A 26-year-old man presents to the clinic for evaluation of numbness and tingling of his right ring and little fingers bilaterally for 3 days. The patient is an avid cyclist, and he states the symptoms began the day after he went on a 50-mile bike ride. He has no past medical history and takes no medications. Family history is significant for father with late-onset type 1 diabetes. He does not drink alcohol, smoke cigarettes, or use illicit drugs. He is in a monogamous relationship with his wife of 3 years. He complains of constant “pins and needles” in the little finger and medial aspect of the ring finger bilaterally. He does not recall any specific injury and denies any pain in the upper extremities. Physical examination shows full range of motion of the upper extremities and the fingers, and there is focal no tenderness or evidence of muscle atrophy. Tinel sign at the elbow and Phalen test are negative.
Given the patient’s most likely diagnosis, which of the following anatomical structures is involved in the pathogenesis of this patient’s symptoms?
- A) Arcade of Struthers
- B) Flexor retinaculum
- C) Medial epicondyle of the humerus
- D) Scaphoid
- E) Volar carpal ligament
Dr. Ted O'Connell