A 69-year-old man has numbness in the middle three digits of his right hand and finds it difficult to grasp objects with that hand. He states that he retired 9 years earlier, after working as a carpenter for 50 years. He has atrophy of the thenar eminence. Which of the following conditions is the most likely cause of the problems in his hand?
(a) Source: GAS 764, 788; GA 406 The median nerve supplies sensory innervation to the thumb, index, and middle fingers and also to the lateral half of the ring finger. The median nerve also provides motor innervation to muscles of the thenar eminence. Compression of the median nerve in the carpal tunnel explains these deficits in conjunction with normal functioning of the flexor compartment of the forearm because these muscles are innervated by the median nerve proximal to the carpal tunnel. The ulnar nerve is not implicated in these symptoms. It does not provide sensation to digits 1 to 3. Compression of the brachial plexus could not be attributed to pressure from the triceps because this muscle is located distal to the plexus. In addition, brachial plexus symptoms would include other upper limb deficits, rather than the focal symptoms described in this case. Osteoarthritis of the cervical spine would also lead to increasing complexity of symptoms.
Compression of the median nerve in the carpal tunnel
Formation of the osteophytes that compress the ulnar nerve at the medial epicondyle
Hypertrophy of the triceps muscle compressing the brachial plexus
Osteoarthritis of the cervical spine
Upper Extremity