Forearm And Hand Pain And Weakness After Motor Vehicle Accident

HISTORY OF CASE: 38-year-old female with no significant medical history who presented for evaluation of left upper extremity numbness and weakness 49 days after a motor vehicle collision. Patient reports difficulty lifting her arms overhead and weakness in her grasp and fine motor activities. PHYSICAL EXAM: In no acute distress. Well-developed and well nourished. 4/5 left first dorsal interosseous, abductor digiti minimi, abductor pollicis brevis, and extensor indicis proprius. 5/5 left shoulder abduction, elbow flexion, elbow extension, and wrist extension. Pain in dorsal aspect of forearm with numbness and pain over the dorsum of the thumb, 2nd, and 3rd fingers. Hoffman’s negative. Soft tissue swelling with the ulnar aspect of the distal forearm, no warmth, rash, or erythema. Tenderness to palpation over the left supinator and medial epicondyle. Spurling's negative, only reproduced neck pain. Tinel’s negative at the left wrist and elbow. DIFFERENTIAL DIAGNOSIS: 1. Cervical Radiculopathy2. Carpal Tunnel Syndrome3. Cubital Tunnel Syndrome4. Brachial Plexopathy TESTS AND RESULTS: Magnetic resonance imaging of the cervical spine:-mild flattening of the ventral cord at left C5-C6 and right C6-C7Electrodiagnostic testing:-No evidence of left median, ulnar neuropathy, or cervical radiculopathyUltrasound:-No evidence of median or ulnar neuropathy-6 mm (millimeters) x 4 mm x 12 mm ganglion cyst against the radial nerve just proximal to it giving off the branch of the posterior interosseous nerve-No increased power Doppler or color Doppler flow in the ganglion cyst FINAL/WORKING DIAGNOSIS: 1. Left dorsal forearm pain consistent with radial neuritis in the setting of a space-occupying ganglion cyst of the elbow2. Progressive left-hand weakness in a predominantly ulnar/C8-T1 distribution TREATMENT AND OUTCOMES: Follow-up for ganglion cyst aspiration and injection with corticosteroid after delivery of child.