Pearls

• Accurate attempt at pinch by patient is crucial to diagnosis— "OK" sign tip to tip.

• Weight lifters often have hypertrophy of the forearm muscles leading to this diagnosis.

• Complete hemostasis is essential during surgery with tourniquet, but limit time to ensure speedy recovery.

Physical Examination

When a patient is asked to pinch, active flexion of the distal interphalangeal (DIP) index is impossible (Fig. 14-1). There is an inability to flex the interphalangeal joint of the thumb and the distal phalangeal joint of the index finger secondary to weakness of the flexor pollicis longus (FPL) and the index flexor digitorum profundus (FDP), with weakness of the pronator quadratus. A positive Tinel's test over the proximal forearm is also seen with pain radiating distally. The patient reports intermittent pain in the proximal portion of the volar forearm, with no atrophy or sensory changes.

Differential Diagnosis

• Isolated rupture of the flexor pollicis longus (FPL)

• Rupture of the index flexor digitorum profundus (FDP)

• Laceration of the nerve

• Tumor of the forearm

• Anterior interosseus nerve palsy

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