Lab 4 - Module 2 - The Hand: Page 1 of 12

READINGS:

Gray's Anatomy for Students (Fourth Edition): Pages: 782-809

CASE REPORT:

56 y/o female who presents with a chief complaint of numbness and tingling in the right thumb, index, and middle finger. It is worse at night, worse with holding a book or newspaper, and it wakes her up at night. She has tried splints at night with only mild benefit. Her symptoms have persisted for two years but have gotten worse over the past 6 months. She had a prior corticosteroid injection 5 months ago that gave her complete relief for 3 months, but her symptoms have returned.

EXAMINATION:

On physical exam her neck has no issues. Her wrist and elbow motion are normal and symmetrical. She has diminished sensory in the median nerve distribution with the exception of an area over the proximal middle palm. Ulnar nerve sensory is normal bilaterally. Positive Tinel’s on the right but not left and a positive Phalen’s maneuver on the right. No intrinsic atrophy, specifically no thenar atrophy

	Based on the case report, what nerve is involved?
The median nerve.

	Where do you suspect the nerve to be entrapped?
Explain why you think it is entrapped at the wrist OR proximal to the wrist.