An Elderly Woman With Numbness in the Hands





An 82-year-old woman with a long-standing history of rheumatoid arthritis (RA) recently suffered a hip fracture that caused difficulty walking, forcing her to use a walker. She presented with numbness and tingling of the hands that had persisted for the previous 6 weeks.


Examination revealed mild limitation of neck movements. Strength and reflexes were normal. She had mild atrophy of the right thenar muscles. There were joint deformities at the hands and wrists. Pain sensation was decreased in the median nerve distribution of the hands; the patient also had a bilateral positive Phalen test.


Neurologic examination was otherwise negative.


What is the Differential Diagnosis?


This patient’s symptoms are characteristic of a median neuropathy at the wrist. There are other possibilities to be considered, including C6–C7 radiculopathy, other median neuropathies, and brachial plexopathy, but these are less likely.


An Electromyography (EMG) Test was Performed




Motor Nerve Studies

























Nerve and Site Latency(ms) Amplitude (mV) Conduction Velocity (m/s)
Median Nerve R. Normal ≤ 4.2 Normal ≥ 6 Normal ≥ 50
Wrist 7.8 1.7 –
Elbow 12.2 1.7 55




















Ulnar Nerve R. Normal ≤ 3.6 Normal ≥ 8 Normal ≥ 50
Wrist 3.0 11 –
Elbow 6.4 10 56

























Nerve and Site Latency (ms) Amplitude (mV) Conduction Velocity (m/s)
Median Nerve L. Normal ≤ 4.2 Normal ≥ 6 Normal ≥ 50
Wrist 4.3 6 –
Elbow 8.4 6 55




F-Wave Studies




















Nerve Latency (ms) Normal Latency ≤ (ms)
Median nerve R. 39.4 30
Ulnar nerve R. 27.2 30
Median nerve L. 28.1 30



Mar 25, 2024 | Posted by in NEUROLOGY | Comments Off on An Elderly Woman With Numbness in the Hands

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