Differential Diagnosis for Nerve Injury

The patient's symptoms of pain and numbness in the dominant hand, particularly in the long and index fingers, suggest a nerve injury. The following differential diagnosis is organized into categories:

• Single most likely diagnosis
  • F) Median nerve at the elbow: The patient's symptoms of numbness in the long and index fingers, as well as minimal atrophy of the thenar muscles, are consistent with median nerve compression at the elbow, also known as pronator teres syndrome or anterior interosseous nerve syndrome.
• Other Likely diagnoses
  • D) Median nerve above the elbow: Compression of the median nerve above the elbow could also cause similar symptoms, although it is less common.
  • E) Median nerve at the wrist: Carpal tunnel syndrome, which affects the median nerve at the wrist, could also cause numbness and pain in the long and index fingers, but the absence of nighttime symptoms and the specific distribution of numbness make it less likely.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • B) Cervical nerve root at the cervical foramen: A cervical radiculopathy could cause similar symptoms, and missing this diagnosis could lead to delayed treatment and potentially serious consequences, such as spinal cord compression.
  • P) Ulnar nerve at the elbow: Ulnar nerve compression at the elbow could cause numbness and weakness in the hand, although the distribution of symptoms would be different.
• Rare diagnoses
  • A) Axillary nerve: Axillary nerve injury would typically cause weakness and numbness in the deltoid muscle and lateral aspect of the arm, which is not consistent with the patient's symptoms.
  • C) Long thoracic nerve: Long thoracic nerve injury would cause weakness of the serratus anterior muscle, leading to winging of the scapula, which is not mentioned in the patient's symptoms.
  • G) Musculocutaneous nerve above the elbow: Musculocutaneous nerve injury would cause weakness of the biceps and brachialis muscles, which is not consistent with the patient's symptoms.
  • I) Musculocutaneous nerve at the wrist: The musculocutaneous nerve does not extend to the wrist, making this diagnosis unlikely.
  • J) Radial nerve above the elbow: Radial nerve injury above the elbow would cause weakness and numbness in the extensor muscles of the arm and hand, which is not consistent with the patient's symptoms.
  • K) Radial nerve at the elbow: Radial nerve compression at the elbow would cause weakness and numbness in the extensor muscles of the hand, which is not consistent with the patient's symptoms.
  • L) Radial nerve at the wrist: Radial nerve injury at the wrist would cause weakness and numbness in the thumb and index finger, but the distribution of symptoms would be different.
  • M) Suprascapular nerve: Suprascapular nerve injury would cause weakness and numbness in the supraspinatus and infraspinatus muscles, which is not consistent with the patient's symptoms.
  • N) Thoracodorsal nerve: Thoracodorsal nerve injury would cause weakness of the latissimus dorsi muscle, which is not consistent with the patient's symptoms.
  • H) Musculocutaneous nerve at the elbow: The musculocutaneous nerve does not extend to the elbow, making this diagnosis unlikely.
  • O) Ulnar nerve above the elbow: Ulnar nerve injury above the elbow would cause weakness and numbness in the ulnar-innervated muscles of the hand, which is not consistent with the patient's symptoms.
  • Q) Ulnar nerve at the wrist: Ulnar nerve compression at the wrist, also known as Guyon's canal syndrome, would cause numbness and weakness in the ulnar-innervated muscles of the hand, which is not consistent with the patient's symptoms.