Median Nerve Palsy: Causes, Clinical Presentation, Investigations, and Treatment

The median nerve is a crucial component of the upper limb's neural network, playing a vital role in movement and sensation. Median nerve palsy can result from trauma, compression, or systemic conditions, leading to functional impairments.

Etiopathogenesis

Median nerve injury can occur due to various reasons, including:

• Trauma: Fractures of the humerus or radius can damage the median nerve.
• Compression: Carpal tunnel syndrome is a common condition leading to median nerve entrapment.
• Neuropathies: Systemic diseases like diabetes can cause neuropathy affecting the median nerve.

Clinical Features

Signs and symptoms of median nerve palsy depend on the site of injury:

• High Median Nerve Palsy: Loss of pronation, weak wrist flexion, and impaired thumb opposition.
• Low Median Nerve Palsy: Characterized by thenar muscle atrophy and sensory loss in lateral digits.

Investigations

Diagnosis involves:

• Clinical Examination: Testing grip strength, sensory deficits, and characteristic hand posture (e.g., 'Ape hand').
• Electromyography (EMG): Assessing nerve conduction velocity.
• Imaging: MRI or ultrasound for detecting nerve compression.

Management

Depending on severity, treatment options include:

• Conservative Management: Splinting, physiotherapy, and corticosteroid injections for mild cases.
• Surgical Intervention: Nerve decompression or tendon transfer in severe cases.
• Rehabilitation: Physical therapy focusing on motor recovery and function.