Chloe Goodheart: A 22-Year-Old Female With Electric Shock–Like Pain and Numbness in the Fingers of the Right Hand

Chloe Goodheart

Chloe Goodheart is a 22-year-old hairstylist with the chief complaint of “I have electric shock–like pain and numbness in my fingers.” Chloe stated that over the past several months she began noticing electric shock–like pains, especially in the index and middle fingers on the right. I asked Chloe if she had experienced any numbness or weakness in her hands before, and she replied, “Doc, it’s funny that you asked because this happened once before. Not as bad, but similar. Last time it went away after a couple of weeks, but this time, it just won’t go away.”

I asked Chloe what she thought was causing her symptoms, and she said that it started after she carried home some especially heavy groceries last Thanksgiving. “My parents were coming to visit, and I wanted to fix a really special Thanksgiving meal. I bought this huge frozen turkey and all the trimmings. I guess I bought more food than we needed, but I wanted to make it nice. I had about an 11-block walk from the supermarket, and I have to tell you, those bags got really heavy. I had them double-bag the turkey and the yams and other heavier stuff, but by the time I got home, the handles of the plastic bag had begun to stretch out and cut into my fingers. I got everything home without any bags breaking, but that night my fingers really hurt. The next day, when I was combing out a client’s hair, I noticed that I was getting electric shock–like pains that shot into the fingertips of the index and middle fingers of my right hand. I figured it would go away, but if anything, it has gotten worse.” I asked Chole what she had tried to make it better, and she said that she used a heating pad at night, and it “seemed to make the shocks a little better. Tylenol PM seemed to help some, at least with sleep.” I asked Chloe to describe any numbness she noticed associated with her pain, and she pointed to the distal portion of her right index and middle fingers, especially on the radial side of the fingers. “Doc, the thumb side of my fingers is really numb, and it makes it hard to do the foil when I am coloring a client’s hair. It’s becoming a real problem.” I asked Chloe about any fever, chills, or other constitutional symptoms such as weight loss, night sweats, etc., and she shook her head no. She denied any weakness, but noted that sometimes the electric shocklike pain woke her up at night.

I asked Chloe to point with one finger to show me where it hurt the most. She pointed to the radial aspect of the index and middle fingers and said, “This is where the shocks seem to come from. And I could live with the shocks, but the numbness is really bothering.”

On physical examination, Chloe was afebrile. Her respirations were 18, her pulse was 74 and regular, and her blood pressure was 110/68. Chole’s head, eyes, ears, nose, throat (HEENT) exam was normal, as was her cardiopulmonary examination. Her thyroid was normal. Her abdominal examination revealed no abnormal mass or organomegaly. There was no costovertebral angle (CVA) tenderness. There was no peripheral edema. Her low back examination was unremarkable. Visual inspection of the right hand was unremarkable. There was no rubor, color, or ecchymosis. There was no obvious infection. The Tinel sign was negative over the right ulnar nerve at the elbow and the right median nerve at the wrist but positive over the digital nerve of the index finger. There was pain on compression of the digital nerves on both the index and middle fingers. The left hand examination was completely normal. Deep tendon reflexes were normal. Chloe’s Allen test was negative ( Figs. 14.1, 14.2 and 14.3 ).

Key Clinical Points—What’s Important and What’s Not