Median Nerve Palsy

　　Long-term excessive use of the hand and wrist can cause chronic injury, leading to chronic inflammatory changes in the transverse carpal ligament and the contained tendons, making the lumen narrow is the most common cause. The next is acute injury of the wrist, radial head fracture, and lunate dislocation can cause acute or secondary compression of the median nerve. Certain systemic diseases can cause spontaneous median nerve damage through the enlargement of the contents of the carpal tunnel.

　　In addition to its clinical manifestations, median nerve palsy can also cause other diseases. The median nerve is rich in sympathetic nerve fibers, and after injury, it is prone to develop causalgia. There may be sensory disturbances, numbness, and pain in the three radial fingers, as well as thenar atrophy.

　　1. Motor disorders are manifested by weakened or lost grip strength and pronation strength of the forearm flexors.

　　When the upper arm is injured, the muscles innervated by the median nerve are completely paralyzed, the forearm cannot be pronated, the flexion strength of the wrist is weak, the thumb, index finger, and middle finger cannot be flexed, the grip is weak, and the thumb and index finger cannot be extended. The thumb cannot be opposed and abduced, the thenar muscle atrophy, resembling an ape hand; severe damage to finger function, difficulty in holding objects, and severe hand disability.

　　When the middle or lower third of the forearm is injured, the functions of the pronator teres, flexor carpi ulnaris, and flexor digitorum muscles can still be preserved, and the motor impairment is limited to the abduction, flexion, and opposition of the thumb.

　　2. Sensory disturbances are mainly in the radial palmar aspect of the first, thumb, index, and middle fingers, the radial aspect of the little finger, and the distal aspect of the phalanx of the thumb, index, and middle fingers. The median nerve is rich in sympathetic nerve fibers, and it is prone to develop灼性神经痛 after injury.

　　3. Carpal Tunnel Syndrome: The carpal tunnel is formed by the carpal flexor retinaculum and the carpal groove, and the median nerve running through it can be compressed, leading to median nerve palsy. It can cause sensory disturbances, numbness, and pain in the three radial fingers, as well as paralysis of the thenar muscle. It is more common in middle-aged women, more common on the right side, exacerbated after labor, and relieved after rest.

　　Common causes of median nerve injury include venous extravasation from intravenous drug injection in the antebrachial area, laceration of the wrist by sharp objects, fractures of the humerus or forearm, penetrating injuries, and carpal tunnel syndrome due to compression. Efforts to remove these factors can effectively reduce or prevent the occurrence of the disease.

　　Neurology routine examination:

　　1. Motor disorders are manifested by weakened or lost grip strength and pronation strength of the forearm flexors.

　　2. Sensory disturbances are mainly in the radial palmar aspect of the first, thumb, index, and middle fingers, the radial aspect of the little finger, and the distal aspect of the phalanx of the thumb, index, and middle fingers. The median nerve is rich in sympathetic nerve fibers, and it is prone to develop灼性神经痛 after injury.

　　3. Carpal Tunnel Syndrome: The carpal tunnel is formed by the carpal flexor retinaculum and the carpal groove, and the median nerve running through it can be compressed, leading to median nerve palsy. It can cause sensory disturbances, numbness, and pain in the three radial fingers, as well as paralysis of the thenar muscle. It is more common in middle-aged women, more common on the right side, exacerbated after labor, and relieved after rest.

　　Dietary Nutrition Porridge for Nerve Palsy Patients:

　　1. Nourishing Yin and Moistening Drought Porridge: 50g Coix Seed, 9g White Peony, 20g Cloud Fuling, 6g Tangerine Peel, first cook the Coix Seed into porridge, then boil the last three ingredients in water, remove the residue, and add to the Coix Seed porridge for three or five boils. Take one dose a day, for several days in a row. The efficacy is to invigorate the spleen and transform dampness, remove phlegm and unblock meridians. It is suitable for symptoms such as facial paralysis, epigastric and abdominal distension, poor appetite, and indigestion due to spleen failure and dampness obstruction.

　　2. Wind-Relieving and Cold-Dispersing Porridge: 10g Gastrodia, 1 healthy pigeon. Boil and eat together, once a day. The efficacy is to invigorate Qi, nourish blood, calm the wind and relieve spasm. In the recipe, pigeon meat tonifies the kidneys and liver, benefits Qi and blood, Gastrodia calms the wind and relieves spasm, and together they are used to treat facial nerve palsy caused by blood deficiency and wind generation.

　　3. Dampness-Relieving and Lung-Invigorating Porridge: Coix Seed 50g, Roasted Mung Beans 15g, Hawthorn 10g, Appropriate Amounts of Brown Sugar and Glutinous Rice. Boil the mixture into porridge. Add brown sugar before eating, for breakfast and dinner. The efficacy is to invigorate the spleen and transform dampness, activate blood circulation and unblock meridians. This is a dietary recipe for facial nerve palsy patients, in which Coix Seed and Mung Beans treat spleen deficiency with dampness, Hawthorn activates blood circulation and resolves stagnation; Brown Sugar nourishes blood and unblocks meridians. The whole recipe makes the spleen healthy, phlegm transforms and dampness is eliminated, and facial meridians are unblocked. It is suitable for symptoms of spleen deficiency and dampness, meridians blocked.

       The treatment of median nerve palsy in Western medicine commonly uses a splint to fix the wrist joint in the middle position on the palmar side. Local immobilization is performed. At the same time, oral anti-inflammatory drugs such as ibuprofen and indomethacin are taken. Severe cases can use 0.5ml of prednisolone and 0.5ml of 2% procaine injected into the carpal tunnel, once a week. If there is no effect after two injections, and electromyography shows denervation of the thenar muscle, surgical treatment should be performed.