Tintelingen en krachtsverlies in de rechterhand bij een 23-jarige man: differentiaaldiagnose

Abstract

Tingling and decreased strength in the right hand of a 23-year-old man: differential diagnosis The medical history of a 23-year-old man with loss of strength and tingling in the right hand is described. The patient presented to the physical medicine consultation with decreased strength at extension and spread position of digit 4 and 5 and at dorsiflexion of the right wrist, as well as impaired fine motor skills. This arose for no apparent reason and progressively increased over the last 2 months. The electromyographic examination and ultrasound of the n. ulnaris were abnormal. Despite treatment (conservative and surgical), there was no improvement. Later, following an epileptic seizure, the diagnosis of a tumoral process in the brain was made. N. ulnar neuropathy of the elbow is the second most common pressure neuropathy in the upper limb, after the carpal tunnel syndrome. Over its course, the n. ulnaris can be affected at different localisations, the most common ones being the elbow (cubital tunnel) and the wrist (Guyon’s canal). The treatment is primarily conservative and, in case of insufficient improvement, surgical. During the diagnostic process, it is important to establish a good differential diagnosis. This requires a thorough history, a rigorous clinical examination and additional technical examinations if necessary. Good clinical reasoning taking into account the possible pathologies of the peripheral and central nervous system is paramount. If there is no evolution as to be expected with a given therapy, the tentative diagnosis should be reconsidered.