Median Nerve Injury

by Carlo Raj, MD

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    00:01 We’ll now move on to the median nerve.

    00:03 Mononeuropathy, common site of injury.

    00:06 Carpal tunnel, at the wrist.

    00:09 Please take a moment and identify the median nerve in the schematic.

    00:16 With the median nerve, clinical features include the following: Dropping objects.

    00:22 Numbness, tingling in the hand, wrist, thumb, index and/or the middle finger.

    00:28 May radiate up the arm and occasionally up into the shoulder.

    00:33 Symptoms primarily at night, patient wakes up and shakes their hand to obtain relief.

    00:39 Median nerve damage, where is it commonly? Carpal tunnel and the wrist.

    00:44 Onset usually slow, insidious, over months to years, is the most common pathogenesis.

    00:53 Risk factors: Women, diabetes, pregnancy, weight gain, trauma, HIV, working a lot with the hands.

    01:02 In other words, you’re typing, secretaries, homemakers, operating machines, computer joysticks, factory workers and so forth.

    01:12 Pretty big deal in the U.S., isn’t it? Take a look at all these occupations.

    01:19 Quite a large population at risk for median nerve damage with carpal tunnel syndrome.

    01:26 The physical examination for the median nerve? Test the abductor pollicis brevis, APB, strength.

    01:33 Push the thumb upward against resistance.

    01:40 Positive what’s known as your Tinel sign.

    01:42 Tingling upon tapping the nerve at the wrist usually with appropriate radiation to fingers with symptoms.

    01:53 Recommendations for median nerve injury: Stop or address the cause of the problem.

    01:57 So if it is, a patient has been, let’s say, in the world of gamification and has been using their hands quite a bit for game controllers and such.

    02:08 Then, unfortunately, you will have to recommend to that patient to ease off and balance what they’re doing because they might not even realize as to how damage that they’re actually causing.

    02:19 Treat diabetes if present.

    02:22 Address weight gain.

    02:24 Wrist splints mostly at night.

    02:27 Remember once again, you wake up in the middle of the night because of the pain and you try to “shake off” the pain.

    02:34 Steroid injections and, unfortunately, when there’s enough of this median nerve damage and carpal tunnel syndrome, then surgery -- surgery -- may be indicated in severe cases.

    02:45 But you want to try to avoid that as much as possible.

    02:48 Spend a little bit of time, please, with the management of median nerve damage on this slide so that you are able to address your issue appropriately.

    02:56 Do not choose surgery first if you know for a fact that you could do lifestyle modifications, always actually.

    03:04 Differential diagnoses: Repetitive stress injury to joint or tendon.

    03:08 Cervical root lesion And thoracic outlet syndrome, very rare; nonetheless, a differential.

    About the Lecture

    The lecture Median Nerve Injury by Carlo Raj, MD is from the course Mononeuropathy.

    Included Quiz Questions

    1. Median nerve
    2. Ulnar nerve
    3. Radial nerve
    4. C5, C6, C7 nerve roots
    5. C7, T1 nerve roots
    1. Surgical decompression
    2. Weight loss
    3. Nonsteroidal anti-inflammatory drugs
    4. Wrist splints
    5. Occupational therapy
    1. Phalen maneuver, Tinel sign
    2. Finkelstein test, Phalen maneuver
    3. Eichhoff test, Finkelstein test
    4. Eichhoff test, Tinel sign
    5. Finkelstein test, Tinel sign

    Author of lecture Median Nerve Injury

     Carlo Raj, MD

    Carlo Raj, MD

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