Dr. Mark E. Pruzansky
Dr. Jason S. Pruzansky
975 Park Avenue New York, NY 10028

Lower Median Nerve Palsy

What is Lower Median Nerve Palsy?

Lower Median Nerve Palsy is a general term that refers to nerve injuries of the wrist that are most commonly caused by untreated compression conditions, such as Carpal Tunnel Syndrome.

However, blunt and open trauma to the wrist, as well as occupational exposure to high-powered vibrating tools, may also result in this dysfunction.

The median nerve controls forearm muscles associated with lateral deviation of the wrist, flexion of distal phalanx of the fingers, and flexion and rotation of the hand at the wrist, thumb movements and sensation in the hand.

Signs and Symptoms of Lower Median Nerve Palsy

Symptoms may include weakness and limited motion in the thumb as well as a loss of feeling in the lateral palm and thumb, index, middle and half of the ring finger. The signs and symptoms of this condition will vary depending on the nature and severity of the nerve injury. Pain may be intermittent or consistent or not at all.

The most commonly reported signs and symptoms of lower median nerve palsy include:

  • Inability to abduct and oppose thumb (also called “ape-hand deformity”)
  • Sensory loss or tingling in thumb and digits and radial aspect of ring fingers
  • Weakened forearm pronation
  • Weakened finger flexion

Causes of Lower Median Nerve Palsy

Lower median nerve palsy may be caused by a variety of by penetrating injuries to the wrist, forearm, or arm. It may also be an injury resulting from chronic overuse, neuropathy, or blunt force trauma.

Injury to the lower median nerve may be a result of chronic overuse from repetitive banging or it is more often the result of a genetic predisposition that can become symptomatic at any age. Certain conditions like diabetes and hypothyroidism may also aggravate conditions like carpal tunnel syndrome.

Injuries Associated with Lower Median Nerve Palsy

Nerve damage can be caused by excess pressure, stretching, or acute injuries such as cuts or blunt force trauma. Carpal tunnel syndrome is symptomatic of excess pressure being placed on the median nerve in the hand, usually from swollen digital flexor tendons.

Anterior interosseous nerve syndrome must be considered as another source of hand and wrist weakness.

Treatment Options for Lower Median Nerve Palsy

Lower Median Nerve Palsy is generally treated initially with occupational therapy and intermittent splinting because many cases resolve partially or completely on their own. However, surgical intervention may be required in the event that an injury or condition does not respond to conservative measures.

Conservative Treatments

There are many ways to treat injuries to the lower median nerve depending on the nature and severity of the injury. An occupational therapist is used to improve mobility, flexibility, ergonomics and range of motion.

Patients may also be introduced to therapeutic exercises include stretching and strengthening to regain range of motion while strengthening the muscles of the forearm. NSAIDs or a cortisone injection may offer temporary relief of symptoms, not cure, in addition to immobilization.

Surgical Treatments

In severe or recurrent conditions, surgical intervention may be required. Most commonly, surgical intervention involves removing the source of nerve compression. Sometimes, Opponensplasty Surgery—the transfer of a tendon and muscle to the thumb from the ring finger—may be indicated in chronic cases with irreversible muscle atrophy and weakness.

Patients experiencing ongoing pain to the wrist area following physical activity, rest, or sports activity should seek medical supervision at once to try to avoid an injury from progressing to debilitating stages.

Prognosis for Lower Median Nerve Palsy

By following an appropriate treatment plan patients will generally return to the activities they love to do. Patients should maintain regular contact with an experienced hand surgeon and occupational therapist in order to achieve optimal wellness and clearance for routine or sports activity.

If You Believe You Have Lower Median Nerve Palsy, Contact HandSport Surgery Institute

Please contact us as soon as possible to schedule an appointment with our talented team. People experiencing Lower Median Nerve Palsy should be evaluated to try and prevent further injury and mobility issues. If you have some of these symptoms, it’s important to be evaluated by a highly skilled professional.

Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.