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Abducted right fifth finger
I have a peculiar case on which i would like to have sought some advice.
30y old male, electrician with no medical Hx. with since 3 weeks abducted little finger on the right side. Unable to bring the finger in adduction. No paresthesia, no other loss of strength. Doesn't remember a trauma or pain.
Clinical examination shows preserved reflexes, strength (FDI / ADM / FPL / FCU / FDP5 / Orther interossei), esthesia. Tests for UNE are negative No UMN signs.
Needle Emg: no denervation potentials in FCU / FDI / ADM / APB / EIP/ 3rd palmaf IO, decreased recruitment in 3rd palmar IO with two rapid firing MUAPs
Ultrasound: normal configuration ulnar nerve from the axilla down to just distal of the pisohamate lig. Further course could not be evaluated but no ganglion cyste or other masses in the palm. Impression of possible myotendinous injury 3rd palmar IO on US but this is not my expertise so MRI is planned.
I had 2 questions about this case:
- Could you have a selective neuroraxia of the branch to the 3rd palmar explaining the clinical image a d findings on EMG? Patient reported repitive use of clipper the day he noticed the paresis
-What would your findings be on needle emg after of musculotendinous / muscular injury? I've searched pubmed but can't find any literature on this. I think this woud give a dcreased recruitment but would this also influence firing rate?
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