Clinical signs and treatment of palsy of median, ulnar and radial nerves
1. Big picture
The median, ulnar, and radial nerves are the three major peripheral nerves of the upper limb. Their lesions are very exam-relevant because each gives a characteristic hand posture, movement deficit, sensory loss, and named sign.
The fastest way to recognize them:
| Nerve | Classic deficit | Classic hand sign |
|---|---|---|
| Median nerve | Loss of thumb opposition, thenar weakness | Ape hand / benediction sign |
| Ulnar nerve | Interossei weakness, finger abduction/adduction weakness | Claw hand, Froment sign |
| Radial nerve | Wrist and finger extension weakness | Wrist drop / Saturday night palsy |
The exam danger is confusing a single nerve lesion with a root lesion, brachial plexus lesion, or central pyramidal lesion. Peripheral nerve palsies cause lower motor neuron signs in the territory of that nerve: weakness, atrophy, reduced local reflexes if the reflex arc is involved, and sensory loss in the nerve distribution.
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