MarkS Cohen

History and Clinical Presentation

A 57-year-old man presents for evaluation of his dominant hand. He complains of a deformity involving his small and ring fingers with loss of function, especially fine motor skills. He relates his problem to a laceration he suffered at the wrist level several years prior. He also reports numbness in his small and ring fingers. He denies any radicular symptoms or problems with his contralateral hand.

Physical Examination

Obvious atrophy is visible in the hand involving the intrinsic musculature. The small and ring fingers are positioned in a claw deformity, although passive interpha-langeal joint extension is present and the joints are supple. The patient has difficulty abducting and adducting his digits. His flexor digitorum profundus function to the small and ring fingers is intact (he can actively flex his small and ring distal inter-phalangeal joints). Sensory examination reveals diminished two-point discrimination in the small and ulnar half of the ring fingers.

Diagnostic Studies

Roentgenograms were obtained of the hand including the wrist. They were within normal limits. Electrical studies were obtained and revealed a complete ulnar nerve lesion at the wrist level with denervation present in all ulnar nerve innervated intrinsic muscles tested (interossei and hypothenar muscles). No reinnervation potentials were present. The thenar muscles were electrically normal and there was no evidence of a peripheral neuropathy or radiculopathy.

Differential Diagnosis

Brachial plexus injury Upper plexus Lower plexus Cervical root compression Peripheral nerve dysfunction

Charcot-Marie-Tooth disease Ulna nerve tunnel compression Cubital tunnel (source) Pancoast tumor Tendon lacerations

Laceration of the ulna nerve at the wrist

The differential diagnosis of a claw deformity of the hand with loss of sensation in the ulnar nerve distribution is somewhat limited. One assumes a lesion of the ulnar

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