Mrs.

Hiroshima, 40-year-old, presents in the Emergency Room Department

of Golden Gate Batangas Hospital Inc with complaints of pain, tingling
sensation, and weakness of the right hand for the past 4 months.

Mrs. Hiroshima is a middle school music teacher and plays the guitar on
the weekends in a friend’s local band, she is hardworking and the
breadwinner of the family. Because of busy schedule she tends to exercise
less. On her past times she loved playing video games with her 4 year-old
son. She is a non-smoker and an occasional drinker. Her mother has a
medical history of rheumatoid arthritis, and diabetes. No other medical
condition is present and accounted to the family

Based on the interview, the client has been controlling the pain by taking
over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for the
past few weeks. Due to the pain, the client has used up all of the sick days
for the school year and has now started to take personal days off without
pay.

Her initial vital signs are: BP 130/80mmHg, PR: 108bpm, RR: 33cpm, O2
Saturation: 99%, T: 36.9°C. The client reports to the nurse that the pain
started gradually and then the tingling and numbness began.

Two hours prior to consultation, the client now has complete loss of
sensation in the fingers of the right hand. The client is right-handed but now
has limited function of the right hand made her decide to bring herself to
the hospital.

　　Upon assessment she manifested a worsening condition she

describes the pain as excruciating at times with a pain scale of 8/10, so
much so that work has become impossible to do, irritable, guarded
behavior on her right hand, facial grimace connotes pain. Dr. Shiva the
doctor assessing her in the Emergency Room noted upon examination very
less ROM on the right hand, (+) pale appearance, appear weak and tired,
rapid breathing. The doctor discussed to her regarding his advised
confinement. Dr. Shiva is evaluating the client for possible carpal tunnel
syndrome.
Questions:

a. Based on the preliminary interview, the health care provider determines

that the client’s symptoms are due to carpal tunnel syndrome. How will the
diagnosis be confirmed?

b. The health care provider conducts several musculoskeletal tests to

assess if any muscles are involved. Describe how this is performed.