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J Natl Med Assoc. 1981 Oct;73(10):995-6.

The pill and the thoracic outlet and bilateral carpal tunnel syndromes.



A case report is reviewed of a 22-year-old woman who presented on July 22, 1980 with a 1-week history of bilaterally recurring complaints of hand paresthesias radiating up both arms followed by coldness, aching, and imperceptible and uncontrollable tremors of her hands. The woman's symptoms usually began within minutes after she began typing, and slowly abated within 10-15 minutes after she was forced by discomfort to discontinue typing and hold her arms at her sides. The woman also described, unilaterally, the same symptoms over the same period of time on awakening each morning. She had previously enjoyed excellent health, had been taking oral contraceptives (OCs)--norgestrol and ethynyl estradiol--during the preceding 4 years without problems, and had gained 12 pounds during the preceding 6 months. Symptoms began exactly 7 days prior to the onset of her menses. Raynaud's phenomena were denied. X-rays of the cervical spine were normal, and specifically revealed no signs of cervical ribs or large lower cervical transverse processes. The patient was given a single oral 80 mg dose of furosemide, and thereafter hydrochlorothiazide 50 mg, orally twice daily for 1 week. Symptoms were dramatically improved within 24 hours. When evaluated again on July 30, 1980, she was asymptomatic except for minimal complaints and physical findings of the carpal tunnel syndrome on the right. There were no complaints referrable to the thoracic outlet syndrome, but physical examination again documented findings of partial thoracic outlet vascular obstruction. Within 2 weeks the patient was asymptomatic. When interviewed on August 29, 1980, the patient was asymptomatic but gave the identical history of onset and recurrence of all her symptoms, to a lesser extent, exactly 1 week prior to the onset of her August menses. The patient's symptoms totally disappeared by the 3rd day of her menses. In sum, both the carpal tunnel syndrome and the thoracic outlet syndrome quickly resolved when treatment with diuretics was extended the patient for a short period of time premenstrually.

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