CASES Flashcards
A 50-year-old right-handed woman presents with hand and wrist pain greater on the right than the left. It is exacerbated with activities such as typing an opening jars. Symptoms are worse at night and awaken her. She will often shake her hands for relief.she had similar symptoms during her first two pregnancies. Those resolved after birth. She denies neck or forearm pain. She has no endocrine abnormalities. Advil helps a little, and resting helps a lot.
Carpal tunnel syndrome
A 45-year-old right-handed male Carpenter presents with right forearm pain. He has difficulty using a screwdriver and picking up nails for three months. His weaknesses is increased when trying to unscrew bolts. He has chronic neck pain. This is not changed recently. No history of trauma. Examination reveals atrophy of the volar forearm and thenar eminence. Sensation is reduced over the palm and thumb and first and second digits.
Pronator Teres syndrome
median nerve entrapment at the elbow
50-year-old male high school teacher presents with right elbow pain and progressive numbness and weakness of the right hand. Pain is worse when using the chalkboard. He has complete numbness of the right pinky finger and difficulty holding objects with the right hand. He has some aching pain in the medial aspect of the right elbow. The left arm is unaffected. He has no neck pain. He has no trauma history.
Ulnar nerve entrapment at the elbow
Cubital tunnel syndrome
A 24-year-old woman presented with progressive dull aching pain in the left neck and shoulder, with paresthesias over the ulnar aspect of the forearm and hand. She has numbness and decrease in sensation of her ring and little finger. She has weakness and clumsiness of the left-hand. On exam she has weakness in her left abductor pollicis brevis and first dorsal interosseous muscles with decreased pin prick the fourth and fifth fingers. She has a Tinel sign in the supraclavicular fossa and a weekly positive elevated arm stress test.
Thoracic outlet syndrome
A 24-year-old woman presented with progressive dull aching pain in the left neck and shoulder, with paresthesias over the ulnar aspect of the forearm and hand. She has numbness and decrease in sensation of her ring and little finger. She has weakness and clumsiness of the left-hand. On exam she has weakness in her left abductor pollicis brevis and first dorsal interosseous muscles with decreased pin prick the fourth and fifth fingers. She has a Tinel sign in the supraclavicular fossa and a weekly positive elevated arm stress test.
Thoracic outlet syndrome
A 44-year-old left-handed and then presents with nine months of pain in the left shoulder it is constant and aching, and has episodic stabbing qualities. He works as a painter and is unable to work secondary to his inability to lift his arm from his side without assistance from his opposite arm. The symptoms began after hospitalization and he was restrained while being agitated and confused. On examination he has atrophy of the supraspinatus and infraspinatus muscles. He has weakness with external rotation of the left arm when his elbow is flexed at the side. He has difficulty abducting his arm. He has decreased sensation in the posterior aspect of the left shoulder and a tinnel sign at the suprascapular notch.
Supra scapular nerve entrapment
A 54-year-old right-handed man presents with right forearm pain and difficulty holding tools at work for six months. He works as a plumber. The pain is exacerbated when he uses a wrench to tighten connections. Pain and weakness are bad after a full days work. He had some neck pain but that’s not very bothersome. He denies trauma. He has difficulty extending his wrist on examination, And sensation is normal.
Posterior Interosseous Nerve Palsy
A 40-year-old man presents with burning, pins, and needles in the right lateral thigh. The skin is sensitive to touch and his clothes are bothering him. These unpleasant sensations are worse after prolonged standing. He has occasional back pain. He is obese with a body mass index of 37. His neurological examination is normal except for decreased light touch sensation in the right anterior lateral thigh. There is a positive Tinnel sign over the inguinal ligament.
Meralgia Paresthetica
64 year old right handed woman presented with 3 years of a severe, electric shock like pains in the right lower and middle face. It did not cross midline. It was severe but lasted only a few seconds. It came on with eating, brushing teeth, and a cold wind blowing across her face. She had times with several months of multiple attacks and then months of relative freedom of attacks. She had good response to medication initially, but then she began having side effects with dose escalation.
Trigeminal Neuralgia
38 year old right handed female presents with LUE pain after MVC 9 months ago. At time of injury she had signifiant injury to the left chest wall and shoulder, with LUE weakness in the arm and hand. On exam she has flaccid weakness of the left triceps and intrinsic muscles of the hand. There is loss of DTR and decreased sensation. The pain began several months after the accident, 8/10, constant, deep, pain into the delta and upper pectoral area. PCP got MRI that showed some fluid filled sacs near the spine.
Lower Brachial Plexus Nerve root avulsion injury (C7 T1)
