Median Nerve Exam

Look

 

Palm up

- Pointing index finger (Bennett's / AIN)

- Wasting thenar eminence

- wasted forearm muscles

- volar scarring

 

Thumb up

- wasting thenar eminence

- radial border wrist

 

Palm down

 

Palms together

- LF

- Axilla scars

 

Feel

 

Sensation

 

Lateral forearm - LCNF / lateral cord / C6

 

Thenar eminence - Palmar Branch Median Nerve / C6

 

IF - C6 Median nerve

 

MF - C7 Median nerve

 

LF - C8 Ulna nerve

 

Median Forearm - MFCN / medial cord / T1

 

Is sensation loss peripheral / dermatomal?

 

Move

 

Median nerve

 

PT (C6)

- first branch 

- test with elbow flexed

 

FCR (C6)

- flex wrist & palpate

 

FDS(C8) 

 

PL (C8)

 

AIN 

 

FDP IF/MF (C8) 

- make fist & resists IF extension

 

FPL (C8) 

- resists extension of IPJ

 

PQ (C8) 

- test with elbow extended (eliminate PT)

 

Motor Recurrent Branch (T1)

 

AbPB 

- patient abduct thumb away from palm against resistance

- palpate muscle belly

 

1st Lumbrical

- Lateral Digital Branch

- thumb to IF pad to pad

 

2nd Lumbrical 

- Medial Digital Branch

- thumb to MF pad to pad

 

Lumbricals

- extend DIPJ

- if not functioning --> unable to pulp to pulp

- will only be able to bring tip to tip

- because unable to extend DIPJ

 

Special Tests

 

Tinel's 

- start distal & move proximally

 

Phalen's 

- 60 second patient holds wrist flexed

 

Allen's test

- if considering CTD

 

C-spine examination

 

DDx

 

CTS

- normal sensation thenar eminence and forearm

 

AIN palsy

- no sensory deficit

- weak FPL / FDP / PQ

 

Pronator syndrome

- Pain only

 

C6

- weak wrist extensors

- decreased sensation medial forearm

 

TOS

- C8 / T1

- weak thenar eminence

- abnormal sensation medial forearm and LF

 

Brachial Plexus

 

Compression syndromes

 

Pronator Syndrome 

- ligament of struthers

- lacertus fibrosis

- pronator teres

- FDS

 

AIN Syndrome

- pronator teres

- FDS

- aberrant muscles or blood vessels

- trauma

 

CTS 

- palmar branch is not involved