A patient who does a great deal of computer work complains of extreme coldness in the fingers of her right (mouse) hand. Could this be a positional or vascular problem?
—Diana Koon, MS, FNP-C, Plano, Tex.

Is the coldness strictly sensory, or is it palpable? Is the rest of her neurovascular exam normal (i.e., grip, sensation, pulses)? Is her hand cold all the time or just when she is using the mouse? Neurologic problems are very common in the workplace, mostly caused by repetitive motion. An electromyogram and nerve conduction study would be the next step in her workup to rule out a problem such as carpal tunnel syndrome.
– Sherril Sego, MSN, FNP (108-1)

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