Median neuropathy is a term describing the injury to the median nerve along its path from the brachial plexus to the distal forearm. The nerve is most susceptible to injury within the carpal tunnel. The term carpal tunnel syndrome is used to describe median nerve injury at that site, but median neuropathy can occur through numerous other mechanisms, which is why a thorough diagnostic workup is necessary.
The clinical presentation of median neuropathy depends on the location where the median nerve is injured. In the vast majority of cases, however, the carpal tunnel is the site where the injury occurs, and the term "carpal tunnel syndrome" is used as a distinct clinical entity to describe the pathophysiological and clinical changes . Several risk factors have been established, such as diabetes mellitus (a significantly higher incidence rate is observed compared to the general population), genetic predisposition, female gender, and profound occupational wrist efforts  . Most important symptoms are a pain of the hand (the thumb and the first two and a half fingers are innervated by the median nerve) and the wrist that often wakes patients at night, and is accompanied by paresthesias. Additionally, sensory loss in the abovementioned fingers on the palmar side of the hand and weakness or wasting of the thenar muscles (opponens pollicis, flexor pollicis brevis and abductor pollicis brevis) are signs of severe median nerve injury   . The dominant hand is more frequently affected, but a bilateral presentation may be observed as well.  . Apart from the carpal tunnel, the antecubital fossa is also an important site where median neuropathy can originate from, with most common causes being the injury during intravenous injection or cannulation, and trauma .
Entire Body System
It may be a difficult diagnosis to make, as it often presents with arm pain that is diffuse and can present as radiating pain to the elbow or even pain radiating down further into the wrist or hand. [drlox.com]
The most common symptom is mild to moderate aching pain in the proximal forearm, sometimes described as tiredness and heaviness. Use of the arm may cause a mild or dull aching pain to become deep or sharp. [clinicalgate.com]
The patient may also have pain at rest (especially at night), weakness in the thumb, and thenar atrophy. [mitchmedical.us]
- Soft Tissue Swelling
Patients with significant soft-tissue swelling and symptoms or signs of median nerve dysfunction are especially at risk for worsening neuropathy after closed reduction and closely applied cast immobilization or after open reduction. [ncbi.nlm.nih.gov]
The possible causes of the compression include the tape over the volar forearm used to affix the arms to the padded arm board, an unexpected venous tourniquet effect in the face of third spacing, or generalized soft tissue swelling. [anesthesiology.pubs.asahq.org]
- Thenar Muscle Atrophy
Thenar muscle atrophy (chronic injury) Recurrent branch of median nerve: Innervates muscles of the thenar eminence Damaged with lacerations of the radial-sided wrist and proximal palm Results in loss of thumb flexion, opposition, and abduction without [amboss.com]
muscle atrophy may occur. [fpnotebook.com]
Physical examination showed bilateral thenar muscle atrophy and muscle weakness of the abductor pollicis brevis, which was more prominent in the left hand. Tendon reflexes were normal and symmetric. [thenerve.net]
Atrophy 62. CLINICAL FEATURES SYMPTOMS Pain paresthesia tingling Awakens the pt. at night SIGNS Decreased grip strength Thenar muscle atrophy Tinels sign 63. [slideshare.net]
- Wrist Pain
The patients with ACTS initially had normal sensation and subsequently developed objective sensory loss (2-point discrimination greater than 15 mm) in the median nerve distribution associated with severe wrist pain. [ncbi.nlm.nih.gov]
Characterized by hand and wrist pain, CTS is a symptomatic distal median nerve neuropathy at the wrist and is the most commonly encountered entrapment neuropathy. [practicalpainmanagement.com]
If you have limited wrist motion or wrist pain, your doctor may order x-rays to exclude other causes for your symptoms, such as arthritis, ligament injury, or a fracture. Magnetic resonance imaging (MRI) scans. [orthoinfo.aaos.org]
Clinical Findings.— Patients with carpal tunnel syndrome experience a burning wrist pain, which may radiate either proximally to the shoulder and neck region or distally into the fingers. [pubs.rsna.org]
- Peripheral Neuropathy
Routinely performed tests would have missed median neuropathy at wrist with concomitant peripheral neuropathy in 59 (37.3%) hands. [ncbi.nlm.nih.gov]
There was no correlation between peripheral neuropathy and gender (p=0.696). Conclusion: Despite the detailed neurological examination, subclinical peripheral neuropathy can be seen in patients with Behçet’s disease. [journal.turkderm.org.tr]
Alcohol consumption has a significant correlation with peripheral neuropathy (p=0.019). Conclusion: Exposure to vibration caused disorders in peripheral nerves system such as motor and sensory neuropathy, axonopathy, and CTS-induced vibration. [scholar.ui.ac.id]
December 17, 2012 Coding for Peripheral Neuropathy For The Record Vol. 24 No. 23 P. 25 Peripheral neuropathy involves damage to the peripheral nerves, which send information to and from the brain and spinal cord to other parts of the body. [fortherecordmag.com]
- Numbness of the Hand
The decision whether to have surgery is based on the severity of your symptoms—how much pain and numbness you are having in your hand. [orthoinfo.aaos.org]
Additionally, NCSs may be normal, but the needle EMG examination may demonstrate abnormalities that identify a more proximal nerve lesion that produces symptoms such as numbness in the hand and that may mimic CTS.” [aetna.com]
- Postural Instability
Introduction Parkinson’s disease (PD) is the second most common neurodegenerative disorder, characterised by tremor, rigidity, bradykinesia, and postural instability associated with degeneration of dopaminergic neurons in the substantia nigra pars compacta [hindawi.com]
The diagnosis of a median neuropathy can be made successfully if all steps during workup are conducted properly, including a detailed patient history, a careful physical examination, and laboratory or imaging studies in the diagnosis is unclear. Firstly, information regarding the onset and severity of symptoms, as well as their location and duration, is of essential importance to the physician. The physical examination must include two tests - flexion of the wrist to 90 degrees for 1 minute, which could result in paresthesia (known as the Phalen's sign) and percussion of the nerve at the carpal tunnel (the onset of paresthesia indicates a positive Tinel's sign)  . If these measures do not provide enough clinical evidence, additional investigations include electromyography, nerve conduction studies, magnetic resonance imaging (MRI) and high-resolution ultrasonography (HRUS), a useful adjunctive method for the diagnosis of median neuropathy, being inexpensive, non-invasive and readily available  . Because diabetes mellitus is an important risk factor for carpal tunnel syndrome, blood glucose levels should be evaluated in all patients who present with signs and symptoms suggestive of this condition  .
Corrective osteotomy without carpal tunnel release is a sufficient treatment for neuropathy in malunited distal radius fractures. [ncbi.nlm.nih.gov]
As you consider any treatment, discuss them with your physician. [drlox.com]
See treatment for carpal tunnel syndrome References: Median nerve neuropathy Summary Etiology Clinical features Anatomical principles Diagnostics Treatment [amboss.com]
Careful clinical evaluation and discerning evaluation of electrodiagnostic studies are helpful in determining the prognosis of recovery with nonoperative and operative management. [ncbi.nlm.nih.gov]
Outlook (Prognosis) Symptoms often improve without surgery. But more than one half of cases eventually need surgery. Even if surgery is successful, full healing can take months. [printer-friendly.adam.com]
In selected cases, nerve conduction studies at the onset of symptoms may provide insights into localization, mechanism, and prognosis. References Dhuner K: Nerve injuries following operations: A survey of cases occurring during a 6 year period. [anesthesiology.pubs.asahq.org]
These women may benefit from taking a higher daily dose of folic acid before they consider becoming pregnant. top What is the prognosis? Children with spina bifida can lead active lives. [ninds.nih.gov]
When this type of defect is detected, parents should seek out a multi-disciplinary team of specialists, including a pediatric neurosurgeon, to understand the condition and prognosis as well as to make an informed decision on the course of the pregnancy [aans.org]
Contrary to earlier studies, this report demonstrates that GH-induced CTS is not an age-related phenomenon and alerts physicians to include GH abuse as a possible etiology of median neuropathy in athletes. [ncbi.nlm.nih.gov]
Etiology Traumatic: e.g., fractures (humerus fracture causing proximal lesion), carpal bone dislocations, or penetrating injuries (gunshots, lacerations, etc) Chronic compression; : e.g., in the carpal tunnel (see carpal tunnel syndrome; ) or between [amboss.com]
Etiological and pathological findings favored the conception of this disorder as some type of localized rheumatic disease. Immobilization of the wrist by a splint and administration of hydrocortisone relieved the symptoms in many cases. [jamanetwork.com]
Etiology This entrapment is more common in patients who are obese, wear tight underwear or pants, or who have diabetes. [casemed.case.edu]
Level of Evidence : Level III, prognostic study Keywords Perilunate dislocations Perilunate fracture-dislocations Epidemiology Median neuropathy Carpal tunnel release This is a preview of subscription content, log in to check access. [link.springer.com]
Anterior interosseous nerve syndrome AINS is a rare entrapment syndrome, with comparatively little robust epidemiological data. AINS is said to account for less than 1% of neuropathies of the upper limb. [neurologyneeds.com]
PROXIMAL DIABETIC NEUROPATHY (PDN) OF THE LOWER LIMBS Clinical and epidemiological aspects – Diabetic patients, usually over the age of 50, may present proximal neuropathy of the lower limbs characterized by a variable degree of pain and sensory loss [scielo.br]
Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev Disabil Res Rev. 2010;16(1):6-15. doi: 10.1002/ddrr.93. Review. Bassuk AG, Kibar Z. Genetic basis of neural tube defects. [ghr.nlm.nih.gov]
SIGNIFICANCE: Assessment of nerve conduction across the common entrapment sites could provide new insights into the pathophysiology of diabetic neuropathy related to metabolic factors. [ncbi.nlm.nih.gov]
In the vast majority of cases, however, the carpal tunnel is the site where the injury occurs, and the term "carpal tunnel syndrome" is used as a distinct clinical entity to describe the pathophysiological and clinical changes. [symptoma.com]
The pathophysiology of this type of lesion is mainly mechanical: a repeated and prolonged compression may develop either directly by the contracting muscle itself or by fixation against more rigid osteoligamentous tissues; the movements performed by our [jnnp.bmj.com]
The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel. [ocneurosurgery.com]
It is believed that hyperglycemia alone can not explain all the pathophysiology of nerve injury and among the factors potentially involved the development stand to insulin resistance (IR) and abnormal lipid metabolism. [bdtd.ibict.br]
All members of the Industrial Injuries and Prevention Committee of the American Society for Surgery of the Hand provided electrodiagnostic reports from their office practices indicating an electrodiagnosis of CTS or median neuropathy at the wrist. [ncbi.nlm.nih.gov]
Strict control of blood sugar levels is necessary to prevent further median nerve damage. [livestrong.com]
A focused neurophysiological approach is mandatory to reach the proper diagnosis and start specific treatment early enough to prevent possible irreversible hand function disabilities. [semanticscholar.org]
- Horinouchi S, Deguchi T, Arimura K, et al. Median neuropathy at the wrist as an early manifestation of diabetic neuropathy. J Diabetes Investig. 2014;5(6):709-713.
- Bland JDP. Carpal tunnel syndrome. BMJ. 2007;335(7615):343-346.
- Thatte MR, Mansukhani KA. Compressive neuropathy in the upper limb. Indian J Plast Surg. 2011;44(2):283-297.
- Melli G, Chaudhry V, Dorman T, Cornblath DR. Perioperative bilateral median neuropathy. Anesthesiology. 2002;97(6):1632-1634.
- Ginn SD, Cartwright MS, Chloros GD, et al. Ultrasound in the diagnosis of a median neuropathy in the forearm: case report. J Brachial Plex Peripher Nerve Inj. 2007;2:23.