Abstract
EK. has worked in the clinical laboratory of a large medical center for 14 years. Her duties include processing and testing specimens, and entering results into a computer. She uses a variety of equipment for these tasks, including a microscope, pipette, and cell counter. E.K. has noted numbness and tingling in both thumbs and index fingers for the past few years, which currently has become constant over recent months. She reports difficulty gripping objects and a loss of grip strength. Last week, she dropped an entire rack of test tubes. This prompted her supervisor to refer her to employee health for evaluation. During her visit, she is nonchalant about her symptoms, noting that everyone in her lab has lots of “aches and pains” and that “it's part of the job.” On examination, she has severe hypothenar atrophy, decreased range of motion of the thumb carpometacarpal joints bilaterally, decreased grip strength, and a loss of sensation to two point discrimination in a medial nerve distribution.