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SCIENTIFIC ARTICLE Common Mononeuropathies E. Wayne Massey, M.D. • A brief guide to the causes and cures of most common mononeuropathies. Most mononeuropathies seen by physicians are ''nontraumatic" in origin and due to nerve entrapment at various articulation points. Median Nerve (Plate I) I. Signs and Symptoms The most common chronic mononeuropathy is the carpal tunnel syndrome (CTS). This very common neuropathy begins with intermittent numbness and tingling in the fingers, usually worse at night or when using the affected hand. The syndrome is more common in the dominant hand and symptoms are accentuated by writing, knitting, driving, bowling or similar exercise of the right hand. The diagnosis of entrapment at the wrist is often obscured by the wide distribution of pain to points distant from the site of the lesion: aching in the forearm or even shoulder which may exceed the severity of local hand symptoms. The patient loses agility and strength in the intrinsic hand muscles supplied by the distal branch of the median nerve (first and second lumbricals, abductor pollicis brevis, opponens pollicis, and the superficial belly of the flexor pollicis brevis) resuhing in inability to use the hand for such tasks as opening jars or bottles. Sensory symptoms may confuse the physician because they may not be localized only to the classical median side of the hands. This may be because of the patient's inaccurate reporting, because of the sensory overlap of peripheral nerves, or because of variation in the dermatomal distribution in the median nerve. Signs of the CTS may be subtle and only detected when the physician has a high degree of suspicion. Atrophy and weakness of the lateral thenar muscles may be signs of motor denervation (figure 1). The hand may appear bruised and have decreased autonomic function, particularly sweating. There may be decreased pain and touch perception in the first three digits and the radial surface of the fourth digit. Tinel's sign, radiation of paresthesias distally in the distribution of the median nerve with percussion over the flexor retinaculum at the wrists, and Phalen's sign, reproduction of paresthesias in the distribution of the median nerve with forced flexion of both wrists, may be helpful in diagnosis. From the Division of Neurology, Department of Medicine. Duke University Medical Center, Durham 27710. Pronator teres Flexor digitorum 6ubllmi6...... Flexor pollicis longus..... Flexor digitorum proFundus- Pronator Cjuadratus-., Abductor pollicis bj^i Opponens pollicis Superfic. headofj, flexor polUcisS . ^ brevis / lst&2nd^ U lumbricals Plate L Median Nerve Supply 2. Diagnostic Procedures Nerve conduction studies demonstrating normal conduction velocities but a delay in either motor or sensory latency (or both) confirm the diagnosis of CTS at the wrist. Electromyography may demonstrate high voltage polyphasic motor units, which are the signs of chronic denervation, and fibrillations, a sign of acute denervation. In early CTS, however, the only abnormality on an electromyogram may be a diminished number of recruitable motor units. 3. Etiologies The underlying processes responsible for CTS may include compression of the median nerve due to swelling in January 1985, NCMJ 16
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1985 |
Identifier | NCHH-17-046 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 46 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-046.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-046 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 7 (image) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1985 |
Identifier | NCHH-17-046-0015 |
Form General | Periodicals |
Page Type | all; all images; diagram; article; article title |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed461985medi1_0015.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 46 |
Issue Number | 1 |
Page Number | 7 |
Health Discipline | Medicine |
Full Text | SCIENTIFIC ARTICLE Common Mononeuropathies E. Wayne Massey, M.D. • A brief guide to the causes and cures of most common mononeuropathies. Most mononeuropathies seen by physicians are ''nontraumatic" in origin and due to nerve entrapment at various articulation points. Median Nerve (Plate I) I. Signs and Symptoms The most common chronic mononeuropathy is the carpal tunnel syndrome (CTS). This very common neuropathy begins with intermittent numbness and tingling in the fingers, usually worse at night or when using the affected hand. The syndrome is more common in the dominant hand and symptoms are accentuated by writing, knitting, driving, bowling or similar exercise of the right hand. The diagnosis of entrapment at the wrist is often obscured by the wide distribution of pain to points distant from the site of the lesion: aching in the forearm or even shoulder which may exceed the severity of local hand symptoms. The patient loses agility and strength in the intrinsic hand muscles supplied by the distal branch of the median nerve (first and second lumbricals, abductor pollicis brevis, opponens pollicis, and the superficial belly of the flexor pollicis brevis) resuhing in inability to use the hand for such tasks as opening jars or bottles. Sensory symptoms may confuse the physician because they may not be localized only to the classical median side of the hands. This may be because of the patient's inaccurate reporting, because of the sensory overlap of peripheral nerves, or because of variation in the dermatomal distribution in the median nerve. Signs of the CTS may be subtle and only detected when the physician has a high degree of suspicion. Atrophy and weakness of the lateral thenar muscles may be signs of motor denervation (figure 1). The hand may appear bruised and have decreased autonomic function, particularly sweating. There may be decreased pain and touch perception in the first three digits and the radial surface of the fourth digit. Tinel's sign, radiation of paresthesias distally in the distribution of the median nerve with percussion over the flexor retinaculum at the wrists, and Phalen's sign, reproduction of paresthesias in the distribution of the median nerve with forced flexion of both wrists, may be helpful in diagnosis. From the Division of Neurology, Department of Medicine. Duke University Medical Center, Durham 27710. Pronator teres Flexor digitorum 6ubllmi6...... Flexor pollicis longus..... Flexor digitorum proFundus- Pronator Cjuadratus-., Abductor pollicis bj^i Opponens pollicis Superfic. headofj, flexor polUcisS . ^ brevis / lst&2nd^ U lumbricals Plate L Median Nerve Supply 2. Diagnostic Procedures Nerve conduction studies demonstrating normal conduction velocities but a delay in either motor or sensory latency (or both) confirm the diagnosis of CTS at the wrist. Electromyography may demonstrate high voltage polyphasic motor units, which are the signs of chronic denervation, and fibrillations, a sign of acute denervation. In early CTS, however, the only abnormality on an electromyogram may be a diminished number of recruitable motor units. 3. Etiologies The underlying processes responsible for CTS may include compression of the median nerve due to swelling in January 1985, NCMJ 16 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-046.pdf |
Document Sort | all; nchh-17 |
Article Title | Common Mononeuropathies |
Article Author | E. Wayne Massey |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-046 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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