Chapter 2 - John Walker: A 30-Year-Old Male With Pain, Numbness, Weakness, and Paresthesias, Radiating Into the Thumb, Index and Middle Fingers

Abstract

Median nerve entrapment at the wrist is one of the most common entrapment neuropathies encountered in clinical practice. Causes include compression of the median nerve by an aponeurotic band that runs from the medial epicondyle of the humerus to the medial border of the olecranon, direct trauma to the median nerve at the wrist, and repetitive wrist motion. Median nerve entrapment at the wrist is also called tardy median palsy, cubital tunnel syndrome, and median nerve neuritis. This entrapment neuropathy manifests as pain and associated paresthesias in the lateral forearm that radiate to the wrist and to the ring and little fingers. Some patients also notice pain referred to the medial aspect of the scapula on the affected side. Untreated, median nerve entrapment at the wrist can result in a progressive motor deficit and, ultimately, flexion contracture of the affected fingers. Symptoms usually begin after repetitive wrist motion or repeated pressure on the wrist, such as leaning on the wrist while lying on the floor. Direct trauma to the median nerve as it enters the cubital tunnel may result in a similar clinical presentation. Patients vulnerable to nerve syndromes, such as diabetic and alcoholic patients, are at greater risk for the development of median nerve entrapment at the wrist.