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