Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
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15.1 Case Presentation
A 41-year-old male complains of weakness and atrophy of the right hand for 5 months. There is no pain, tingling, or numbness. He also noticed clawing of the little finger. The patient is otherwise healthy without significant PMH. Motor examination reveals weakness of his adductor pollicis 4+, ADQ 3, lumbricals to the 4th and 5th digits 4, and IO 3. The remaining muscle groups are 5/5. Sensation is intact to light touch. There is a Tinel’s sign over the right carpal tunnel and the ulnar n at the elbow.
What is the differential diagnosis?
How do you work this up?
What is the plan for treatment?
Figure 15.1. (A) Wartenberg’s sign: inability to adduct the right little finger, from weakness of the IO . Also noticed is the atrophy of the hypothenar eminence as well as the first dorsal IO. The IPJ of the right thumb is flexed to compensate for the weakness of the adductor pollicis . (B) Positive Froment’s sign on the right side. The patient is compensating by using FPL (supplied by AIN ) on the right side. (C) Ulnar claw hand involving the little finger. Also note the atrophy of the hypothenar eminence. Tinel’s sign doesn’t fit with the rest of the clinical picture.
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