Quick On The Trigger: Finger Pain That Masked An Underlying Problem

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Quick On The Trigger: Finger Pain That Masked An Underlying Problem - Page #3

Other Studies: EMG/NCS: 1. Mild focal left ulnar mononeuropathy at the elbow 2. No evidence of ulnar entrapment at left wrist Vascular Doppler with segmental pressures: 1. Normal bilateral upper extremity segmental pressures and triphasic subclavian, brachial, radial, and ulnar artery doppler waveforms. 2. No hemodynamically significant bilateral peripheral arterial disease. 3. Mild diffuse bilateral digital ischemia [most pronounced within digits 3,4,5]. Case Photo #1 - Demonstrates normal doppler waveforms. Case Photo #2 - Demonstrates increased arterial pressures concerning for ischemia. Compare 1st digit to remaining digits. X-Ray Wrist Left 3 views: No osseous abnormality. Ulnar neutral variance X-Ray Elbow Left 3 views: minor osteophytosis of ulnotrochlear and radiocapitellar joint MRI Wrist Left: There is enlargement of the ulnar artery with surrounding perivascular interstitial soft tissue swelling within Guyon's canal. There is a lack of flow void suggesting thrombosis. Case Photo #3 - Lack of arterial flow in the distal ulnar artery. Can locate just palmar to hook of hamate. Case Photo #4 - Proximal view of ulnar artery demonstrating dilation and occlusion with thrombotic material. Long axis view of the ulnar artery course demonstrating dilation and surrounding inflammatory changes. Consultations: Orthopedic Hand Surgery Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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