A man was seen by a doctor and had the following symptoms: 1) Inability of movin

Question

A man was seen by a doctor and had the following symptoms:

1) Inability of moving the fingers of the right hand. More specifically, there was tingling and numbness of the thumb, 2nd, and 3rd fingers. There was also atrophy of the muscles of the thumb. These were the only abnormal signs and there was no paralysis.

2) There was loss of pain and temperature along both upper limbs. This region went from the shoulders to the base of the neck and extended to the upper part of the thorax. There were no abnormalities and her reflexes were normal.

Now here's the question:

For each symptom, which structures could most likely be involved? What are the possible levels of involvement?

Explanation / Answer

1) Median Nerve Compression. The median nerve supplies motor innervation to the 1st and 2nd lumbrical muscles. It also innervates the skin lateral 3.5 digits (i.e. thumb, pointer, middle, and half of ring), as well as the thenar eminence (i.e. muscles of the thumb). Injury to the median nerve can result in something called "ape hand". Contrary to what bruinfan says, the radial nerve does not innervate the palmar side of the hand. It innervates part of the dorsal side along with the ulnar n. 2) I'm not completely sure, but I would guess that there is injury to the lateral spinothalmic tract. The lateral spinothalmic tract is a bundle of sensory axons ascending through the white matter of the spinal cord, carrying sensory information to the brain. It carries pain and temperature sensory information to the thalamus of the brain. But again I'm not completely sure.

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