The Postman With The Sore Hand

 

A 50 yo Postman is refered to your office because of pain in his rith hand. He feels the pain is an ache, but sometimes it can be sharp. The pain seems to be related to moving the wrist, but is worse on arising in the morning. The pain radiates into his thumb and first two fingers. It began insidiously as "pins and needles" about 8 months ago and has gradually increased. Now it occasionally awakens him from sleep. If he shakes his hand, it feels better. It also feels better when he has had a vacation or several days off from work.

 

His physical and neurological examination is normal except for mild atrophy of the right thenar eminence, weakness of the oppens policis, and hypesthesia in the distribution of the median nerve on the right.

Questions:

  1. Where is the lesion causing the symptoms?

  2. What tests should be done to confirm this localization?
    (Hint: Name tests that can be done at the bedside and by a laboratory.)

  3. What type of neuropathy is this?
    1. Mononeuropathy
    2. Mononeuropathy Multiplex
    3. Autonomic Polyneuropathy
    4. Sensory Polyneuropathy
    5. Motor Neuropathy
    6. Mixed Motor-Sensory Neuropathy
  4. Draw the Brachial plexus. Draw the palmar and dorsal sides of the right hand and indicate the distributions of the median, ulnar, and radial nerves on each side.

  5. How can you tell an ulnar nerve lesion from a C8 lesion?
Last updated by Webmaster on August 18, 2009

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