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Thumbs down: testing anatomy in the ED
  1. Eoghan Smith1,
  2. Santosh Bongale2
  1. 1 Department of Anaesthetics, Glasgow Royal Infirmary, Glasgow, UK
  2. 2 Emergency Department, Royal Alexandra Hospital, Paisley, UK
  1. Correspondence to Dr Eoghan Smith, Department of Anaesthetics, Glasgow Royal Infirmary, Glasgow G4 0SF, UK; eoghansmith{at}

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Clinical introduction

A 58-year-old woman presented to the emergency department with inability to use her right thumb after attempting to tear open the packaging of a dishwasher tablet with her hands. There was no other history of trauma with the loss of function in her thumb occurring suddenly at the time described. She had a history of rheumatoid arthritis. On examination, her thumb was dropped as in the image below. She was able to abduct, adduct, oppose and flex but was unable to extend her thumb. Her hand was …

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  • Contributors Both authors reviewed this patient within the ED. Both contributed to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Correction notice Since this image challenge was first published online, a correction has been made to option D in the question section. The abbreviation APL should read abductor pollicis longus and not adductor pollicis longus.