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A 48-year-old man with no significant past medical
history presents to the emergency department (ED) with a 3- to 4-month
history of slowly progressive difficulty with active, but not passive,
extension of the ring and little fingers of his right hand. He denies any
tingling, numbness, or skin changes in his hands or his forearms. There is
no neck pain, and a thorough neurologic review of symptoms, including
motor weakness, decrease in proprioception, and 2-point discrimination, is
negative.
On physical examination, the patient appears well with
normal vital signs. His temperature is 98.6°F (37°C); pulse, 86 bpm;
respiratory rate, 18 breaths/min; and blood pressure, 135/85 mm Hg. The
patient’s oxygen saturation is 98% while breathing ambient air. The
appearance of the patient’s hands is shown in Image 1. The palmar surfaces
are noted to be normal, without any skin changes (including rashes or
discrete lesions). He has no pain or tenderness in the neck, with a full
range of motion. Passive range of motion of the wrist and fingers is
normal, with no evidence of increased resistance to movement. Active
flexion of the fingers is normal, but all extension of the ring and little
fingers of the right hand is absent. The left hand has a normal range of
motion, including extension and flexion, of all fingers.
The
examining physician (please note, this was not the author) was also able
to guess the patient’s occupation.
Which
anatomic structure is affected, and where is it most
vulnerable? |
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The condition is a
classic but less common compression
neuropathy.
Author:
Daniel
M. Lindberg, MD, Instructor of Medicine - Emergency Medicine,
Harvard Medical School. Attending Physician, Department of Emergency
Medicine, Brigham & Women’s Hospital, Boston,
MA.
eMedicine Editor:
Rick G. Kulkarni, MD, FACEP,
Assistant Professor, Yale School of Medicine, Section of Emergency
Medicine, Department of Surgery, Attending Physician, Medical
Director, Department of Emergency Services, Yale-New Haven Hospital,
CT |
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