0:00

Finally the wrist.

0:01

So the last joint on our journey here, uh,

0:04

we're gonna get back to that median nerve, right?

0:06

So one we're very familiar with,

0:08

we see it on all our wrist MRIs.

0:10

It kind of sits within this compartment with the rest

0:12

of the flexor tendons.

0:14

Um, and it's really bound superficially by that ret ulu

0:17

and the median nerve innervates our, um, are thenar muscles.

0:21

So most of the radial aspect

0:24

and the palmer aspect of the hand

0:27

and median nerve entrapment, uh, is a common one clinically,

0:31

right, carpal tunnel syndrome.

0:33

Uh, so chronic repetitive injury, a lot of typing.

0:36

Um, positional abnormalities when you're sleeping can cause

0:39

carpal tunnel syndrome.

0:41

Um, one thing

0:42

that's interesting about this is we just don't image it very

0:44

often, and that's because usually the clinical

0:47

symptomatology, uh, is pretty diagnostic, right?

0:50

It's worse when you're in certain positions.

0:52

It's worse when you're typing, et cetera.

0:53

It gets better when you wear those splints.

0:55

Um, there are great reasons to do imaging, right?

0:58

If you have patients who have refractory carpal tunnel

1:01

syndrome after treatment, if you're suspicious

1:03

that there's an underlying mass lesion really narrowing the

1:07

space, uh, that the nerve has to travel through,

1:09

those are great indications to do MRI, um, surgeons,

1:13

in addition to just decompressing

1:14

that carpal tunnel can go in and remove those ganglia cysts

1:18

or address other kind of, um,

1:20

space occupying lesions in that region.

1:23

The other thing to note about the median nerve in the carpal

1:25

tunnel is it can have a variable appearance.

1:28

So there are plenty of instances

1:29

of an abnormal looking median nerve

1:31

that relatively absent clinical

1:33

symptomatology and vice versa.

1:36

So again, you have to take the imaging findings in the

1:38

context of the clinical picture, uh,

1:40

particularly true for the median nerve.

1:44

So here's a, a great example of carpal tunnel syndrome

1:47

with some, uh, very condensing imaging findings.

1:50

So again, this was a patient who had those

1:51

characteristic symptoms.

1:53

She even had some volume loss in atrophy of one

1:55

of her thenar eminences compared to the contralateral side.

1:58

And starting with their secondary imaging findings,

2:01

we're looking for that muscle edema.

2:03

Uh, we see some, um, volume loss as well at this area,

2:07

predominantly in the thenar muscles.

2:08

The rest of the muscles in the hands looked normal

2:11

and when we're evaluating the median nerve,

2:13

we see those same primary abnormalities.

2:15

We can see that very vesicular appearance, uh,

2:18

variable sizes of the individual fascial of

2:21

that median nerve overall increase in signal.