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A Basketball Player With Acute Hand Weakness - Page #1
 

Author: Rafay Malik, MD
Co Author #1: Irene Lin, MD
Co Author #2: Joshua Manuel, MD
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Adam Lewno, DO

Patient Presentation:
A 19-year-old female college basketball athlete presented to the pediatric emergency department with left leg heaviness and new left hand weakness.

History:
Three days prior to presentation, she noted left leg heaviness with knee buckling when she attempted to run. One day prior to presentation, she became unable to straighten the fingers of her left hand and began dropping objects. She denied any accompanying pain, paresthesia, or loss of sensation. She denied any inciting injury but reported body aches and decrease in appetite the week before presentation with exposure to influenza from her teammates. She denied any accompanying respiratory or gastrointestinal symptoms.

Her past surgical history was notable for a recent right scaphoid fracture with casting and right knee meniscal tear 5 months prior status post arthroscopy. She reported no chronic medical history.

Physical Exam:
She was found to have pupils equal, round, and reactive to light, extra occular movements intact, symmetric facial movements. Sensation was intact to light touch within the bilateral upper and lower extremities. There was additionally full active range of motion and strength at the bilateral shoulders and elbows.

There was left hand weakness of the 2-5th fingers with extension, abduction, and adduction. Passive range of motion was intact without stiffness or pain. She had normal left hand grip strength and left wrist Tinel was negative.

Her reflexes were 1 at the patellar and Achilles on the left while the right were 2. She had a normal heel- toe gait pattern.

Her left knee had no focal tenderness on palpation and no effusion was present. McMurray and Bounce home were found to be negative. Her left lower extremity had no edema. The calf muscle had no focal enlargement or tenderness with a negative thompson test.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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