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NBME 20 Answers

nbme20/Block 4/Question#24 (43.9 difficulty score)
A 27-year-old man comes to the physician ...
Deep branch of the ulnar nerve at the hook of the hamate bone🔍,📺

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submitted by hello(350),
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unoyG Clnaa yrmSdone is deu to an aUrnl erNve seoisln nda is essataodci iwht ibyccel nlderahba s.ue

oslA EGIRNF adouctbin nda acdndotui is idaemdte yb rluan ee.nrv The tntpeia si ahivng lerotbu with IRNFEG unatdboic and autcddion.

The Fmronte nsig si etgntsi DCODURAT LCSIPOI AITYTICV, whcih si imadtdee yb eth NALUR VNREE iitctav.y tI is TON nitetgs utmhb pno,ooptiis hiwhc wuold eb eeiatmdd yb the emiand nver.e

See trmneoF ings

submitted by waterloo(89),

As so many posts mentioned this is an ulnar n. problem. cool. But you also have to be able to distinguish between ulnar nerve at the hook of hamate vs ulnar nerve as it courses through the flexor carpi ulnaris.

with the Froment sign you know the deep branches of the ulnar nerve are being effected. This guy is on his bike and rides for 8-10 hours a day - pretty cray. But that's how you know its more likely compression from the handlebars at the hook of the hamate bone and not on the side from his flexor carpi ulnaris.

submitted by celeste(85),
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heT roductad iosilcpl usmecl is eiaventdnr by teh lurna eve,nr gvgnii thsi ygu a itiuflfcd meit gdonlih a teseh fo ep.rap

submitted by neonem(578),
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sMot of isictrnni lmuscse fo het nadh rae tneaveidnr yb lnaur nvere - rincoch scponmeoirs ta the hkoo fo maheta ucdlo lead ot nrvee iismecah

submitted by xxabi(267),
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Blcyeic blehadrna ynruji dlniyrltiatao mgedasa nlaur evren @ the ohko fo hte matahe enbo

submitted by trazobone(59),

Why has no one commented about recurrent branch of median? Recurrent branch of the median nerve innervates all thenar muscles, with the exception of the adductor polis which is innervated by the ulnar.

Also the recurrent branch does not innervate interosseous muscles, that’s ulnar.

Also also Froment’s sign tests thumb adduction.

utap2001  It is important to differentiate the function of recurrent branch of median nerve and deep branch of ulnar nerve. Thumb opponens function is innervated by recurrent branch of median n. Adductor of thumb is innervated by deep branch of ulnar n. +