Mononeuropathy - Median Nerve (C6-T1) Palsy

 

Thank you for asking me Harry who presented with weakness in his hands.

 

The salient findings were:

• Wasting of the thenar eminence, with sparing of the hypothenar eminence

• The was weakness in thumb abduction, flexion and opposition, with normal “distal” thumb flexion, finger abduction/adduction, wrist flexion, and pronation.

• There was sensory loss of the palmar aspect of the first three and a half fingers.

• Cause:

  • Tinel’s and Phalen’s sign were positive (if carpal tunnel).

  • Oschner’s clasping test was positive (clasp hands together, index finger sticks out - indicates lesion in or above cubital fossa - flexor digitorum sublimis which flexes PIP is affected)

  • If proximal, can get weakness of thumb flexion, pronation, and wrist flexion.

• This is most consistent with a median nerve palsy