tailieunhanh - Hand and Wrist Surgery - part 3

Một tay thợ điện 49 tuổi, quyền chi phối trình bày khiếu nại của sự yếu kém tiến bộ trong cánh tay phải của mình. Ông cũng mô tả có đau ở cổ của mình mở rộng xuống phía trước của cánh tay của mình để bàn tay của mình. Ông đã gặp khó khăn trong việc nâng vật bằng tay phải của mình | COMPRESSION NEUROPATHY PEARLS Spurling s maneuver reproduces a patient s arm pain and paresthesias by turning the patient s head toward the symptomatic side and extending the neck. This position decreases the size of the neuroforamina. Use an EMG to differentiate first-degree shoulder problems from a C5 root problem. Biceps weakness may be the first sign of rotator cuff disease although a herniated C6 root can give similar findings. PITFALLS Patients with sensory changes in the thumb and index finger may have carpal tunnel syndrome and not a C6 radiculopathy. Check for a local Tinel s and Phalen s sign. An incomplete cervical spine exam in a patient with upper extremity problems often leads to an incorrect diagnosis. A full cervical spine x-ray series should be used to see on oblique films encroachment on the foramina by osteophytes. 1102 18__ Cervical Root Compression Bradley M. Thomas John M. Olsewski and Jerry G. Kaplan History and Clinical Presentation A 49-year-old right hand dominant electrician presented with complaints of progressive weakness in his right arm. He also described having pain in his neck extending down the front of his arm to his hand. He was having difficulty lifting objects with his right hand and performing repetitive-type motions with weakness of his right shoulder and biceps. He reported occasional numbness in his thumb and index finger while at work. He did not recall any trauma to his neck or arm. He denied bowel or bladder dysfunction and was not experiencing disturbances in his gait. On further questioning he denied any history of smoking diabetes or hypertension. He also denied night pain. Physical Examination Examination revealed a patient in no acute distress with a full range of motion of the cervical spine. Reproduction of his right arm pain was elicited with extension of the neck and rotation of his head to the right Spurling s maneuver . He appeared to have mild deltoid .