Topic Overview

Clinicoanatomical Problems – Chapter: Forearm and Hand

1. A typist complains of pain, tingling, and numbness in thumb, index, and middle fingers, worsening at night.

Diagnosis: Carpal Tunnel Syndrome
Anatomical Basis: Compression of median nerve beneath the flexor retinaculum.
Key Features:

• Numbness in lateral 3½ fingers.

• Wasting of thenar muscles.

• Loss of thumb opposition.
  Tests: Phalen’s and Tinel’s signs.
  Treatment: Surgical decompression of flexor retinaculum.

2. A carpenter has weakness in gripping and adduction of fingers with sensory loss in medial 1½ digits.

Diagnosis: Ulnar Nerve Palsy (at wrist or Guyon’s canal).
Anatomical Basis: Compression of ulnar nerve superficial to flexor retinaculum.
Findings:

• Clawing of ring and little fingers.

• Flattened hypothenar eminence.

• Froment’s sign positive (flexion of thumb IP joint due to adductor pollicis paralysis).

3. A tennis player develops severe pain over lateral epicondyle on gripping a racket.

Diagnosis: Tennis Elbow (Lateral Epicondylitis).
Anatomical Basis: Inflammation of common extensor origin (especially ECRB).
Findings: Pain on resisted wrist extension and supination.
Treatment: Rest, physiotherapy, corticosteroid injection if severe.

4. A golfer presents with pain and tenderness over medial epicondyle aggravated by wrist flexion.

Diagnosis: Golfer’s Elbow (Medial Epicondylitis).
Anatomical Basis: Inflammation of common flexor origin (mainly pronator teres and FCR).
Findings: Pain on resisted flexion and pronation.

5. A patient after radial head fracture cannot extend fingers but can extend wrist slightly.

Diagnosis: Posterior Interosseous Nerve Palsy.
Anatomical Basis: Compression in the supinator (arcade of Frohse).
Findings:

• Loss of finger extension.

• Wrist extension preserved (ECRL intact).

• No sensory loss (purely motor nerve).

6. A factory worker develops pain on lateral wrist and thumb base; Finkelstein’s test positive.

Diagnosis: De Quervain’s Tenosynovitis.
Anatomical Basis: Inflammation of synovial sheath of abductor pollicis longus and extensor pollicis brevis (1st dorsal compartment).
Test: Pain on thumb flexion and ulnar deviation of wrist.

7. A tailor has a swollen, painful thumb; infection spreads to forearm causing “hourglass swelling.”

Diagnosis: Acute Tenosynovitis with Spread to Parona’s Space.
Anatomical Basis: Infection of radial bursa (FPL sheath) communicating with space of Parona in forearm.
Significance: Requires prompt drainage to prevent necrosis.

8. A patient develops infection in little finger followed by swelling of palm and lower forearm.

Diagnosis: Mid-Palmar Space Abscess with Extension to Parona’s Space.
Anatomical Basis: Infection spreads via ulnar bursa from tendons of FDS & FDP → mid-palmar space → forearm.
Symptoms: Pain on finger flexion, swelling of palm, and restricted hand movement.

9. A cricketer presents with wrist pain and limited thumb movement after a fall on outstretched hand.

Diagnosis: Scaphoid Fracture.
Anatomical Basis: Fall leads to fracture across waist of scaphoid → radial artery injury → avascular necrosis of proximal fragment.
Clinical Sign: Tenderness in anatomical snuffbox.

10. A typist’s finger tip is swollen, red, and extremely painful; throbbing increases on flexion.

Diagnosis: Whitlow (Felon).
Anatomical Basis: Pus collection in pulp space of finger, bounded by fibrous septa → increased tension and severe pain.
Complication: Osteomyelitis of distal phalanx if untreated.

11. A patient presents with palmar skin thickening and flexion deformity of ring and little fingers.

Diagnosis: Dupuytren’s Contracture.
Anatomical Basis: Progressive fibrosis and shortening of palmar aponeurosis.
Risk Groups: Manual laborers, diabetics, chronic alcoholics.

12. A typist cannot extend the distal phalanx of middle finger after minor trauma.

Diagnosis: Mallet Finger (Baseball Finger).
Anatomical Basis: Avulsion or rupture of extensor tendon at DIP joint → finger tip droops.

13. A patient with supracondylar fracture of humerus cannot flex thumb and index finger DIP joints.

Diagnosis: Anterior Interosseous Nerve Lesion.
Anatomical Basis: Damage to branch of median nerve → paralysis of FPL and lateral half of FDP.
Sign: “OK” sign defect (Pinch sign).

14. A housewife complains of tingling in ring and little fingers, aggravated by elbow flexion.

Diagnosis: Cubital Tunnel Syndrome.
Anatomical Basis: Compression of ulnar nerve between heads of flexor carpi ulnaris.
Findings: Numbness in medial 1½ fingers; weakness of intrinsic hand muscles.

15. A trauma patient has complete wrist drop with inability to extend elbow.

Diagnosis: High Radial Nerve Injury (Spiral Groove or Axilla).
Anatomical Basis: Lesion proximal to origin of triceps branches → paralysis of triceps, wrist and finger extensors.
Clinical Sign: Wrist flexed, MCP joints flexed, sensory loss on dorsum of hand.

✅ Summary Insight

The forearm and hand are among the most common regions for nerve compression syndromes, tendon injuries, and infective spread due to close fascial compartments and extensive synovial continuity.
Early anatomical localization ensures complete functional recovery.