|A 69-year-old woman visits the outpatient clinic with a complaint of numbness and tingling of her hand for the past 3 months. Physical examination reveals she has numbness and pain in the lateral three digits of her right hand that are relieved by vigorous shaking of the wrist. In addition, the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles are weakened. Sensation was decreased over the lateral palm and the volar aspect of the first three digits. Which of the following nerves is most likely compressed?
The median nerve provides innervation to the flexor compartment of the forearm; cutaneous innervation of the second, third, and fourth digits and palmar and dorsum aspects of the hand; and innervation of four intrinsic hand muscles: first and second lumbricals, abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis. The thenar compartment contains the muscle abductor pollicis brevis, opponens pollicis, and flexor pollicis brevis, and these muscles are innervated by the recurrent branch of the median nerve. The patient has weakening of the first two lumbricals and not simply the thenar muscles, so the median nerve is most likely to be compressed. Another indication that the median nerve is compressed is the vigorous shaking of the wrist. Because the median nerve traverses the carpal tunnel, carpal tunnel compression could lead to this action on part of the patient. The ulnar nerve provides innervation for part of the flexor digitorum profundus and flexor carpi ulnaris. These muscles are not weakened in this patient. The radial nerve provides cutaneous supply to the dorsum of the hand and forearm as well as extensor muscles of the forearm. The posterior interosseous nerve is a branch of the radial nerve and provides innervation of the extensor muscles in the forearm.
Ulnar
Radial
Recurrent median
Median
Upper Extremity