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NEJ Cases Orthopaedic A 44-year-old woman presented with painful diplopia

A 44-year-old woman presented with painful diplopia

A 44-year-old woman presented with painful diplopia while looking up or down after being struck in the left eye with a bare fist. She had no proptosis or ptosis, and her afferent visual system and pupils were normal. She had orthophoria (normal muscular balance) in primary gaze but could not look up or down with her left eye (Panel A).

image 

Forced ductions were positive up and negative down, 

image

What is the ocular muscle( s ) that involve mainly in this condition ?

Comment about this  CT scan ( image B ) ?

What type of damage it is , (Entrapment /direct trauma) Explain ?

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NEJ Cases, Orthopaedic
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