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  • Ape hand deformity

  • Median nerve palsy

  • Median nerve compression

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ICD-9-CM Codes

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  • 354.1 Other lesion of median nerve

  • 955.1 Injury to median nerve

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ICD-10-CM Codes

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  • 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

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Preferred Practice Patterns

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Key Features

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Description

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  • 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, including

    • - 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.

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Essentials of Diagnosis

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  • 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 in thenar muscles may occur, characterized by weakness, atrophy, loss of coordination

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General Considerations

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  • In entrapment neuropathy, nerve becomes compressed, causing ischemic damage to the nerve

  • Often associated with repetitive motions or sustained position of the elbow

  • Unrelieved compression of the nerve results in neurapraxia with segmental demyelination;6 further ischemic damage results in axonotmesis and wallerian degeneration5,6

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Demographics

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  • 4 times more common in women (PS)7

  • AINS is rare, accounting for less than 1% of upper extremity neuropathies7

  • Most common among people in their 5th decade of life7

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Clinical Findings

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Signs and Symptoms

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  • Ape hand deformity

  • First symptom is usually pain or paresthesias;3 most commonly with gradual onset

  • Pain at proximal volar forearm exacerbated by repetitive forearm rotation or elbow motion

  • Pain complaints include numbness (most common), tingling, burning

  • Pain is experienced in distribution of the median nerve in the hand, particularly the palm of hand over the thenar eminence, though may radiate up to elbow, shoulder, or neck

  • Tenderness to percussion or deep pressure over the pronator teres, proximal FDS, or distal volar arm above the elbow

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