Case of the day

Motor Neuropathy

Motor Neuropathy of Left Median Nerve leading to wasting of small Ms of left hand. Chief Complaints A 18 yr old complaining of weakness of lt hand for past 7 months. Initially it started with tremors followed by weakness. He is unable to grasp, adduct, abduct or hold objects or make a fist. The weakness is gradual n progressive and assymetric with wasting of thenar, hypothenar and other intrinsic ms of left hand. Wrist joint, elbow n shoulder joint movement n power are normal in b/l upper limb. No visible fasciculations. Jerks are normal. No cerebellar , sensory, cranial Nv abnormality. No significant past history or family history. O/E pt is normotensive, no H/O trauma,loc,,cva,DM,thyroid disorder, paresthesisas, Hansen disease or other causes of neuropathy. One small nodule was seen on abdomen most likely to be neurofibroma. Rest examinations are normal. No H/O neck pain etc. According to me D/D motor neuropathy,MND.. Or compressive myelopathy due to neurofibroma. Has sent pt for MRI Cervical spine and NCV and other examinations. His MRI cervical spine is normal while NCS is suggestive of Motor neuropathy of left Median nerve.

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Median nerve neuropathy. Distal median nerve dysfunction is a form of peripheral neuropathy that affects the movement of or sensation in the hands. A common type of distal median nerve dysfunction is carpal tunnel syndrome. Signs of a median nerve lesion include weak pronation of the forearm, weak flexion and radial deviation of wrist, with thenar atrophy and inability to oppose or flex the thumb; - sensory distribution includes thumb, radial 2 1/2 fingers, and the corresponding portion of palm. Splinting is considered a first-line treatment option for mild to moderate carpal tunnel. Other conservative therapies include physical therapy, yoga, and therapeutic ultrasound.

Please post the full NCV report. Carpal tunnel syndrome is not a motor neuropathy, rather it is sensory first, motor later, because the sensory fibres are peripheral and compressed initially. Anterior interosseous neuropathy (AIN) may cause only motor symptoms. The age of the patient is not conducive to CTS, too. Hirayama disease (C8 -T1 radiculopathy) is a distinct possibility in such young boy with multi focal wasting in upper limb. The dorsal interosseoi and hypothenar muscles supplied by ulnar nerve are also seen wasted along with the thenar muscles supplied by median nerve. Both these nerves originated from C8 - T1 common root in the spinal cord.

Agree with Dr Krishnendu.
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Pt must be referred to neurologist As per available details and clinical picture this is a case of Anterior horn cell disease most likely Hirayama disease Although it is self limiting condition with severe disability.. But we are doing cervical fixation to prevent further disability..!!

Sir we have taken neurological opinion from BHU and they have advised multivitamin and physiotherapy along with splinting.
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Most likely a c/o motor neuropathy bcz of compression 9f median nerve at carpel tunnel so CT SYNDROME should be considered

How can one explain atrophy of hypothenar muscles under the diagnosis of median nerve neuropathy and CTS. EMG should be done for motor neurone disease
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Neuropathy of lt median nerve Carpel tunnel syndrome Steriod effective Opinion of orthopedic Neurologist Pressure on median nerve causes wasting of muscle

Consult a expert Physiotherapist. They will suggest se strengthening and finger grasping movement. And finger exercises. Some electrotherputic modalities e.g. TENS+ULTRASOUND. shoulder and elbow exercises. CARPEL TUNNEL SYNDROME. coming pressure on median nerve.

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