CASE STUDy questions
The following 6 case studies will provide an opportunity to depict what you have learnt by discerning between the different types of TOS and the aforementioned common differential diagnoses.
CASE STUDY 1
A 45-year-old male office worker presents with tingling and numbness in their thumb, index, and middle fingers after extensive typing throughout a full day of work. Pain is confined to the wrist, occasionally radiates to the hand, and increases during the night, to the point of awakening. This patient also has weakness in thumb opposition movements and has trouble gripping objects.
Objective findings include decreased sensation in the thumb and index finger, weakness in the thenar muscles and atrophy at the thenar eminence. Special tests depict positive Tinel’s sign and positive Phalen’s results.
Choose the correct diagnosis
CASE STUDY 2
A 27 year old female patient working at a desk job for 10-12 hours a day presents with nondescript shoulder and neck pain with occasional numbness radiating distally to the arm and hand. Their symptoms consist of paraesthesia and pain that worsens throughout the day with prolonged poor postures (sitting at a desk). They had EMG and nerve conduction studies conducted, however they returned negative results.
Objective examination depicted a forward head posture and rounding of the shoulders, tenderness in the scalene, and pec minor muscles on palpation, however, cervical ROM was found to be normal. The patient returned a positive ROO’s test after 90 seconds.
Choose the correct diagnosis
Case study 3
A 52-year-old male high school teacher presents with a 4-week history of pain and tingling in the neck, which refers to the left shoulder and arm after he awoke one morning with a stiff neck. The pain is described as sharp and burning with numbness referring in to the thumb, index, and middle fingers.
The objective assessment depicted pain and limited cervical ROM during left lateral flexion and extension movements. A neurological exam also revealed numbness and tingling in the thumb and index finger on the left-hand side, which follows the C6 dermatomal pattern. Spurling’s test identified a reproduction of pain in the left arm.
Choose the correct diagnosis
CASE STUdy 4
A 28-year-old female recreational tennis player presents with intermittent swelling and a slight blue discoloration in her left upper limb following a 2-hour hit of tennis. The patient presented with a 6-month history of gradually increasing symptoms. The discoloration and swelling along with aching at the shoulder are now occurring during activities of daily living, including lifting her 2-year-old child.
An objective examination depicts tenderness over the supraclavicular fossa and scalene muscles on palpation with mild distension in the veins identified during shoulder abduction. A diminished radial pulse was found on the affected side during abduction and external rotation of the shoulder (Wright’s test), and with the arm extended and externally rotated (Adson’s test).
Choose the correct diagnosis
Case Study 5
A 35-year-old male carpenter presents with tingling and numbness in the ring and little fingers on his right hand along with pain on the medial side of his elbow. These symptoms began after a 14-hour day on the worksite 3 months ago and have gradually worsened over time. Weakness and pain was also depicted during tasks that utilise fine motor skills e.g., gripping power tools and prolonged elbow flexion.
An objective examination illustrated tenderness along the medial epicondyle on palpation and slight muscle wastage in the intrinsic hand muscles. Special tests including Tinel’s sign and Froment’s sign were positive for a reproduction of symptoms.
Choose the correct diagnosis
CASE STUDy 6
A 27 year old female swimmer presents with pallor, cold sensations and discoloration in her left hand and arm during and after training in the pool. The symptoms have been occurring for the last 2 months and have gradually increased in severity in the last 3 weeks. She also complains of fatigue, cramping and pain in the shoulder that is intermittent, occurring mostly during longer distances in the pool. She has begun to notice a bluish tinge in her hand after training.
Objective findings include pallor in the left hand when compared to the right. Palpation of the upper arm depicts a normal temperature at rest but a cooling sensation when the arm is held overhead. The patient returned a positive Adson’s test (diminished radial pulse) and slightly lower blood pressure reading in the left arm upon completion of the Adson’s test.