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At least 19 recordsLinked to original sources
PubMed1999

Distal median neuropathies.

Distal median neuropathy is the most common entrapment neuropathy affecting the upper extremity. Although most often idiopathic, there are a large number of associated medical disorders. Electrophysiologic testing plays a central role in the diagnosis of distal median neuropathy in establishing localization; assessing severity; and excluding disorders of the proximal median nerve, plexus, and nerve roots which can mimic the clinical symptoms of distal median neuropathy. Treatment is usually successful, especially when diagnosis is established early in the course before any significant axonal loss has occurred.

Carpal Tunnel Syndrome↗
PubMed1999

Proximal median neuropathies.

Proximal median neuropathies are uncommon. They are usually caused by overuse of the forearm, anatomic variations, or both. Forearm pain, weakness of muscles supplied by the affected nerves, and sensory loss, including the thenar eminence, are common clinical findings. Nerve conduction studies and needle electromyography are helpful in the diagnosis of these syndromes. Treatment is avoidance of overuse and release of mechanical compression. Prognosis is generally good.

Diagnosis, Differential↗
PubMed2000

The pathology of median neuropathy in acromegaly.

BACKGROUND: Median neuropathy is commonly associated with acromegaly, although its pathology is uncertain. OBJECTIVE: To study the pathology of median neuropathy in acromegaly by using magnetic resonance imaging (MRI). DESIGN: Case series. SETTINGS: Outpatient clinic and MRI unit. PATIENTS: Nine patients with acromegaly, four of whom had clinical symptoms of neuropathy. MEASUREMENTS: At presentation and 6 months after treatment, median nerve size, its signal intensity, and the volume of the carpal tunnel contents were measured. RESULTS: At presentation, patients with symptoms of neuropathy had increased nerve size and signal intensity compared with asymptomatic patients, but the two groups did not differ in volume of carpal tunnel contents. These measures improved with treatment of acromegaly in symptomatic patients; asymptomatic patients experienced no change or worsening. CONCLUSION: The predominant pathology of median neuropathy in acromegaly seems to be increased edema of the median nerve within the carpal tunnel rather than extrinsic compression from increased volume of the carpal tunnel contents.

Acromegaly↗
PubMed2000

Proximal median neuropathy secondary to humeral neck fracture.

Median neuropathies proximal to the wrist are uncommon and usually result from penetrating injuries, fracture dislocation of the distal humerus, or compression by fibrous bands. A 66-year-old man suffered a comminuted fracture of the proximal humerus after a fall. Electrodiagnostic studies revealed a severe proximal median neuropathy and a mild distal radial mononeuropathy. Proximal median neuropathy rarely occurs in humeral neck fracture, mostly because the median nerve is not in close contact with the humerus proximally.

Accidental Falls↗
PubMed1992

Proximal median neuropathies: electromyographic and clinical correlation.

Results of electrophysiologic and clinical findings in 17 patients with proximal median neuropathy were reviewed. The cause of neuropathy was trauma in 5 patients, overuse of the pronator teres in 3 patients, postinfectious in 2 patients, secondary to a congenital lesion in 1 patient, and undetermined in 6 patients. The neuropathy involved the main branch of the median nerve at or proximal to the pronator teres muscle (high median neuropathy) in 14 patients, and the anterior interosseous portion of the nerve in 3 patients. Electrophysiologic findings, especially needle electromyography (EMG), were more definitive than findings expected from clinical examinations. EMG and operative findings demonstrated that median nerve compression by the pronator teres produces denervation of this muscle as well as distal muscles. EMG cannot differentiate a median nerve lesion at the pronator teres from a more proximal lesion. Follow-up data were available in 7 of 10 nonsurgically managed patients, and in 6 of 7 patients with surgical decompression. Six patients in each group were either improved or normal.

Adult↗
PubMed2006

Pediatric median neuropathy due to pruritus in Alagille syndrome.

Median entrapment neuropathy or carpal tunnel syndrome is uncommon in children. The majority of cases are related to genetic conditions which result in skeletal dysplasia or altered connective tissue characteristics, direct injury to the median nerve caused by intensive sports or trauma, or hereditary neuropathy with liability to pressure palsies. This report describes a 10-year-old patient with Alagille syndrome who presented with poor fine motor skills because of an entrapment neuropathy of the median nerve at the wrist. This condition was probably caused by intermittent external compression at the wrists due to years of rubbing both wrists and hands to relieve pruritus. To our knowledge, median neuropathy has never been associated with Alagille syndrome, although severe pruritus is considered a major symptom and many patients exhibit widespread scratching and rubbing.

Alagille Syndrome↗
PubMed2000

Bilateral median neuropathy and growth hormone use: a case report.

A male elite bodybuilder suffered bilateral median nerve neuropathy during a self-administered course of growth hormone (GH). Nerve conduction velocities revealed bilateral median neuropathy consistent with carpal tunnel syndrome (CTS). This is the first case of GH-induced CTS occurring in an athlete. Contrary to earlier studies, this report demonstrates that GH-induced CTS is not an age-related phenomenon and alerts physicians to include GH abuse as a possible etiology of median neuropathy in athletes.

Adult↗
PubMed1995

Delayed high median neuropathy after supracondylar humeral fracture. A case report and review of the literature.

Compression neuropathy of the median nerve around the elbow is an uncommon yet well-recognized clinical entity. Acute compression can occur after trauma to the elbow, whereas prolonged compression neuropathy usually involves compression under a normal or aberrant anatomic structure. The authors present a case of severe median nerve compression neuropathy above the elbow that occurred several months after a supracondylar humeral fracture in a previously asymptomatic adolescent with aberrant soft tissue anatomy.

Child↗
PubMed1998

Electrodiagnostic reports of median neuropathy at the wrist.

The diagnosis of carpal tunnel syndrome (CTS) is confirmed by electrodiagnostic testing. Practice parameters for electrodiagnostic testing of CTS have been defined in a summary statement published by the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. All members of the Industrial Injuries and Prevention Committee of the American Society for Surgery of the Hand provided electrodiagnostic reports from their office practices indicating an electrodiagnosis of CTS or median neuropathy at the wrist. One hundred consecutive reports were analyzed to determine how often these electrodiagnostic studies adhered to the standards and guidelines of the summary statement. Variability in the thoroughness of the studies, hence in the quality of information in the reports, was noted. The clinical implications of this survey are that some patients were diagnosed and treated for CTS who did not have median neuropathy at the wrist.

Carpal Tunnel Syndrome↗
PubMed2003

A Bayesian argument against rigid cut-offs in electrodiagnosis of median neuropathy at the wrist.

BACKGROUND: Nerve conduction (NC) tests, using rigid cut-offs separating normal from abnormal test values, are commonly used to confirm median neuropathy at the wrist (MNW). The authors studied patients with clinically defined mild MNW and a normal median distal motor latency to determine 1) how much sensory or mixed NC test results increase (or decrease) the probability of MNW and 2) the NC test values required to confirm (or exclude) MNW for the range of pretest probabilities of MNW. METHODS: Palmar, digit 4 (D4), and digit 2 (D2) median NC tests were reviewed in 125 hands with mild carpal tunnel syndrome (CTS) and 100 control hands with musculoskeletal pain. Receiver operating characteristic curves and interval likelihood ratios were plotted for the three tests. Using Bayes theorem, post-test probability of MNW was then determined for the range of pretest probabilities and NC test values. RESULTS: Receiver operating characteristic curves showed that for a set specificity of 97%, palmar and D4 studies had higher electrodiagnostic utility than D2 studies with cut-off test values (sensitivities of 0.3 msec, 64.0%; 0.4 msec, 71.2%; and 50 m/sec, 44.8%). However, Bayesian analysis showed that to confirm MNW more conservative cut-off values (palmar 0.5 msec, D4 0.7 msec, D2 44 m/sec) were required for pretest probabilities or=75%. Conversely, normal test values could exclude MNW only for pretest probabilities <25%. CONCLUSIONS: For a given NC test value, post-test probability of MNW can be determined from the estimated pretest probability (derived from clinical data), interval likelihood ratios, and Bayes theorem. Use of rigid cut-off values to confirm MNW is problematic, because more conservative cut-offs are required for low pretest probability. Conversely, NC tests with sensitivity <95% cannot exclude MNW when pretest probability is high.

Adolescent↗
PubMed1994

Acute median neuropathy after wrist trauma. The role of emergent carpal tunnel release.

Ten cases of acute carpal tunnel syndrome (ACTS) and six cases of nerve contusion were identified in patients with acute median neuropathy associated with blunt wrist trauma. The patients with ACTS initially had normal sensation and subsequently developed objective sensory loss (2-point discrimination greater than 15 mm) in the median nerve distribution associated with severe wrist pain. Patients with nerve contusion injuries had immediate sensory loss and symptoms were nonprogressive. Wick catheter measurements of the carpal canal pressure were used in seven patients to help distinguish ACTS (pressure greater than 40 mm Hg) from nerve contusion. The interstitial carpal tunnel pressure was elevated an average of 52 mm Hg in four of five patients with ACTS but was normal in two patients with nerve contusion. Four of five patients who underwent carpal tunnel release within 40 hours of the onset of numbness had normal 2-point discrimination within 96 hours. The results of this study and review of the literature reflect the urgency of carpal tunnel release in ACTS. Neuropathy, secondary to nerve contusion without coexisting ACTS, may be treated initially by observation. Acute carpal tunnel syndrome must be distinguished from nerve contusion as a cause of acute posttraumatic median neuropathy.

Acute Disease↗
PubMed2000

Median neuropathy at the wrist: diagnostic utility of clinical findings and an automated electrodiagnostic device.

Clinical findings have limited value in predicting electrophysiologically confirmed median neuropathy at the wrist (MNW). To determine the value of clinical findings and an automated electrophysiologic neurodiagnostic device (AEND) in diagnosing MNW, we studied two groups of 75 consecutive patients (an initial group and a validation group, 150 total) referred to an academic electrophysiology laboratory for upper extremity complaints. The definitive standard for MNW was the neurologist's diagnosis after formal clinical and electrodiagnostic evaluation. The neurologist was blinded to the results of the AEND (NC-Stat, NeuroMetrix, Inc). In the validation group, the AEND yielded a distal motor latency (DML) in 97% of hands with a conventional motor response, and the correlation of the AEND DML with the conventional DML was 0.94 (P < 0.001). Of 248 symptomatic hands, the neurologist diagnosed 117 (47%) with MNW. At 90% specificity, the AEND DML had a sensitivity of 86% for MNW. Age, body mass index, sensory symptoms in digits 1 to 3, and nocturnal awakening were independent clinical predictors of MNW. Each 1-msec increase in the adjusted AEND DML was independently associated with an OR of 298 (95% confidence interval, 40 to 2233) for MNW. Each 1-msec increase in the F-wave latency was independently associated with an OR of 2.6 (95% confidence interval, 1.3 to 4.9) for MNW. Compared with a model based solely on clinical variables, an algorithm including symptom variables plus the AEND DML had an odds ratio for correct diagnostic classification of 6.3 (95% confidence interval, 3.8 to 12.3). The sensitivity at 90% specificity improved from 40% for the clinical model to 86% for the model with DML. A practical method for integrating clinical and electrophysiologic findings to assess the risk of MNW was proposed. This method correctly stratified 79% of control and MNW patients into very low- and high-risk groups, respectively. We concluded that MNW diagnosis is significantly improved with an AEND.

Adult↗
PubMed2003

Somatosensory evoked potentials for the diagnosis of proximal sensory median neuropathy with preserved distal sensory action potential.

A 33 year-old-man with paresthesia in first three fingers of the right hand after minor trauma of the arm was examined electrophysiologically. The proximal sensory median neuropathy was isolated which it is unusual in traumatic lesion. Motor and distal sensory conduction studies were normal but sensory evoked potentials (SEPs) were abnormal by right median nerve stimulation at the wrist level with decrease in amplitude of peripheral potential at the Erb's point, the cervical and contralateral parietal levels. This pattern, preserved distal sensory action potential and abnormal peripheral SEPs were suggesting the presence of proximal sensory block conduction without wallerian degeneration. The recovery was complete and fast in correlation with the absence of axonopathy.

Action Potentials↗
PubMedDate not supplied

Acute median neuropathy following physeal fractures of the distal radius.

Displaced distal physeal fractures of the radius are at risk for development of median neuropathy. The mechanism of injury includes compression of the nerve by the displaced fracture, contusion of the nerve at the time of fracture or reduction, or the development of a compartment syndrome. Patients with significant soft-tissue swelling and symptoms or signs of median nerve dysfunction are especially at risk for worsening neuropathy after closed reduction and closely applied cast immobilization or after open reduction. Closed reduction and percutaneous pin fixation may be the optimal treatment for these patients.

Acute Disease↗
PubMedDate not supplied

Sensory and mixed nerve action potential temporal dispersion in median neuropathy at the wrist.

This retrospective pilot study was undertaken to help determine the usefulness of measuring sensory nerve action potential and mixed nerve action potential temporal dispersion in median neuropathy at the wrist (MNW; i.e., carpal tunnel syndrome). The records were reviewed for 34 patients who were referred to an electrodiagnostic medicine laboratory with normal antidromic median sensory nerve action potential (recording from the index finger), median transcarpal mixed nerve action potential, and ulnar transcarpal mixed nerve action potential peak distal latencies (NO group) and 29 patients with prolongation (>2.2 ms) of the left median transcarpal mixed nerve action potential peak distal latency or relative prolongation of this response (>0.4 ms) compared with the ipsilateral normal ulnar transcarpal mixed nerve action potential peak distal latency (MNW group). By using the time difference between onset and negative peak as a measure of waveform temporal dispersion, mean +/- standard deviation of the median transcarpal mixed nerve action potential time difference for the MNW group (0.57 +/- 0.15 ms) was found to be greater than the NO group (0.44 +/- 0.09 ms; P < 0.01). No statistically significant differences were found for the median sensory nerve action potential time difference between the two groups or between the subgroup of MNW patients with concurrent prolongation of the median sensory nerve action potential peak distal latency and the NO group. These findings suggest that increased median transcarpal mixed nerve action potential temporal dispersion may occur in association with median transcarpal mixed nerve action potential peak distal latency prolongation in MNW. The small magnitude of this increase, however, makes the clinical usefulness of this observation unclear.

Action Potentials↗
PubMed1994

Proximal median neuropathy and cervical radiculopathy: double crush revisited.

"Double crush" refers to the hypothesis that a single lesion along the course of a nerve predisposes that nerve to a second lesion further along its course. The reason for this is uncertain and indeed the existence of the double crush syndrome is itself debated. We present two cases of proximal median neuropathy (PMN) associated with cervical radiculopathy which we diagnosed in our EMG laboratory over a short period of time. Seeing these cases in relative rapid succession and considering the extreme rarity of PMN, its association in both cases with cervical root disease supports the notion that the cervical radiculopathy may have predisposed the nerve to a second lesion along its course, resulting in the so called double crush syndrome, and that this syndrome may therefore be a true entity.

Aged↗
PubMed1983

Papular mucinosis, destructive arthropathy, median neuropathy, and sicca complex.

A patient with papular mucinosis (scleromyxedema) developed an erosive seronegative rheumatoid-like arthropathy, carpal tunnel syndrome, sicca complex, and marked increase in TG(OKT8) suppressor/cytotoxic circulating T-cells akin to that reported in scleroderma. Sclerodactyly, acrolysis and stiff digits were striking but other features of scleroderma, i.e., Raynaud's and esophageal hypoperistalsis, were absent. The diagnosis of papular mucinosis, a pseudoscleroderma syndrome, should be considered in a patient with atypical arthritis, median neuropathy, myopathy, and/or sclerodactyly and a papular lichenoid dermatopathy. Skin mucin stain and the demonstration of the distinct serum paraprotein (PM-spike) are confirmatory. We stress the salient diagnostic clinical features of the leonine-like facies of papular mucinosis.

Autoimmune Diseases↗