Upper Limb Case #1 Table 36 Farah Abbas Jeremy Jacobs Brian McQuillan David Smith

Chief Complaint and HPI 35 yr/o female, computer software executive Burning/tingling sensation in left hand Symptoms progressing over past 3 months Localized to thumb, index, middle, and lateral side of left ring finger Difficulty grasping objects Frequently drops things

Vitals Normal Vital signs: Blood Pressure: 130/80 Pulse: 75 Rhythm: Regular Temperature: 99.0oF Respiratory rate: 17 Height: 5’10” Weight: 150 lbs. HEENT Examination: Normal All other systems: Normal

Musculoskeletal Exam Thenar eminence of left hand flattened Minor loss of touch sensation on thumb, index, middle, and lateral side of left ring finger Positive Tinel’s Sign (tapping over the median nerve on flexor retinaculum caused pain to shoot from wrist to hand) Loss of strength of certain movements of left thumb

WHAT’S IN THE FOREARM AND HAND?

Anatomy of the Forearm and Hand

Anatomy of the Forearm and Hand

Anatomy of Forearm and Hand Muscle Innervation Origin Insertion Action Flexor Pollicis Brevis (Thenar) Median n. Flexor Retinaculum Trapezium Proximal Phalanx of 1st digit Flexes the Carpometacarpal & Metacarpophalangeal joints of Thumb Opponens Pollicis Flexor Retinaculum Trapezium Shaft of 1st Metacarpal Opposes the Thumb Abductor Pollicis Brevis Scaphoid Abducts the Thumb, Grasping

WHAT’S THE DIAGNOSIS?

Diagnosis Weakness of thumb muscles (thenar) Loss of touch sensation Positive Tinel’s sign Compression of the median nerve Carpal Tunnel Syndrome

Treatment Splint the affected wrist, 2-6 weeks NSAIDs (aspirin or ibuprofen) See a specialist if there is atrophy of thenar muscles or continued weakness for an injection of corticosteroids Surgery (cut the transverse carpal ligament to relieve swelling)

References Hellman, David B., Current Medical Diagnosis & Treatment 2008, Forty-Seventh Edition, "Musculoskeletal Disorders- Carpal Tunnel Syndrome." 2008. Netter, F.H. Atlas of Human Anatomy (4th ed.) Deune, E. Gene. Current Rheumatology Diagnosis & Treatment, Second Edition. 2007. "CH 6: The Patient with Hand, Wrist, or Elbow Pain"

References Harris: Kelley’s Tesxbook of Rheumatology, 7th ed. 2005. “Common Etiologies for Hand and Wrist Pain.”