PHANTOM CARPAL-TUNNEL SYNDROME

Phantom sensation is ubiquitous among persons who have had amputation; however, if it develops into phantom pain, a thorough clinical invest igation must ensue. We illustrate this with the case of a 49-year-old woman, 14 years after traumatic amputation of her left 2nd through 5th fingers, and 10 years after traumatic left transfemoral amputation. S he had had phantom sensation in her absent fingers for pears and devel oped progressive pain in her phantom fingers 3 months before presentat ion. Nerve conduction study revealed a high-normal distal motor latenc y of the left median nerve and a positive Bactrian test (sensitivity 8 7%). She was diagnosed with ''phantom'' carpal tunnel syndrome and tre ated with a resting wrist splint, decreased weight bearing on the left upper limb, and two corticosteroid carpal tunnel injections with mark ed improvement. Clinicians should recognize that phantom pain may be r eferred from a more proximal region and may be amenable to conservativ e management. (C) 1997 by the American Congress of Rehabilitation Medi cine and the American Academy of Physical Medicine and Rehabilitation.