Median neuropathy

Mazen M Dimachkie MD (Dr. Dimachkie, Director of the Neuromuscular Disease Division and Vice Chairman for Research Programs, Department of Neurology, The University of Kansas Medical Center, received honorariums from Baxter, Genzyme, and Pfizer for serving as a guest speaker; consultation fees from Catalyst and Nufactor; and honorariums from Alnylam, CSL-Behring, Malinckrodt, and Novartis for advisory board meetings.)
Francine J Vriesendorp MD (Dr. Vriesendorp of SUNY Upstate Medical University in New York has no relevant financial relationships to disclose.)
Randolph W Evans MD, editor. (Dr. Evans of Baylor College of Medicine received honorariums from Allergan, Amgen, Avanir, DepoMed, and Novartis for speaking engagements and honorariums from Alder, Amgen, Lilly, Novartis, and Promius for advisory board membership.)
Originally released February 2, 1998; last updated July 2, 2017; expires July 2, 2020

This article includes discussion of median neuropathy, lacertus fibrosus, bicipital aponeurosis, Kiloh-Nevin syndrome, pronator teres syndrome, anterior interosseous syndrome, median entrapment at the bicipital aponeurosis, median entrapment at the ligament of Struthers, and median nerve laceration. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Historical note and terminology

After carpal tunnel syndrome, the most common median nerve entrapment is the pronator teres syndrome (Gessini et al 1983). Other less common entrapment sites include the ligament of Struthers, lacertus fibrosus, and the tendinous origin of the flexor digitorum superficialis.

Image: Entrapment sites of the median nerve above the wrist
In 1848, Struthers depicted in finer detail the supracondylar process 5 cm above the medial epicondyle and its ligament. Struthers ligament can compress the median nerve (Lund 1930). Anterior interosseous neuropathy was originally described in 2 patients who had spontaneous recovery (Kiloh and Nevin 1952). Around the same time, the pronator teres syndrome was recognized (Seyffarth 1951). Median nerve entrapment under the bicipital aponeurosis was described over 2 decades ago (Koppel and Thompson 1976).

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