Anatomy clinical correlates Quiz: Ace Your Exams

A 57-year-old woman presents to her primary care physician to evaluate bilateral wrist discomfort. The patient has had worsening pain and numbness over the first, second, and third digits and half of the fourth digit. She recently started working as a secretary and spends most of the day typing on a keyboard. She is currently undergoing treatment for breast cancer with anastrozole. The patient’s other medical problems include obesity, hypertension, hyperlipidemia, and hyperthyroidism. She smokes half a pack of cigarettes daily and drinks one to two glasses of wine nightly. Vital signs are within normal limits. Physical examination is notable for reproducible pain and paresthesias with a tapping of the volar aspect of the wrist. Which of the following factors most likely contributed to the development of this patient’s clinical condition?