Median nerve neuropathy
The median nerve stretches from the inner surface of the shoulder, passes through the region of the elbow joint, continues on the palmar surface of the forearm, innervating the round and square muscles and, crossing the carpal tunnel, ends on the palmar part of the hand. In the area of the forearm, the median nerve innervates the muscle of the anterior group of the forearm, with the help of which the fingers are bent, movement is made with the hand.
The nerve is often injured in the lower third of the forearm, since it is located there superficially. The medianus nerve is responsible for the motor and sensory ability of the muscles. It consists of fibers of the spinal nerves of the median and lower trunk of the brachial plexus. Median nerve neuropathy occurs due to a number of causes, often associated with trauma. Also, a nerve injury in the area of the carpal tunnel leads to such a disease.
Neuropathy is a pathology that occurs as a result of a fracture in the area of the hand, a bruise, or a cut. Even if the nerve itself remains intact during injury, the scars that form during wound healing can compress it, which causes the development of neuropathy. This disease develops with rheumatoid arthritis, arthrosis, diabetes mellitus. Its obvious symptoms are decreased sensitivity and muscle atrophy. Numbness in the fingers is especially noticeable at night. Patients complain not only of loss of sensitivity, but also of a decrease in the grasping power of the hand and swelling of the hand.
With neuropathy of the median nerve, the ability to move the hand is impaired, there is no function of flexion of at least three fingers. The patient fails to extend the middle phalanges of two fingers and an attempt to squeeze the hand into a fist remains unsuccessful. With neuropathy, atrophy of the base of the fingers is observed, because of this, the little finger and ring fingers are set in the same plane, the hand looks like a monkey's paw.
In the zone of innervation of the nerve, the disorder of the sensitivity of the radial region of the palm, the palmar surface of the ring and middle fingers and partially the index finger is determined. When a nerve is damaged, gross changes in trophism, secretory and vasomotor functions occur. It is also often possible that an intense persistent pain sensation (hyperpathy) and a burning sensation in the limb (causalgia) appear.
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During the diagnosis, first of all, a visual inspection of changes in the position of the hand is performed, identifying the zone on which the sensitivity is reduced.
To diagnose neuropathy of the median nerve, the Phalen test is performed, which determines the degree of numbness of the fingers and muscle atrophy. After this stage of examination, an instrumental examination is prescribed by a specialist. The electroneuromyography method allows you to observe the passage of the impulse along the nerve. This is how the level of damage is revealed. Ultrasonography and ultrasound are used.
The complete picture of the disease is shown by the method of magnetic resonance imaging, showing the type and size of the localization of this lesion. Among modern diagnostic methods used before and after surgery to confirm the dynamics of recovery, excellent results can be obtained using Doppler flowmetry.
Treatment of neuropathy of the median nerve is always successfully carried out with a timely visit to a doctor with initial symptoms. At this stage of the development of the disease, the limb is fixed in a physiological position using a splint. Effective in the early period is the intake of non-steroidal anti-inflammatory drugs, drugs that normalize the state of nerve tissue cells and promote their rapid regeneration.
Traditionally, treatment is not complete without physiotherapy. Surgical treatment is often used to release the nerve from compression by scar tissue. In the case of an advanced disease, specialists have to resort to stitching a nerve or plastic, because they already have to ascertain neurogenic contracture of the hand and irreversible changes that provoke muscle contracture.
Also, for the correction or prevention of neurogenic contractures, the limbs restore the innervation of the muscles using the method of neurotization.
The disease can occur due to many factors, each person is obliged to take their health seriously and not to start the course of the disease. Early detection of neuropathy contributes to a successful treatment outcome.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
