A patient presents with weakness extending the fingers and thumb and weakness with supination. The patient reports pain in the lateral elbow, but denies pain or sensory changes in the hand or forearm. Which of the following entrapment syndromes BEST explains these findings?

1. Radial tunnel syndrome
2. Anterior interosseous nerve syndrome
3. Posterior interosseous nerve syndrome
4. Carpal tunnel syndrome

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

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A patient presents with weakness extending the fingers and thumb and weakness with supination. The patient reports pain in the lateral elbow, but denies pain or sensory changes in the hand or forearm. Which of the following entrapment syndromes BEST explains these findings?

1. Radial tunnel syndrome
2. Anterior interosseous nerve syndrome
3. Posterior interosseous nerve syndrome
4. Carpal tunnel syndrome

Peripheral Nerve Entrapment

Peripheral nerve entrapments in the arm occur when a nerve is compressed or irritated as it passes through narrow spaces (e.g., muscles, connective tissue). Common sites include the carpal tunnel, cubital tunnel, and radial tunnel. Symptoms can include pain, tingling, numbness or weakness in the area the nerve supplies.

Remember, Clinical Presentation is King! Basic familiarity with the clinical presentation of commonly and to a lesser extent, uncommonly encountered medical conditions can be extremely valuable to students on the NPTE. Reviewing the Gold, Silver, and Bronze Clinical Application Templates in the review book PTEXAM: The Complete Study Guide is a fantastic learning activity to make sure your pathology knowledge is on point!

Let’s explore each of the options:

Option 1 – Radial tunnel syndrome

Radial tunnel syndrome causes deep aching pain in the lateral forearm, often with tenderness on palpation near the radial tunnel. It does not cause motor weakness, making it distinct from posterior interosseous nerve syndrome, which is characterized by weakness.

Option 2 – Anterior interosseous nerve syndrome

Option 3 – Posterior interosseous nerve syndrome

Posterior interosseous nerve syndrome results from compression of the motor branch of the radial nerve, typically near the supinator muscle. It causes weakness in thumb and finger extension, as well as with supination. With posterior interosseous nerve syndrome, there are no sensory deficits, distinguishing it from other radial nerve issues.

Option 4 – Carpal tunnel syndrome

Carpal tunnel syndrome is a median nerve entrapment at the wrist that causes numbness and tingling in the thumb, index, middle, and half of the ring finger, with thenar muscle weakness occurring in advanced cases. Finger and wrist extension are not affected.

The correct answer is Option 3
Let’s explore the all student data:
 
All Student Results
35% of students selected Option 1 - Radial tunnel syndrome
15% of students selected Option 2 - Anterior interosseous nerve syndrome
45% of students selected Option 3 - Posterior interosseous nerve syndrome - the correct response
5% of students selected Option 4 - Carpal tunnel syndrome
 
System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.
 
Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.
 
Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.
 
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