J Korean Med Assoc.  2017 Dec;60(12):944-950. 10.5124/jkma.2017.60.12.944.

Median nerve neuropathy

• Hong SW
• Gong HS

• KMID: 2397862
• DOI: http://doi.org/10.5124/jkma.2017.60.12.944

Abstract

The median nerve is the most important nerve in the upper extremity, as it is responsible for most of the sensation of the hand, the fine motor functions of the thumb, and finger grasping. Median neuropathies most commonly occur as compressive neuropathy or entrapment neuropathy, but sometimes as neuritis without any compressive lesion. Carpal tunnel syndrome (CTS), anterior interosseous nerve syndrome, and pronator teres syndrome are the subtypes of median nerve neuropathies, of which CTS is the most common. Median neuropathies can be diagnosed clinically by careful history-taking and a physical examination. Typical symptoms of CTS include night pain (crying), a tingling sensation of the radial digits, numbness or paresthesia, clumsiness, and atrophy of the thenar muscles. Electrophysiologic testing can be used for confirmation of the diagnosis and for documentation before surgical treatment. Imaging modalities including ultrasonography or magnetic resonance imaging can be used to ensure diagnostic accuracy and to detect unusual causes of compression. Conservative treatments include rest, bracing, nerve stretching, non-steroidal anti-inflammatory drugs, and steroid injections. If nonsurgical approaches are unsatisfactory or the nerve damage is severe, surgical treatment should be considered. Carpal tunnel release for CTS is a relatively simple procedure that involves division of the transverse carpal ligament and decompression of the median nerve. Early diagnosis and proper management are important, as muscle atrophy and sensory loss may persist when surgical release is delayed in patients with advanced disease.

Keyword

Median nerve; Compressive neuropathy; Entrapment neuropathy; Carpal tunnel syndrome

MeSH Terms

Atrophy
Braces
Carpal Tunnel Syndrome
Decompression
Diagnosis
Early Diagnosis
Fingers
Hand
Hand Strength
Humans
Hypesthesia
Ligaments
Magnetic Resonance Imaging
Median Nerve*
Median Neuropathy
Muscles
Muscular Atrophy
Nerve Expansion
Neuritis
Paresthesia
Physical Examination
Sensation
Thumb
Ultrasonography
Upper Extremity

Figure

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  Figure 1 Struther's ligament and two heads of pronator teres.

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  Figure 2 Cross section of carpal tunnel.

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  Figure 3 Open carpal tunnel release.

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