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Finger Weakness*

History of Present Illness:

A man in his 40’s with a prior elbow fracture and surgery presents to the ED with 3 days of worsening pain in his right elbow, numbness in his pinky and ring finger and weakness in the left hand that started after participating in a tug-of-war.  X-rays done at an urgent care 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.  Physical exam is normal except for anesthesia in the middle and half of the ring finger and weakness to finger spread and opposition

What is the most likely diagnosis:

  1. Cubital tunnel syndrome
  2. Cervical radiculopathy
  3. Brachial plexus injury
  4. Ulnar tunnel syndrome

 

SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT

 

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ANSWERS:

  1. Cubital tunnel syndrome: CORRECT
  2. Cervical radiculopathy: usually doesn’t include numbness in half of a finger
  3. Brachial plexus injury: usually doesn’t include numbness in half of a finger
  4. Ulnar tunnel syndrome: Usually has wrist pain rather than elbow pain

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CASE CONCLUSION:  Outpatient MRI showed   HIGH-GRADE ACUTE ON CHRONIC TEAR/AVULSION OF COMMON FLEXOR TENDON AT THE MEDIAL HUMERAL EPICONDYLE.  ADVANCED HYPERTROPHIC OSTEOARTHRITIS OF THE HUMERO-ULNAR AND HUMERO-RADIAL JOINTS CAUSING PARTIAL EFFACEMENT OF THE CUBITAL TUNNEL.

CASE LESSONS: if half of the ring finger is numb along with other fingers this will usually mean that it is the ulnar or median nerve that is involved rather than a spinal nerve.

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