Skip to Main Content

++

CONDITION/DISORDER SYNONYMS

++

  • Ape-hand deformity

  • Median nerve palsy

++

ICD-9-CM CODES

++

  • 354.1 Other lesion of median nerve

  • 955.1 Injury to median nerve

++

ICD-10-CM CODES

++

  • G56.10 Other lesions of median nerve, unspecified upper limb

  • S44.10XA Injury of median nerve at upper arm level, unspecified arm, initial encounter

  • S54.10XA Injury of median nerve at forearm level, unspecified arm, initial encounter

  • S64.10XA Injury of median nerve at wrist and hand level of unspecified arm, initial encounter

++

PREFERRED PRACTICE PATTERNS

++

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury2

++

PATIENT PRESENTATION

Patient is a 44-year-old male who works in a new home construction. He spends the majority of his day using power tools, such as a drill and nail gun, in various positions of the elbow and forearm. After a long period of part time work he has returned to work 60+ hours/week and spent the interim lifting weights. Over the past 2 weeks, he has begun to notice a burning/achy pain at his volar/medial forearm. This pain is exacerbated while at work and seems to get worse throughout the day, especially with usage of hand power tools. He also reports a painful tingling that radiates all the way to his thumb and first two fingers when he is really symptomatic. Functionally, he reports that he feels as if his hand fatigues quickly at work.

Clinically, he is a mesomorphic male with hyperalgesia reported across median nerve distribution of hand (thenar eminence, volar surface and tips of digits I, II, and radial side of III. No weakness of pronator teres but overall grip strength is decreased 20 lb on the affected side. Forearm pain is aggravated by sustained forearm pronation, especially with elbow extension. Palpable tenderness deep in the pronator teres with positive pronator compression test and median nerve neurodynamic testing.

++

KEY FEATURES

++
Description
++

  • Entrapment neuropathy of the median nerve other than within the carpal tunnel of the wrist3,4

  • Common entrapment sites include; ligament of Struthers, bicipital aponeurosis, and pronator teres (all generically called pronator syndrome—PN), fibrous arch of flexor digitorum superficialis (anterior interosseous syndrome—AINS)

  • Signs and symptoms typical of neuropathy, includes:

    • Pain

    • Paresthesias

    • Loss of sensation

    • Later loss of muscle function

  • Symptoms are seen in the distribution of the median nerve in the hand3, distal upper arm, and volar forearm

++
Essentials of Diagnosis
++

  • Pain, paresthesias, and sensory loss perceived on radial side of the palm and the palmar side of thumb, index, middle, and radial side of the ring fingers (no sensory loss if AINS)

  • Pain may radiate up to the elbow, shoulder, neck

  • In advanced cases, motor dysfunction ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.