Dorsal Interosseous Muscle Weakness from Mid-palm Ganglion Cyst

Document Type : CASE REPORT

Authors

Rothman Orthopaedic Institute, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA

10.22038/abjs.2024.80728.3684

Abstract

Ulnar nerve compression is commonly seen at the elbow at the cubital tunnel and the wrist at the Guyon
canal but is rarely seen in the hand. This case report describes an 18 -year-old male presenting with 
seven months of atraumatic hand weakness and atrophy associated with heavy weightlifting. Exam 
demonstrated isolated interosseous muscle atrophy mostly sparing the abductor digiti minimi with intact 
sensation and negative nerve compression tests including Tinel at carpal and ulnar tunnels, Froment 
sign, Wartenberg test, cross finger test, and Spurling test. Electromyography and nerve conduction 
studies demonstrated prolonged distal latency, low amplitude potential, and large amplitude fibrillations 
with severely reduced motor unit firing in the first dorsal interosseous muscle consistent with ulnar 
nerve deep motor branch compromise. Magnetic resonance imaging revealed a ganglion cyst between 
the third metacarpal shaft and the flexor profundus tendon. Given the progressive symptoms, ganglion 
cyst excision and ulnar motor nerve branch neurolysis were performed.
 Level of evidence: V

Keywords

Main Subjects


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