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: <br>1. Mild focal left ulnar mononeuropathy at the elbow <br>2. No evidence of ulnar entrapment at left wrist <br> <br>Vascular Doppler with segmental pressures: <br>1. Normal bilateral upper extremity segmental pressures and triphasic subclavian, brachial, radial, and ulnar artery doppler waveforms. <br>2. No hemodynamically significant bilateral peripheral arterial disease. <br>3. Mild diffuse bilateral digital ischemia [most pronounced within digits 3,4,5]. <a href="CaseStudyImages/CS1QuickontheTrigger-633.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a> - Demonstrates normal doppler waveforms. <br> <a href="CaseStudyImages/CS2CS1QuickontheTrig-633.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a> - Demonstrates increased arterial pressures concerning for ischemia. Compare 1st digit to remaining digits. <br> <br>X-Ray Wrist Left 3 views: No osseous abnormality. Ulnar neutral variance <br> <br>X-Ray Elbow Left 3 views: minor osteophytosis of ulnotrochlear and radiocapitellar joint <br> <br>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. <br> <a href="CaseStudyImages/CS3CS2CS1QuickontheT-633.jpg" title="Case Photo #3" data-lity><b>Case Photo #3</b></a> - Lack of arterial flow in the distal ulnar artery. Can locate just palmar to hook of hamate. <br> <a href="CaseStudyImages/CS4CS3CS2CS1Quickont-633.jpg" title="Case Photo #4" data-lity><b>Case Photo #4</b></a> - 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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