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Finger Weakness

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 42-year-old man with a prior elbow fracture and surgery presents to the ED with pain in his right elbow, numbness in his pinky and ring finger and weakness in the left hand after participating in a tug-of-war.  X-rays showed just arthritis. He denies any neck pain symptoms in his legs or his other arm fever or other complaints

Vital Signs & Physical Exam:

Vital signs are normal except for   Physical exam is otherwise normal except for anesthesia in the middle and half of the ring finger and weakness to finger spread and opposition.

Initial Differential Diagnosis:

  • Cubital Tunnel syndrome
  • Cervical radiculopathy
  • Brachial plexus injury

Initial Diagnostic Testing:

  • EKG: none
  • Labs: none ordered
  • Imaging: none

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows .
  2. What should you do next?  Treat with.  Consult.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: We’ll just have to see

CASE LESSONS:

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IMPRESSION:

HIGH-GRADE, NEAR-COMPLETE TEAR/AVULSION OF THE COMMON FLEXOR TENDON ORIGIN AT THE MEDIAL HUMERAL EPICONDYLE, APPEARING ACUTE ON CHRONIC, WITH APPROXIMATELY 2.5 CM RETRACTION.

NO ACUTE FRACTURE OR DISLOCATION.

ADVANCED HYPERTROPHIC OSTEOARTHRITIS OF THE HUMEROULNAR AND HUMERORADIAL ARTICULATIONS, WITH ASSOCIATED PARTIAL EFFACEMENT OF THE CUBITAL TUNNEL.

MODERATE ELBOW JOINT EFFUSION, NONSPECIFIC.

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