :   because the sensation is in the whole palm and the median nerve inervates only portion of the anterior surface of the palm
User :   for the other portion would be the ulnar nerve responsible, I think
User :   I'm just guessing that
Doctor :   no , there are least chances for the both nerves to be affected
User :   Why
Doctor :   they share two different compartments in the carpal tunnel
Doctor :   the mechanism of injury to affect the both nerves is diff
User :   how is it diff
Doctor :   i mean the mech of inj for the median nerve and ulnar is diff
User :   maye you can explain this
Doctor :   the direction of force if its against the long axis of the wrist which is more likely wen in accidents where the person will lay pout his palm to support him on the ground
Doctor :   but for thr ulnar nerve injury the direction of force should be from lateral side and more common in defence wounds in assault
Doctor :   the*
User :   Ok. Thank you
Doctor :   Thanks for consulting me
Doctor :   bye for now
Doctor :   take care

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