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Hand & Wrist Exam
 
 

Wasting of the Hand Muscles

 
 
 
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Overview

  • Look For

  • Decreased mass of the thenar and/or hypothenar eminence.
  • Interpretation

  • Forearm flexor wasting - median nerve lesion, e.g. entrapment at or above the cubital fossa
  • Thenar wasting - median nerve lesion, e.g. entrapment at or above the carpal tunnel
  • Hypothenar wasting - ulnar nerve lesion e.g. entrapment at or above the cubital fossa
  • Causes of Muscle Wasting

  • Localised Muscle Wasting

  • Disuse
  • Denervation - brachial plexopathy, ulnar or medial nerve lesion, motor neuron disease, Guillain-Barre Syndrome, Charcot-Marie-Tooth
  • Muscular disorders - inflammatory myopathy, muscular dystrophies
  • Generalised Muscle Wasting (Sarcopaenia)

  • Frailty
  • Malnutrition - poor diet, malabsorption, cancer
  • Chronic disease - cancer, heart failure, COPD, infection, cirrhosis, kidney disease
  • Tip

  • Muscle wasting and shiny skin with reddish discolouration is a very specific for reflex sympathetic dystrophy.
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