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Central nervous system
Central nervous system


Distal median nerve dysfunction

Definition:

Distal median nerve dysfunction is a form of peripheral neuropathy that affects the movement of or sensation in the hands.

A common type of distal median nerve dysfunction is carpal tunnel syndrome .



Alternative Names:

Neuropathy - distal median nerve



Causes:

Dysfunction of one nerve group, such as the distal median nerve, is called a mononeuropathy . Mononeuropathy means there is a local cause of the nerve damage, although occasionally body-wide (systemic ) disorders may cause isolated nerve damage.

Distal median nerve dysfunction occurs when the nerve is inflamed, trapped, or injured by trauma. The most common reason is trapping (entrapment), which puts pressure on the nerve where it passes through a narrow area. Wrist fractures may injure the median nerve directly or may increase the risk for trapping a nerve later on.

Inflammation of the tendons (tendonitis ) or joints (arthritis ) can also cause nerve compression. Some repetitive movements increase the chance of developing carpal tunnel entrapment.

Conditions that affect connective tissue or cause deposits to form in tissue can block blood flow and lead to nerve compression. Such conditions include:

In some cases, no cause can be identified. Diabetes can make this condition worse.



Symptoms:
  • Pain in the wrist or hand that may be severe and wake you up at night, and that may be felt in other areas, such as the upper arm (this is called referred pain) 
  • Sensation changes in the thumb and pointer (index), middle, and part of the ring fingers, such as a burning feeling, decreased sensation , numbness , and tingling
  • Weakness of the hand that causes you to drop things or have difficulty grasping objects or buttoning a shirt


Exams and Tests:

Your doctor will examine your wrist and ask questions about your medical history. The examination may show decreased sensation in the thumb side of the hand. This is called the "radial" side. There may be weakness of the thumb and difficulty using it to pinch.

Tests that reveal distal median nerve dysfunction may include:

Tests are guided by the suspected cause of the nerve dysfunction, which is based on your history, symptoms, and the way symptoms developed. They may include various blood tests, x-rays, imaging scans, or other tests and procedures.



Treatment:

Treatment is aimed at correcting the underlying cause.

If the median nerve is affected by carpal tunnel syndrome, a wrist splint can reduce further injury to the nerve and help relieve symptoms. Wearing the splint at night will give the area a rest and allow inflammation to decrease. An injection into the wrist may help with symptoms, but it won't fix the underlying problem.

In some cases, no treatment is required and recovery happens on its own. Over-the-counter or prescription medication may be needed to control nerve pain (neuralgia ).

If other nerves are also affected, it is necessary to look for an underlying medical problem that can affect nerves. Medical conditions such as diabetes and kidney disease can damage nerves. In these cases, treatment is directed at the medical condition.

Physical therapy exercises may help some peoplemaintain muscle strength. Orthopedic assistance may maximize the ability to use the hand. Such therapy may involve braces, splints , or other appliances. Vocational counseling, occupational therapy, occupational changes, job retraining, or other measures may be recommended.

Some patients with carpal tunnel syndrome may need surgery. See: Carpal tunnel release



Outlook (Prognosis):

If the cause of the nerve dysfunction can be identified and successfully treated, there is a good chance of full recovery. In some cases, there may be partial or complete loss of movement or sensation. Nerve pain may be severe and persist for a prolonged period of time.



Possible Complications:
  • Deformity of the hand (rare)
  • Partial or complete loss of hand movement
  • Partial or complete loss of sensation in the fingers
  • Recurrent or unnoticed injury to the hand


When to Contact a Medical Professional:

Call your health care provider if you have symptoms of distal median nerve dysfunction. Early diagnosis and treatment increase the chance of curing or controlling symptoms.



Prevention:

Prevention varies depending on the cause. In patients with underlying diabetes, controlling blood sugar may reduce the risk of developing nerve disorders.

In occupations that require repetitive wrist movements, a change in the way the job is performed may be necessary. Frequent breaks in activity, "wrist rests" on keyboards, and other measures may reduce the risk of distal median nerve dysfunction. When possible, avoid prolonged repetitive movement of the wrist.



References:

Jarvik JG, Comstock BA, Kliot M, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomized parallel-group trial. Lancet.2009 Sep 26;374(9695):1074-81.

Katirji B, Koontz D. Disorders of peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76.




Review Date: 7/27/2014
Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Morristown Medical Center

100 Madison Avenue
Morristown, NJ 07960
973-971-5000

Overlook Medical Center

99 Beauvoir Avenue
Summit, NJ 07901
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Pompton Plains, NJ 07444
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Morristown, NJ 07960
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