|A 69-year-old woman visits the outpatient clinic with a complaint of numbness and tingling of her hand for the past 3 months. Physical examination reveals she has numbness and pain in the lateral three digits of her right hand that are relieved by vigorous shaking of the wrist. In addition, the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles are weakened. Sensation was decreased over the lateral palm and the volar aspect of the first three digits. Which of the following nerves is most likely compressed?
|A 69-year-old woman visits the outpatient clinic with a complaint of numbness and tingling of her hand for the past 3 months. Physical examination reveals she has numbness and pain in the lateral three digits of her right hand that are relieved by vigorous shaking of the wrist. In addition, the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles are weakened. Sensation was decreased over the lateral palm and the volar aspect of the first three digits. Which of the following nerves is most likely compressed?
π‘ Explanation
**Core Concept**
The patient is presenting with symptoms of nerve compression, specifically affecting the lateral three digits of her right hand. This is likely due to compression of a nerve that supplies the affected muscles and skin areas.
**Why the Correct Answer is Right**
The patient's symptoms are characteristic of median nerve compression, also known as carpal tunnel syndrome. The median nerve runs through the carpal tunnel in the wrist, and compression of this nerve can cause numbness, tingling, and pain in the lateral three digits of the hand. The affected muscles, including the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles, are also innervated by the median nerve. The relief of symptoms with vigorous shaking of the wrist is due to the temporary reduction in pressure on the median nerve.
**Why Each Wrong Option is Incorrect**
**Option A:** The ulnar nerve is responsible for innervating the interosseous muscles and the medial two-thirds of the flexor digitorum profundus muscle, but it does not affect the lateral three digits or the affected muscles in this patient.
**Option B:** The radial nerve is responsible for wrist extension and innervates the extensor muscles of the forearm and hand, but it does not affect the lateral three digits or the affected muscles in this patient.
**Option C:** The musculocutaneous nerve is responsible for innervating the biceps brachii, brachialis, and coracobrachialis muscles, but it does not affect the lateral three digits or the affected muscles in this patient.
**Clinical Pearl / High-Yield Fact**
Carpal tunnel syndrome is a common condition that can be caused by repetitive motion, trauma, or other factors that increase pressure on the median nerve. A key clinical finding is the presence of Tinel's sign, which is a tingling sensation elicited by tapping over the median nerve at the wrist.
**Correct Answer:** C. The median nerve.
β Correct Answer: D. Median
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