Abstract
A 42-year-old highway maintenance worker patient presents to your Monday morning clinic in February with a history of episodic blanching of the right second and third digits for several months with associated paraesthesia and loss of sensation in the finger tips. He explains that his work involves operating pneumatic drills to break up road surfaces and his symptoms are more noticeable after work. There is no cervicalgia. No other neurological symptoms are reported. He has a past medical history of psoriasis and is otherwise fit and well.
What would your list of differential diagnoses be?
What would be the occupational implications of these diagnoses?
What medications could make this condition worse?
What advice would you give to this patient on the best course of management?
