Signs
 

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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