A 30-year-old man comes to the office to evaluate clumsiness and a pins-and-needles sensation in his right hand. The patient is worried that he won't be able to participate in an upcoming road bicycle race due to his hand weakness. The patient suffered a fall while riding his bicycle four months ago. Vitals are within normal limits. Physical examination of the right hand demonstrates hypothenar eminence atrophy, decreased sensation over the 4th and 5th digits, diminished finger abduction, and weakness in adduction of the fingers and thumb adduction. Which of the following is the most likely site of nerve injury?
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Step 1: Based on the symptoms and physical examination findings, the most likely site of nerve injury is the ulnar nerve. Show more…
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An otherwise healthy 82-year-old man is brought to the physician by his wife because of a 6-month history of progressive numbness and tingling in his toes bilaterally. His wife says that he also has had mildly increased short- term memory difficulties during this period. He has not been examined by a physician for the past 3 years. His vital signs are within normal limits. Physical examination shows normal muscle mass and tone. Muscle strength is 5/5 in the lower extremities. Patellar and calcaneal (Achilles) deep tendon reflexes are normal. Sensation to pinprick is decreased in the lower extremities below the level of the knees. He walks with a wide-based gait. Laboratory studies show a hemoglobin concentration of 9 g/dL, hematocrit of 28%, and platelet count of 175,000/mm 3. A photomicrograph of a peripheral blood smear is shown. Which of the following is the most likely diagnosis? A) Anterior cord syndrome B) Central cord syndrome C) Hemicord syndrome D) Posterior cord syndrome E) Segmentary syndrome
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