Interesting Case

[Guest guest]

Matt -

Your discussion mentioned a history of ongoing alcoholism. Was there heavy consumption and intoxication the night before? Consider Radial Nerve Palsy (AKA Saturday Night Palsy) which results from compression of the nerve against the humerus, such as the arm being draped over the back of a chair or deep sleep on the extremity.

Symptoms would include weakness of the wrist and finger extensors (wristdrop) and, occasionally, sensory loss over the dorsum of the 1st interosseous muscle.

Treatment is gear toward avoidance of compressive forces.

Tom Freedland

[Guest guest]

Dear Docs,

Here is an interesting new case that came into the office yesterday. Male patient age 29 complaining of left thumb paresthesia and weakness along with almost total weakness in the left wrist extensors. Onset was upon awakening last Sunday morning. Went to bed fine Saturday night, woke up with full symptoms on Sunday. Symptoms confirmed by exam and also included no reflex for Biceps, but did have +1 to +2 everywhere else. All other muscle tests were strong except the wrist extensors. Dyno tests were about 90 on right and 20 on left. No other abnormal findings in exam. Past history reveals ongoing alcoholism, and a open compound fracture of the left forearm and wrist in 1984.

By the time he saw me yesterday, he stated his symptoms had improved slightly and he felt like he was slowly improving. No known mechanism of injury. He is a mixed martial artist and had done some submission wrestling the Thursday before, but nothing out of the ordinary. Went to his PC earlier this week who gave him a wrist brace and suggest he see a neurologist. He wanted to come to me first. Any ideas? Onset of symptoms was very fast.

Matt Terreri, DC

[Guest guest]

Matt,

It sounds like pretty clear C6 involvement. Could it be cervicogenic? Sudden onset of symptoms can be a mononeuropathy, but I would look for more mundane causes like a disc herniation first. Could be a median nerve entrapment/contusion also, particularly given the history of submission wrestling. Can you get a positive Tinels at the wrist or up by the elbow? Good case - thanks for sharing it.

D Freeman Mailing address: 1165 Union Street NE, Suite 300Salem, Oregon 97301ph 503 586-0127 fax 503 763-3581cell 503 871-0715 drmfreeman@...

Interesting Case

Dear Docs,

Here is an interesting new case that came into the office yesterday. Male patient age 29 complaining of left thumb paresthesia and weakness along with almost total weakness in the left wrist extensors. Onset was upon awakening last Sunday morning. Went to bed fine Saturday night, woke up with full symptoms on Sunday. Symptoms confirmed by exam and also included no reflex for Biceps, but did have +1 to +2 everywhere else. All other muscle tests were strong except the wrist extensors. Dyno tests were about 90 on right and 20 on left. No other abnormal findings in exam. Past history reveals ongoing alcoholism, and a open compound fracture of the left forearm and wrist in 1984.

By the time he saw me yesterday, he stated his symptoms had improved slightly and he felt like he was slowly improving. No known mechanism of injury. He is a mixed martial artist and had done some submission wrestling the Thursday before, but nothing out of the ordinary. Went to his PC earlier this week who gave him a wrist brace and suggest he see a neurologist. He wanted to come to me first. Any ideas? Onset of symptoms was very fast.

Matt Terreri, DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Aside from the fact that he was getting tired because of the leukemia

and they misdiagnosed it? What other coincidences?

K. Carpentier, DC, DABCO

Burns, OR

Interesting Case

Saw a new patient on tuesday that was referred by an MD for back

pain secondary to a slip and fall after a chemo session. The

patient has a rare form of Leukemia (APL) and has been getting

ongoing chemo. While I was poking around as to the timing of the

leukemia he said he was getting tired a few years back and his MD

put him on injectable testosterone as well as androgel (topically

applied through the belly). Within 6 months he was dx of Leukemia.

Sounded too coincindental to me...anybody have any thoughts?

Dennis Nowack DC

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve

members will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere.

However, it is against the rules of the listserve to copy, print,

forward, or otherwise distribute correspondence written by another

member without his or her consent, unless all personal identifiers have

been removed.