We’ll now move on to
the median nerve.
Mononeuropathy, common site of injury.
at the wrist.
Please take a moment and identify
the median nerve in the schematic.
With the median nerve, clinical
features include the following:
Numbness, tingling in the hand, wrist,
thumb, index and/or the middle finger.
May radiate up the arm and
occasionally up into the shoulder.
Symptoms primarily at night, patient wakes
up and shakes their hand to obtain relief.
Median nerve damage, where is it commonly?
Carpal tunnel and the wrist.
Onset usually slow, insidious,
over months to years,
is the most common pathogenesis.
Women, diabetes, pregnancy,
weight gain, trauma, HIV,
working a lot with the hands.
In other words, you’re typing,
computer joysticks, factory
workers and so forth.
Pretty big deal in
the U.S., isn’t it?
Take a look at all
Quite a large population at risk for median
nerve damage with carpal tunnel syndrome.
The physical examination
for the median nerve?
Test the abductor pollicis
brevis, APB, strength.
Push the thumb upward
Positive what’s known
as your Tinel sign.
Tingling upon tapping
the nerve at the wrist
usually with appropriate radiation
to fingers with symptoms.
median nerve injury:
Stop or address the
cause of the problem.
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.
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.
Treat diabetes if present.
Address weight gain.
Wrist splints mostly at night.
Remember once again,
you wake up in the middle of
the night because of the pain
and you try to “shake
off” the pain.
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.
But you want to try to avoid
that as much as possible.
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.
Do not choose surgery first
if you know for a fact that you could do
lifestyle modifications, always actually.
Repetitive stress injury
to joint or tendon.
Cervical root lesion
And thoracic outlet syndrome, very
rare; nonetheless, a differential.