Case XVII: Hand Weakness 4

Abstract

A 74-year-old male, with a 20-year-history of progressive sensorimotor polyneuropathy, has recent increase in weakness of the left hand with loss of dexterity as well as numbness of the medial one and a half fingers. He is taking gabapentin, which is controlling his pain very well. PMH: hypertension, migraine, kidney stones, peptic ulcer, and left hip replacement. He used to smoke cigarettes but quit 35 years ago; he takes 15 alcoholic drinks per week. His father died of metastatic cancer. Examination of the left hand reveals significant atrophy of the FDI, IO 3, FDP to 4th and 5th digits 4. The remaining muscle groups are 4+/5. Sensation to light touch and pinprick is diminished over the little finger and medial half of the ring finger on the left, extending to the medial aspect of the hand up to the wrist both palmar and dorsal aspects. DTRs are 1+ in the upper limbs and 0 in the lower limbs. Romberg’s test is positive.