index finger mal rotation without direct trauma.

index finger mal rotation without direct trauma.


Dear Forum members,

Please forgive the fact that this is not an arthroscopy case but I need clever hand surgeons to comment.

This man suffered a crush injury to his right hand. He has presented to me with florid cubital tunnel syndrome AND this unexplained mal-rotation of his index finger.

The injury was three years ago. He also had a 4th CMCJ injury and fixation of the ring metacarpal which is all good except for a FFD of 20deg at the MCPJ of 4th.

He has hand weakness which has been investigated with MRI (1.5T) and NCS (x2). The second NCS/EMG shows weakness of the first volar interosseous muscle specifically (an injury in keeping with metacarpal #) i.e. an injury distal to Guyons canal. MRI -ve for neuroma but not high res.

Here are my questions:

What is the cause of the rotation? Could it be a subtle change secondary to weak intrinsic muscles?

Or, is it due to an unrecognised soft tissue injury?

Can you see the prominent flexor in the palm? That must be due to wasting of the other small muscles, yes?

The failure to pinch all five fingers is due to the radial sided palmar ulnar nerve lesson, yes?

Regards
Phil Grieve
Dublin

 

See the discussion  in the attached .pdf file below

 

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