median neuropathy

Median neuropathy, also known as median nerve dysfunction or entrapment syndrome, is a condition that affects the median nerve, which runs from the forearm to the hand. It can cause pain, numbness, and weakness in the hand, wrist, and forearm.

Causes of Median Neuropathy

Median neuropathy can be caused by compression or squeezing of the median nerve as it travels through the wrist, forearm, or elbow. This compression can be due to various factors such as:

• Carpal tunnel syndrome (CTS), which is the most common form of mononeuropathy and occurs when the median nerve is compressed at the wrist.
• Compression from repetitive movements or activities that involve bending or twisting of the wrist.
• Swelling or inflammation in the wrist or forearm.
• Trauma or injury to the wrist, forearm, or elbow.

Symptoms of Median Neuropathy

The symptoms of median neuropathy can vary depending on the severity and location of the compression. Common symptoms include:

• Pain, numbness, or tingling sensations in the hand, wrist, or forearm.
• Weakness or fatigue in the muscles of the hand, wrist, or forearm.
• Difficulty moving the fingers or thumb.
• Numbness or loss of sensation in the palm or fingers.

Types of Median Neuropathy

There are several types of median neuropathy, including:

• Carpal tunnel syndrome (CTS), which is the most common form of mononeuropathy and occurs when the median nerve is compressed at the wrist.
• Distal median nerve dysfunction, which affects the movement or sensation in the hands.
• Median neuropathy of the forearm, which can cause pain, numbness, or weakness in the forearm.

References

[4] [5] [6] [8] [9] [10]

Common Signs and Symptoms of Median Neuropathy

Median neuropathy, also known as carpal tunnel syndrome, can cause a range of symptoms that affect the hand, wrist, and forearm. The signs and symptoms of median neuropathy include:

• Pain or discomfort in the hand and fingers: This is often felt at night, especially when trying to sleep (4, 7)
• Numbness or tingling sensation in the hands: This can be a result of pressure on the median nerve, causing abnormal sensations in the hands (3, 6, 8)
• Weakness in the hand: This can make it difficult to perform everyday tasks such as grasping items or using a keyboard (10, 11)
• Tenderness or pain in the elbow: In some cases, median neuropathy can cause pain or tenderness in the elbow area (10)
• Loss of muscle in the thumb: This is a common symptom of carpal tunnel syndrome, which is a type of median neuropathy (9)

These symptoms can vary depending on the severity and location of the nerve compression. In some cases, median neuropathy can cause more severe symptoms such as pain or burning sensations in the forearm.

References:

• [3] Symptoms include thenar weakness, numbness in the radial three-and-one-half fingers, and paresthesias.
• [4] Pain in the wrist or hand that may be severe and wake you up at night, and that may be felt in other areas, such as the upper arm (this is called ...
• [6] Distal median nerve dysfunction is a form of peripheral neuropathy that affects the movement of or sensation in the hands.
• [7] Symptoms of median neuropathy can vary but often include pain or discomfort in the hand and fingers (especially at night), numbness or tingling sensation in ...
• [8] This abnormal pressure on the nerve can result in numbness, tingling, pain, and weakness in the hand. Carpal tunnel syndrome is caused by pressure on the ...
• [9] Sometimes, when neuropathy affects a single nerve, symptoms are clearly confined to one area. For example, the most common single-nerve form of neuropathy, Feldman says, is carpal tunnel syndrome. It happens when the median nerve, which runs from the forearm into the hand, gets inflamed or squeezed, causing numbness, pain and weakness in the ...
• [10] What are the signs of median nerve problems? Signs of a pinched median nerve include: Hand or wrist pain, numbness, weakness or tingling. Hand pain that wakes you up at night.
• [11] Common signs of a median nerve injury may include: Pain, weakness, or numbness in the hand, wrist, or forearm ... Symptoms of carpal tunnel syndrome include pain or numbness in the fingers and ...

Diagnostic Tests for Median Neuropathy

Median neuropathy, also known as carpal tunnel syndrome (CTS), can be diagnosed using several tests that assess the function and integrity of the median nerve in the wrist. Here are some common diagnostic tests used to diagnose median neuropathy:

• Tinel's test: This test involves tapping over the volar carpal ligament, along the median nerve at the carpal tunnel for up to 60 seconds [5]. A positive test result is indicated by a tingling or numbness sensation in the hand.
• Phalen's test: This test involves flexing the wrist and holding it for 30-60 seconds. If this causes a numbing or tingling sensation, it may indicate median neuropathy [4].
• Carpal Compression Test: This test involves applying pressure with thumbs over the median nerve within the carpal tunnel, located just distal to the wrist crease [3]. A positive result is indicated by a decrease in sensation or a numbing sensation.
• Median sensory NCS (Nerve Conduction Study): This test measures the speed and strength of electrical impulses traveling through the median nerve. An abnormal result may indicate median neuropathy [1].
• Ultrasound: Ultrasound can be used to evaluate the soft tissues of the carpal tunnel and the median nerve. High-frequency sound waves bounce off the nerves, allowing healthcare providers to visualize the median nerve and assess its integrity [7].

These tests are often used in combination to diagnose median neuropathy. A diagnosis is typically made based on a combination of clinical evaluation, patient history, and test results.

References: [1] Oct 1, 2024 — Perform a median sensory NCS across the wrist with a conduction distance of 13-14 cm (Technique G). If the result is abnormal, compare the ... [3] Jul 17, 2018 — Carpal Compression Test (Apply pressure with thumbs over the median nerve within the carpal tunnel, located just distal to the wrist crease. [4] Jul 18, 2023 — Phalen's test is a series of hand and wrist movements and positions healthcare providers use to diagnose carpal tunnel syndrome. [5] Tinel's test involves the examiner tapping over the volar carpal ligament, along the median nerve at the carpal tunnel for up to 60 seconds [4]. A positive test ... [7] Your doctor may use ultrasound to evaluate the soft tissues of the carpal tunnel and the median nerve. During an ultrasound, high-frequency sound waves bounce ...

Treatment Options for Median Neuropathy

Median neuropathy, also known as carpal tunnel syndrome (CTS), can be treated with various medications to alleviate symptoms and prevent further nerve damage.

• Corticosteroids: Injecting corticosteroids into the carpal tunnel or taking oral cortisone can help reduce inflammation and relieve pain [1]. This treatment is often used in conjunction with other therapies.
• NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be prescribed to control nerve pain and inflammation [4].
• Nerve pain medications: Gabapentin or pregabalin may be prescribed to help manage nerve pain associated with median neuropathy [8].

Other Treatment Options

In addition to medication, other treatment options for median neuropathy include:

• Physical therapy: Stretching exercises and physical therapy can help alleviate symptoms by improving wrist mobility and reducing pressure on the median nerve.
• Wrist splints: Wearing a wrist splint at night or during activities that exacerbate symptoms can help reduce pressure on the median nerve.

Important Considerations

It's essential to note that treatment for median neuropathy may vary depending on individual circumstances, such as the underlying cause of the condition. In some cases, addressing the underlying medical problem (e.g., diabetes) may be necessary to prevent further nerve damage.

References:

[1] Corticosteroid injections into the carpal tunnel can help reduce inflammation and relieve pain. [4] NSAIDs can control nerve pain and inflammation associated with median neuropathy. [8] Nerve pain medications such as gabapentin or pregabalin may be prescribed to manage nerve pain.

Median Neuropathy Differential Diagnosis

Median neuropathy, also known as carpal tunnel syndrome (CTS), can be challenging to diagnose due to its similarity with other conditions affecting the wrist and hand. The differential diagnosis for median neuropathy includes various neurologic, musculoskeletal, and vascular conditions that present with pain, paresthesia, sensory loss, or weakness in the affected limb.

Conditions to Consider:

• Carpal Tunnel Syndrome (CTS): The most common median nerve compression neuropathy, caused by entrapment of the median nerve at the wrist [1][6].
• Pronator Syndrome: A condition where the median nerve is compressed as it passes through the pronator teres muscle in the forearm [2][4].
• Anterior Interosseous Nerve Syndrome: A rare condition where the anterior interosseous nerve, a branch of the median nerve, is compressed or damaged [2][4].
• Nerve Root Compression at the Cervical Spine: Compression of the cervical spine can cause symptoms similar to CTS, including pain and sensory loss in the affected limb [5].
• Compression at the Brachial Plexus: Compression of the brachial plexus, a network of nerves that supply the arm, can also present with symptoms similar to CTS [5].

Other Conditions:

• Tendinitis or Tendinosis: Inflammation or degeneration of tendons in the wrist and hand can cause pain and sensory loss.
• Vascular Conditions: Vascular conditions such as vasculitis, thrombosis, or embolism can also present with symptoms similar to CTS.

References:

[1] Oct 1, 2024 — Carpal tunnel syndrome (CTS) is the most common focal peripheral neuropathy. CTS is caused by entrapment of the median nerve at the wrist as ... [2] by MR Bair · 2016 · Cited by 5 — Median nerve compression syndromes include pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. [3] by P Löppönen · 2022 · Cited by 16 — Carpal tunnel syndrome (CTS) is the most common median nerve compression neuropathy. Its symptoms and clinical presentation are well known. [4] by MR Bair · 2016 · Cited by 5 — Median nerve compression syndromes include pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. [5] by P Löppönen · 2022 · Cited by 16 — Differential diagnosis for PMNC should include CTS but also nerve root compression at the cervical spine and compression at the brachial plexus ... [6] Oct 1, 2024 — Carpal tunnel syndrome (CTS) is the most common focal peripheral neuropathy. CTS is caused by entrapment of the median nerve at the wrist as ...