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A 55-year-old patient presents with numbness and tingling in the right small and ring fingers and associated hand weakness. On examination, there is decreased sensation on the volar, ulnar and radial aspect of the small finger and the volar, and ulnar aspect of the ring finger, but the sensation on the dorsum of the hand is preserved. Symptoms are reproduced with pressure over the wrist during flexion. There is weakness of finger adduction and grip strength, but flexor digitorum profundus strength of the ring and small finger remains preserved. The patient denies any previous trauma to the right hand or wrist. What study would most likely identify the causative lesion?
MRI of the cervical spine
EMG/NCV of the upper extremity
MRI of the wrist
Carpal tunnel view radiographs
CT and MRI of the elbow
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A 26-year-old male construction worker presents with a six-month history of paresthesias in the small and ring fingers. Physical examination reveals weakness of the first dorsal interosseous muscle. An MRI is demonstrated in Figure A. Which additional finding is characteristic of this pathology?
Abnormal sensation over the dorsal ulnar hand
Inability to flex the thumb interphalangeal joint (IPJ) without flexing the distal IPJ joint of the index finger
Thumb and index finger IPJ flexion when attempting to pinch a piece of paper
Inability to flex both the thumb IPJ and index finger IPJ
A 38-year-old female presents with 8 months of gradual weakness of her right hand. She denies paresthesias, numbness, and pain in the right upper extremity. She has compensatory thumb interphalangeal flexion during key pinch and intact two point discrimination. She has a negative Tinel's sign at the wrist and elbow. Electromyography (EMG) shows normal sensory conduction velocities but delayed motor conduction to the first dorsal interosseous muscle. Figure A and B show MRI images of pre and post contrast, respectively. Ultrasound is shown in Figure C. What is the next best step?
Biopsy of the mass
MRI of cervical spine
Excision of the hook of hamate
Cubital tunnel release
A 72-year-old female complains of progressive weakness with grasp and key pinch in her left hand. Physical exam of the hand is significant for decreased sensation on the volar aspect of the fourth and fifth digits. Dorsal sensation throughout the hand is normal. A clinical photo displaying bilateral key pinch is shown in Figure A. What is the most likely cause of compression?
Accessory head of the FPL
Flexor carpi ulnaris
Ganglion within Guyon's canal