Loss of force in the digital clamp

Specialty: Musculoskeletal.

• weakness of the hand clamp
• difficulty opposing thumb
• flexor longus weakness

Why it occurs

• Severe carpal tunnel syndrome (median nerve compression)
• Neuropathy of the anterior interosseous nerve (branch of the median, prevents making the "OK" sign due to weakness of the flexor pollicis longus and flexor profundus of the index finger)
• C8-T1 cervical radiculopathy due to disc herniation or uncovertebral osteoarthritis
• Ulnar nerve entrapment at the elbow or Guyon's canal (weakness of the adductor pollicis and interossei muscles, positive Froment's sign)
• Advanced trapeziometacarpal arthritis (painful rhizarthrosis with muscle inhibition due to pain)
• Amyotrophic lateral sclerosis (ALS, distal onset in the upper extremity)

Initial workup

Electromyography (EMG) of the upper extremity and nerve conduction velocities (ENG) to locate the exact point of entrapment or root origin | Ultrasound of the wrist and elbow to assess compression of the median and ulnar nerve | Magnetic resonance imaging of the cervical spine.

Standard management

• Pregabalin — 75 mg orally every 12 hours, useful to alleviate associated neuropathic symptoms
• Methylcobalamin — 1000 mcg orally daily; adjuvant in the regeneration of the myelin sheath
• Gabapentin (300 mg every 8 hours orally).