Median nerve palsy for PACES

There is wasting of the thenar eminence.
There is weakness of thumb abduction and opposition.
There is decreased sensation of the thumb, index and middle fingers.

Recap of Part I and II carpel tunnel syndrome notes here

What is the nerve root of the median nerve?
C6, C7, C8 and T1.

What is carpel tunnel syndrome?
Carpel tunnel syndrome is entrapment of the median nerve at the wrist between the flexor retinaculum and the carpal bones, resulting in altered sensation and pain in the hand.  This is often worst at night and may be relieved by shaking the hand.

What tests do you know of to reproduce the symptoms of carpel tunnel syndrome?
  • Tinnel's test: tapping over flexor retinaculum causes tingling in distribution of median nerve over hand
  • Phalens test: keeping both wrists in palmar flexion for 1 minute (the 'prayer sign') reproduces the symptoms.

What causes of carpel tunnel syndrome do you know?
  • endocrinological: diabetes, hypothyroidism, acromegaly
  • rheumatological: RA, SLE
  • renal: renal failure, long term dialysis
  • other: pregnancy, alcoholism, work related repetitive strain

How would you treat carpel tunnel syndrome?
Options include splinting, steroid injections and surgical decompression

What muscles does the median nerve supply? 
  • C6 - pronators in forearm
  • C7 - flexor carpi radialis
  • C8 - flexor digitorum profundus and flexor digitorum superficialis of the middle and index fingers and flexor pollicis longus
  • T1 - the lateral 2 lumbicals, oppenens pollicis brevis, abductor pollicis brevis and flexor pollicis brevis.

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