Thursday, 15 September 2011

Case study: upper limb

25 year old Caucasian male presented with 8 week history of left arm stiffness and pain, tingling and numbness in the thumb and index finger of his left hand.

Prior to onset of symptoms he had been in a surfing accident, his left arm was forcefully abducted with sudden onset pain in the shoulder. The following morning his left arm seemed to 'seize-up' with shooting pains travelling down the length of the arm into the fingertips. There was no feeling in the thumb or index fingers of the left hand, albeit mild tingling which was present constantly. Over the next couple of weeks there was improvement in strength but with significant residual weakness.

O/E the left hand was smaller than the right, there was marked wasting of the abductor pollicis brevis (APB) and forearm flexors. Power in the proximal muscle groups was normal. He was unable to form a tightly folded fist in the left hand or the shape of an 'O' between the left thumb and index finger. There was also weakness of thumb abduction and finger flexion/extension, and forearm pronation. Sensory loss was confined to the left thumb and index finger.

Nerve conduction studies revealed a post-ganglionic lesion involving the median nerve, medial antebrachial cutaneous nerve and motor fibres of radial nerve.

Level 1

1) Localise the lesion?

2) What is the cause?

3) What is the treatment?

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