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  1. #1
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    hELP ME, PLEASE EXPLAIN EACH ANSWER

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    A 48-year-old white female secretary presents with progressive
    difficulty typing over the past month. She also notes that her hands
    begin to feel numb and weak after typing for long periods of time.
    Upon testing, which of the following deficits would be predicted?
    A. Difficulty in abducting the fifth finger
    B. Difficulty in adducting the thumb
    C. Difficulty in flexing digits two and three at the
    metacarpophalangeal joints
    D. Loss of sensation over the lateral half of the dorsum
    of the hand
    E. Loss of sensation over the lateral half of the palm
    F. Loss of sensation over the medial half of the dorsum
    of the hand
    G. Loss of sensation over the medial half of the palm

  2. #2
    Zoe MD is offline Newbie
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    This qs is a presentation of carpal Tunnel Syndrome. Is secretary and this syndrome is more common in this profesion. This Syndrome is a compression of the median nerve within the tunnel at the level of the wrist. for the reason that the patient will present with difficulty opposing the thumb, because loss of function of the thenar muscle (opponens policis, abductor pollicis brevis, flexor pollicis brevis), also loss of function of lumricals 1, 2 and 3 and half of 4 lumbrical. the sing is ape hand and flattening of the thenar emminence. also Carpal tunnel can present with pain and paresthesias ( altered sensation over the palmar aspect of the lateral digits)
    i hope this can help you

  3. #3
    dchaos_g's Avatar
    dchaos_g is offline Junior Member 510 points
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    From Instant Anatomy website - a nice review.
    Last edited by dchaos_g; 06-04-2006 at 05:36 AM.

  4. #4
    miasma's Avatar
    miasma is offline Senior Member
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    so whats the correct answer?
    the car's on fire and there's no driver at the wheel and the sewers are all muddied with a thousand lonely suicides and a dark wind blows. the government is corrupt and we're on so many drugs with the radio on and the curtains drawn. we're trapped in the belly of this horrible machine and the machine is bleeding to death.

    -GYBE!


  5. #5
    Unregistered Guest
    Quote Originally Posted by miasma
    so whats the correct answer?
    C: no function fingers 2:index and 3:middle

    No loss of sensation rules out D..G
    5th(pinky) is Ulnar N.
    Thumb adduction I dunno.

  6. #6
    miasma's Avatar
    miasma is offline Senior Member
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    but isn't there also loss of motor function of thumb too?
    the car's on fire and there's no driver at the wheel and the sewers are all muddied with a thousand lonely suicides and a dark wind blows. the government is corrupt and we're on so many drugs with the radio on and the curtains drawn. we're trapped in the belly of this horrible machine and the machine is bleeding to death.

    -GYBE!


  7. #7
    Goldspot6 is offline Newbie 510 points
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    maybe its a little late for this answer, but Moore's clinically oriented anatomy... trauma to the median nerve at the elbow region (i.e. supracondyle of the humerus) results in inability to flex the 2nd and 3rd fingers (Pope's blessing)... however trauma to the median nerve at the location of the wrist (i.e. attempted suicide) results in paralysis of the thenar muscles (no opposition), paralysis of 2nd and 3rd lumbricals (fine motor movements are impaired) and sensation is lost to the thumb and adjacent two fingers.. this is because the injury occurs ABOVE the flexor retinaculum.. in Carpal Tunnel, as we all know, the median nerve is compressed.. this will result in an inability to oppose the thumb.. the book doesnt say anything about why that is the only symptom however this could be because of what dchaos_g said (palmar sensation is not lost because palmar branch comes off before retinaculum).. hope this helps

  8. #8
    lyuda_m@yahoo.com is offline Junior Member 510 points
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    Correct answer is C

  9. #9
    blrman76 is offline Newbie 510 points
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    Quote Originally Posted by Unregistered
    A 48-year-old white female secretary presents with progressive
    difficulty typing over the past month. She also notes that her hands
    begin to feel numb and weak after typing for long periods of time.
    Upon testing, which of the following deficits would be predicted?
    A. Difficulty in abducting the fifth finger
    B. Difficulty in adducting the thumb
    C. Difficulty in flexing digits two and three at the
    metacarpophalangeal joints
    D. Loss of sensation over the lateral half of the dorsum
    of the hand
    E. Loss of sensation over the lateral half of the palm
    F. Loss of sensation over the medial half of the dorsum
    of the hand
    G. Loss of sensation over the medial half of the palm
    The answer is C

    This is because the palmar branch of the Median Nerve comes just before the Median Nerve enters the Carpal Tunnel. The palmar branch of the Median Nerve supplies the lateral half of the palm and will enter the palm superficial to the carpal tunnel. As it enters the palm superficial to carpal tunnel, it will be spared in carpal tunnel syndrome and will hence be intact.

    There is weakness in flexing the 2nd and 3rd digits at the metacarpophalangeal joint due to the fact that the median nerve innervates the 1st and 2nd lumbricals.

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