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Retired NBME 20 Answers

nbme20/Block 4/Question#24 (reveal difficulty score)
A 27-year-old man comes to the physician ...
Deep branch of the ulnar nerve at the hook of the hamate bone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: anatomy msk repeat

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 +11  upvote downvote
submitted by โˆ—hello(429)
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Guyon Canal Syndrome is due to an Ulnar Nerve lesions and is associated with bicycle handlebar use.

Also FINGER abduction and adduction is mediated by ulnar nerve. The patient is having trouble with FINGER abduction and adduction.

The Froment sign is testing ADDUCTOR POLICIS ACTIVITY, which is mediated by the ULNAR NERVE activity. It is NOT testing thumb opposition, which would be mediated by the median nerve.

See Froment sign

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 +9  upvote downvote
submitted by โˆ—waterloo(126)
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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.

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an1  Froment may be + in both. But the difference is that damage at the flexor carpi ulnas may result in loss of sensation over the entire ulnar supply regional's. This guy has no pain or numbness. But yes the bike handles are a give away fro hamate injury. More info if you want to read: https://teachmeanatomy.info/upper-limb/nerves/ulnar-nerve/ +2
athenathefirst  Why is it not E? ulnar nerve as it courses through flexor carpi ulnaris muscle? I knew it was ulnar nerve but chose this wrong answer :( +
coco  Compression of ulnar nerve as it courses through the flexor carpi ulnaris muscle suggest cubital tunnel syndrome.Cubital tunnel syndrome is a common sports injury in throwing and racket sports that require repetitive elbow flexion and extension combined with ulnar and radial deviation of the wrist. while cycling,hamate bone can be compressed,but medial epicondyle(ulnar nerve passes posterior to the medial epicondyle) cannot be compressed.It is Guyon canal syndrome.so E is incorrect. +1



 +8  upvote downvote
submitted by โˆ—celeste(96)
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The adductor pollicis muscle is innervated by the ulnar nerve, giving this guy a difficult time holding a sheet of paper.

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 +2  upvote downvote
submitted by โˆ—neonem(629)
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Most of intrinsic muscles of the hand are innervated by ulnar nerve - chronic compression at the hook of hamate could lead to nerve ischemia

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 +2  upvote downvote
submitted by โˆ—xxabi(293)
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Bicycle handlebar injury traditionally damages ulnar nerve @ the hook of the hamate bone

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 +1  upvote downvote
submitted by โˆ—trazobone(97)
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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, thatโ€™s ulnar.

Also also Fromentโ€™s sign tests thumb adduction.

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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. +



 +0  upvote downvote
submitted by alexv0815(10)
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https://www.google.com/search?q=guyons+canal+syndrome+hamate&tbm=isch

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