Your patient is a 31 yr old man who fell, striking his right elbow & spraining h
ID: 139731 • Letter: Y
Question
Your patient is a 31 yr old man who fell, striking his right elbow & spraining his ankle three months previously He reports that after using axillary crutches for 3 weeks, he developed diffuse weakness & numbness of his right upper extremity that has persisted since then. Weakness is present in his right triceps, brachioradialis wrist & finger extensors, FCU, intrinsic hand muscles (thenar muscles were spared). He had decreased sensation and complaints of pain over the entire hand except the thumb and pointer finger area. DTRs were active and symmetric except for a decreased right triceps reflex. 1) After the initial exam, you are considering a referral for diagnostic testing. Describe why an electrodiagnostic study would be appropriate in this patient and which specific studies would be most appropriate. What might be the expected results of specific electrodiagnostic testing? Be sure to commentjustify your thoughts on what nerve(s) may be involved and give a broad overview (not specific numbers) of potential results that would indicate abnormal nerve function. 2)Explanation / Answer
1) Electrodiagnostic studies help to check the electrical activity of muscles and nerves this patient
have decreased reflexes and sensation on the right upper extremity so an electrodiagnostic study
like electromyography to test the functioning of muscle along with a nerve conduction study to be
do for identify whether decreased sensation due to nerve damage.
2) Expected result for this patient is axillary and ulnar nerve injury because
* Patient use cruches to walk which compress the axillary nerve result in diffuse weakness
and numbness of upper extremity and due to this abnormal nerve function patient exhibit
* Numbness of teres minor and deltoid muscle which affect the abduction
of arm.
* Weakness in shoulder extension and rotation and loss of skin sensation
over the lateral right upper arm.
* Patient have weakness over FCU(Flexor carpi ulnaris) and intrinsic hand
muscles which are supplied by ulnar nerve and the ulnar nerve injury may
result in
* Burning sensation of hand.
* Loss of co-ordination of fingers.
* Loss of grip strength and pain.
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