What is the best diagnostic approach to paresthesias of the hand?
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There have been no good studies comparing different strategies for the evaluation of the patient with hand paresthesias. A reasonable strategy is to first evaluate for carpal tunnel syndrome (CTS), the most common condition associated with hand paresthesias. If the patient does not have findings consistent with CTS, then consider other diagnoses (Table). (Grade of recommendation: D, based on expert opinion.) Findings consistent with CTS include a history of repetitive hand work, asymmetric paresthesias in the distribution of the median nerve, hypoalgesia, weak thumb abduction, or latency of nerve conduction studies. Tingling in the median nerve distribution or on the entire palmar surface also supports the diagnosis. Common conditions associated with CTS are pregnancy, obesity, and hypothyroidism. (Grade of recommendation: B, systematic review of case control studies).
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