Median Nerve Palpation

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Questions and Answers

A patient presents with thenar muscle wasting and an inability to oppose or flex the thumb. During a fist-making attempt, digits 4 and 5 flex, but digits 1, 2, and 3 do not. Which of the following best describes the most likely condition?

Combined median and ulnar nerve compression, resulting in mixed presentation of deformities.
Pronator teres syndrome exacerbating carpal tunnel syndrome, leading to complex motor deficits.
Median nerve lesion resulting in Ape hand and Oath hand deformities. (correct)
Resting ulnar nerve deformity (Bishop's hand) accompanied by radial nerve damage.

Compression in pronator teres syndrome involves degeneration of the nerve rather than neuropraxia.

False (B)

Describe the specific location where the median nerve is palpable in the medial intermuscular septum of the brachium, and explain how its position relates to the ulnar nerve and brachial artery.

The median nerve is palpable in the medial intermuscular septum of the brachium where it runs alongside the ulnar nerve and brachial artery until the midpoint of the brachium at roughly the insertion of the coracobrachialis. Here, the ulnar nerve runs more medially, while the median nerve continues alongside the brachial artery.

In carpal tunnel syndrome, the carpal tunnel is formed by the carpal bones on one side, and on the opposite side by the ______, otherwise known as the transverse carpal ligament.

flexor retinaculum Signup and view all the answers

Match the following clinical signs with the most likely underlying nerve pathology:

Ape hand deformity = Median nerve lesion Ulnar digits 4 and 5 flex but median digits 1, 2, and 3 do not, when attempting to make a fist = Median nerve lesion Edema, nail ridges, thin glossy skin = Autonomic dysfunction due to nerve injury Achy, tired, heavy feeling in the forearm, numbness in thumb & index finger = Pronator teres syndrome Signup and view all the answers

Which combination of nerve roots gives rise to the median nerve?

C5-C8 & T1 (D) Signup and view all the answers

The median nerve only innervates muscles in the posterior compartment of the forearm.

False (B) Signup and view all the answers

Describe the sensory distribution mediated by the palmar cutaneous branch of the median nerve, distinguishing it from the digital sensory branches within the carpal tunnel.

The palmar cutaneous branch of the median nerve provides sensation to the skin over the thenar eminence and the lateral aspect of the palm, bypassing the carpal tunnel. Digital sensory branches, conversely, supply the palmar surface and fingertips of digits 1-3 and the radial half of digit 4, and pass through the carpal tunnel. Signup and view all the answers

In the context of median nerve injury, ________ refers to a severe pain syndrome that can arise due to the high proportion of autonomic fibers in the nerve.

causalgia Signup and view all the answers

Match the following conditions with their respective mechanisms of injury (MOI) related to median nerve pathology:

Brachial plexus injury = Traction Carpal tunnel syndrome = Compression due to fibrosis or inflammation Dislocation of lunate = FOOSH (Fall On OutStretched Hand) Fractures of wrist or carpal bones = Direct trauma Signup and view all the answers

Which of the following clinical findings would argue MOST strongly against carpal tunnel syndrome and suggest pronator teres syndrome as the primary diagnosis?

Reproduction of symptoms with resisted pronation and elbow flexion. (B) Signup and view all the answers

In treating carpal tunnel syndrome, decreasing trigger points involves only addressing the flexor retinaculum, completely neglecting other forearm muscles.

False (B) Signup and view all the answers

Explain how tissue health/trophic changes, stemming from autonomic fiber involvement in median nerve pathology, clinically manifest, and provide specific relevant examples.

Tissue health/trophic changes, attributable to autonomic fiber involvement, manifest clinically as edema, nail changes, skin fragility or discoloration, and potential alterations in sweating. These changes indicate disrupted autonomic regulation of blood flow and local metabolism in the affected tissues. Signup and view all the answers

Struther's ligament, contributing to median nerve compression proximal to the elbow in a subset of the population, runs from the medial epicondyle to the ________.

supracondylar ridge Signup and view all the answers

Match the following treatment approaches with their respective rationales in managing carpal tunnel syndrome:

Pillowing and elevation = Reduction of edema and venous stasis Manual therapy addressing flexor retinaculum = Release of fascial restrictions and adhesions Nerve glides = Improved nerve mobility and reduced tension Ergonomic modifications = Prevention of repetitive strain and symptom exacerbation Signup and view all the answers

During a median nerve assessment, a therapist performs Phalen's test. What specific anatomical structures are being compressed or approximated during this test, leading to potential symptom provocation?

Median nerve against the transverse carpal ligament (A) Signup and view all the answers

A positive Upper Limb Tension Test 1 (ULTT1) definitively confirms median nerve compression at the carpal tunnel.

False (B) Signup and view all the answers

Describe the key differential diagnostic criteria used to distinguish between compression of the C6 nerve root and pronator teres syndrome, focusing on symptom location and aggravating factors.

C6 nerve root compression typically presents with radicular pain down the arm, often involving the neck and shoulder, and may be aggravated by specific cervical movements. Pronator teres syndrome primarily involves forearm pain exacerbated with pronation and elbow flexion, with sensory changes specifically in the median nerve distribution. Signup and view all the answers

In cases of suspected carpal tunnel syndrome, nocturnal paresthesia is thought to arise due to ________ occurring during sleep, leading to increased median nerve compression.

venous stasis Signup and view all the answers

Match the following sensory innervation territories with the corresponding nerve branch:

Skin over thenar eminence (bypassing carpal tunnel) = Palmar cutaneous branch of median nerve Fingertips of 1st, 2nd, 3rd, and radial half of 4th digits = Digital sensory branches of median nerve Skin of lateral 2/3 of palm = Palmar Cutaneous Branch Signup and view all the answers

Which of the following statements accurately describes the relationship between the median nerve and the two heads of the pronator teres muscle?

The median nerve passes between the two heads of the pronator teres. (C) Signup and view all the answers

Alleviating compression associated with pronator teres syndrome guarantees permanent symptomatic relief, eliminating the possibility of symptom recurrence.

False (B) Signup and view all the answers

Describe the mechanism by which repetitive wrist flexion and extension contribute to the etiology of carpal tunnel syndrome, specifying the involved tissues and pathological changes.

Repetitive wrist flexion and extension lead to inflammation, edema, and eventual fibrosis within the carpal tunnel. These changes increase pressure on the median nerve, resulting in the characteristic symptoms of carpal tunnel syndrome. Signup and view all the answers

According to the content, one should instruct a patient with carpal tunnel to perform ________ modifications around wrist postures to assist with home care management.

ADL Signup and view all the answers

Match the following motor functions with their respective innervating nerve source (per the slide content):

Forearm flexors = Median nerve Forearm pronators = Median nerve Lateral lumbricals = Median nerve Thenar eminence muscles = Median nerve Signup and view all the answers

In the context of nerve injuries, what is the primary distinction between neuropraxia and axonotmesis concerning nerve fiber integrity and potential for recovery?

Neuropraxia involves demyelination without axonal disruption, whereas axonotmesis involves axonal disruption but intact neural tubes. (B) Signup and view all the answers

If a patient with suspected median nerve compression reports experiencing night pain, it is MOST likely indicative of pronator teres syndrome rather than carpal tunnel syndrome.

False (B) Signup and view all the answers

Describe the specific hand posture typically observed in 'Ape hand' deformity resulting from median nerve damage, and explain the underlying muscular imbalance causing this posture.

Ape hand deformity presents with the thumb resting in line with the fingers due to paralysis and atrophy of the thenar muscles. This muscular imbalance prevents thumb opposition and palmar abduction, resulting in the characteristic flattened appearance of the thenar eminence and thumb alignment. Signup and view all the answers

When palpating for the median nerve in the brachium, you should place your thumb on the medial epicondyle and direct it superolaterally. Doing this, will place your thumb again on the ________ nerve.

median Signup and view all the answers

Match potential home care interventions (right) with their clinical goal (left):

Improve nerve mobility and reduce tension = Nerve Glides Reduce risk of re-injury = Ergonomic assessment Improved tissue health = Forearm strengthening & stretching Signup and view all the answers

Which of the following statements best synthesizes the rationale for incorporating contrast hydrotherapy into the home care regimen for managing median nerve-related conditions?

Contrast hydrotherapy modulates vasomotor activity, reducing edema, enhancing blood flow, and facilitating tissue healing. (C) Signup and view all the answers

According to the documents, solid forearm massage is completely dissimilar to massage for carpal tunnel syndrome.

False (B) Signup and view all the answers

Synthesize the key differences in symptom presentation that would lead you to suspect pronator teres syndrome over carpal tunnel syndrome, and how would your treatment approach differ based on this distinction?

Pronator teres syndrome presents with forearm pain exacerbated by resisted pronation and elbow flexion, with sensory changes felt in the palm. Carpal tunnel syndrome’s presentations are nocturnal pain, and fingers rather than palms. Treatment for pronator teres focuses on muscle specific release and ergonomics while carpal tunnel syndrome focuses on the wrist. Signup and view all the answers

Tinel's sign, when applied to the carpal tunnel, involves percussing over the ______ to provoke symptoms related to median nerve compression.

flexor retinaculum Signup and view all the answers

Match the conditions to their nerve injury classification:

Carpal tunnel syndrome = Neuropraxia Pronator teres syndrome = Neuropraxia Signup and view all the answers

Given the potential for altered autonomic function in median nerve injuries, which of the following clinical signs would indicate sudomotor dysfunction related to the injury?

Changes in sweating patterns (B) Signup and view all the answers

In assessing nerve compression, a positive Reverse Phalen's Test indicates compression of the ulnar nerve over compression of the median nerve.

False (B) Signup and view all the answers

Explain how a 'double crush' phenomenon could exacerbate symptoms of carpal tunnel syndrome, citing specific anatomical locations and potential mechanisms related to the axoplasmic transport of the median nerve.

A 'double crush' phenomenon occurs when the median nerve experiences compression at two distinct sites along its course. For example, coexisting cervical radiculopathy (C6 nerve root compression) and carpal tunnel syndrome can impair axoplasmic transport within the median nerve. Proximal compression reduces the nerve's resilience to distal compression at the carpal tunnel, leading to a greater manifestation, a reduction in nourishment for the nerve, and impaired function distally even with less compression distally. Signup and view all the answers

Flashcards

Median Nerve Anatomy

The median nerve originates from nerve roots C5-C8 & T1 and is the terminus of both the medial and lateral cords of the brachial plexus.

Palpation of the Median Nerve

The median nerve is first palpable in the medial intermuscular septum of the brachium and travels alongside the ulnar nerve and brachial artery.

Median Nerve in Forearm

The median nerve runs deep in the middle of the forearm and emerges as a superficial sensory branch at the distal forearm.

Digital Sensory Branch

The median nerve supplies digits 1-3 and the lateral 4th digit on the palmar aspect and fingertips through a digital sensory branch.