SGS 7 - Case 1

SGS7 - Case 1

A 52 year-old woman presented with a history of left hand numbness and weakness, which has progressed over a 2 year period. She also had developed weakness of the hand and had difficulty carrying heavy objects. She noted that her symptoms were worsened by repetitive physical tasks such as cleaning or lifting heavy objects. The numbness was most apparent over the medial aspect of the forearm and over the fifth digit. On examination, there was atrophy of the thenar eminence and she had difficulty with thumb abduction and flexion, as well as weakness of index finger adduction and abduction. Sensory examination revealed reduction in sensation over the medial forearm and fifth digit. Deep tendon reflexes were normal.

Open Ended

What would you expect to see in a patient who has a lesion of the ulnar nerve in the axilla?

Open Ended

Based on this knowledge of motor and sensory supply of the hand, do you think the lesion is more likely to involve spinal nerves (if so, which ones?) or a terminal branch of the brachial plexus (if so, which one)?

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Why?

Open Ended

What are the possible underlying lesions/deformities that might cause this clinical picture?