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Pain in the forearm 05

Topic: Adult

Created on Saturday, April 18 2009 by jdmiles

Last modified on Saturday, April 18 2009.

A 25 year-old woman presents complaining of pain and tingling in her right arm. The pain is in her wrist, forearm, and elbow. The tingling is in her thumb and index finger. She says it's been going on for about 4 weeks, and getting worse. It frequently wakes her up at night. When it does, she shakes it out, and after a few minutes it feels better. She is diabetic, has hypothyroidism, and is 9 months pregnant. She works as a cashier.
You perform a nerve conduction study (NCS) in her right upper extremity. Her median motor response recording the abductor pollicis brevis shows an amplitude of 15 mV, a distal latency of 4.0 ms, and a conduction velocity of 53 m/s. Her median sensory response, recording at the index finger, shows an amplitude of 23 mV, a distal peak latency of 3.4 ms, and a conduction velocity of 53 m/s.

Which of the following statements about this study is most accurate?

 
        A) This is an inconclusive study, and no further testing needs to be done at this time
 
        B) This study excludes a median mononeuropathy at the wrist
 
        C) This study is suggestive of peripheral polyneuropathy
 
        D) A median/ulnar digit 4 comparison study should be performed
 
        E) This study confirms a median mononeuropathy at the wrist
 

 


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This question was created on April 18, 2009 by jdmiles.
This question was last modified on April 18, 2009.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) This is an inconclusive study, and no further testing needs to be done at this time

This answer is incorrect.


This patient has symptoms suggestive of a median mononeuropathy at the wrist, consistent with a clinical diagnosis of Carpal Tunnel Syndrome (CTS). Her median motor and sensory studies are normal. This does not exclude the diagnosis of a median mononeuropathy at the wrist. At this point, additional comparison studies should be performed to increase the diagnostic yield of the nerve conduction study. Comparison studies that could be performed at this point include the median/ulnar 2nd lumbrical/interosseous study, the median-versus-ulnar digit 4 sensory comparison study, the median-versus-radial digit 1 sensory comparison study, and the median-versus-ulnar palmar comparison study. Performing at least 3 comparison studies increases the sensitivity for detecting CTS to 97%.  (See References)

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B) This study excludes a median mononeuropathy at the wrist

This answer is incorrect.


This patient has symptoms suggestive of a median mononeuropathy at the wrist, consistent with a clinical diagnosis of Carpal Tunnel Syndrome (CTS). Her median motor and sensory studies are normal. This does not exclude the diagnosis of a median mononeuropathy at the wrist. At this point, additional comparison studies should be performed to increase the diagnostic yield of the nerve conduction study. Comparison studies that could be performed at this point include the median/ulnar 2nd lumbrical/interosseous study, the median-versus-ulnar digit 4 sensory comparison study, the median-versus-radial digit 1 sensory comparison study, and the median-versus-ulnar palmar comparison study. Performing at least 3 comparison studies increases the sensitivity for detecting CTS to 97%.  (See References)

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C) This study is suggestive of peripheral polyneuropathy

This answer is incorrect.


This patient has symptoms suggestive of a median mononeuropathy at the wrist, consistent with a clinical diagnosis of Carpal Tunnel Syndrome (CTS). Her median motor and sensory studies are normal. This does not exclude the diagnosis of a median mononeuropathy at the wrist. At this point, additional comparison studies should be performed to increase the diagnostic yield of the nerve conduction study. Comparison studies that could be performed at this point include the median/ulnar 2nd lumbrical/interosseous study, the median-versus-ulnar digit 4 sensory comparison study, the median-versus-radial digit 1 sensory comparison study, and the median-versus-ulnar palmar comparison study. Performing at least 3 comparison studies increases the sensitivity for detecting CTS to 97%.  (See References)

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D) A median/ulnar digit 4 comparison study should be performed

This answer is correct.


This patient has symptoms suggestive of a median mononeuropathy at the wrist, consistent with a clinical diagnosis of Carpal Tunnel Syndrome (CTS). Her median motor and sensory studies are normal. This does not exclude the diagnosis of a median mononeuropathy at the wrist. At this point, additional comparison studies should be performed to increase the diagnostic yield of the nerve conduction study. Comparison studies that could be performed at this point include the median/ulnar 2nd lumbrical/interosseous study, the median-versus-ulnar digit 4 sensory comparison study, the median-versus-radial digit 1 sensory comparison study, and the median-versus-ulnar palmar comparison study. Performing at least 3 comparison studies increases the sensitivity for detecting CTS to 97%.  (See References)

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E) This study confirms a median mononeuropathy at the wrist

This answer is incorrect.


This patient has symptoms suggestive of a median mononeuropathy at the wrist, consistent with a clinical diagnosis of Carpal Tunnel Syndrome (CTS). Her median motor and sensory studies are normal. This does not exclude the diagnosis of a median mononeuropathy at the wrist. At this point, additional comparison studies should be performed to increase the diagnostic yield of the nerve conduction study. Comparison studies that could be performed at this point include the median/ulnar 2nd lumbrical/interosseous study, the median-versus-ulnar digit 4 sensory comparison study, the median-versus-radial digit 1 sensory comparison study, and the median-versus-ulnar palmar comparison study. Performing at least 3 comparison studies increases the sensitivity for detecting CTS to 97%.  (See References)

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References:

1. Preston, D.C., and Shapiro, B.E. (2005). Electromyography and Neuromuscular Disorders: Clinical-Electrophysiologic Correlations, 2nd Edition. Elsevier, Philadelphia. (ISBN:075067492X) Advertising:
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adult
Pain in the forearm 05
Question ID: 041809078
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 04/18/2009
Modified: 04/18/2009
Estimated Permutations: 360

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