miscellaneous/ulnar neuropathies

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683d0f4ac1b3f4bd827da870

Orthopedics

miscellaneous

ulnar neuropathies

A 45-year-old woman presents to an outpatient clinic for follow-up, six weeks after a severe motor vehicle collision where she sustained a left humeral shaft fracture. She reports persistent weakness and numbness in her left hand, which she initially attributed to the acute injury. Despite the fracture healing well, her hand symptoms have not improved significantly. She denies any new trauma or falls. Her past medical history is unremarkable, and she is not on any chronic medications. On examination, her temperature is 36.80C, blood pressure is 128/70 mmHg, pulse is 78/min, respirations are 16/min, and oxygen saturation is 99% on room air. Inspection of her left hand reveals a noticeable flattening of the hypothenar eminence and a subtle "clawing" appearance, particularly in the fourth and fifth digits, characterized by hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints, especially pronounced when attempting to extend her fingers. Sensation is diminished along the medial aspect of her palm and the palmar and dorsal surfaces of her ring and little fingers. Motor testing shows weakness in adduction and abduction of the fingers, and she struggles with fine motor tasks requiring precision grip. Given the persistent findings, what is the most appropriate next step in management and what is a potential long-term complication if left untreated?

Lab ParameterValueReference Range
Hemoglobin135 g/L120-150 g/L
White Blood Cell Count7.5 x 10^9/L4.0-11.0 x 10^9/L
C-reactive protein (CRP)<5 mg/L<5 mg/L

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