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(D) Advanced thenar muscle atrophy. [8] Signs and symptoms depend on the specific disease, but motor neuron diseases typically manifest as a group of movement-related symptoms. [6] They come on slowly, and worsen over the course of more than three months. Various patterns of muscle weakness are seen, and muscle cramps and spasms may occur.
The thenar eminence is the mound formed at the base of the thumb on the palm of the hand by the intrinsic group of muscles of the thumb. [1] The skin overlying this region is the area stimulated when trying to elicit a palmomental reflex. The word thenar comes from Ancient Greek θέναρ (thenar) 'palm of the hand'. [2]
This hand deformity is not by itself an individual diagnosis; it is seen only after the thenar muscles have atrophied. While the adductor pollicis remains intact, the flattening of the muscles causes the thumb to become adducted and laterally rotated.
Atrophy of the thenar muscles, weakness of palmar abduction, and loss of sensibility (constant numbness as opposed to intermittent paresthesia) are signs of advanced neuropathy. Advanced neuropathy is often permanent. The nerve will try to recover after surgery for more than 2 years, but the recovery may be incomplete. [113]
Patients with hereditary motor and sensory neuropathies are diagnosed through a physical evaluation that looks for muscle atrophy, weakness, and sensory responses. [3] In addition to this, electromyography and motor nerve conduction tests can help clinicians decide what type of motor and sensory neuropathy it is and how severe the disease is.
To an extent, these features can also be seen in normal aging (although technically, the apparent muscle wasting is sarcopenia rather than atrophy). [5] The term split hand syndrome was first coined in 1994 by a researcher from the Cleveland Clinic called Asa J. Wilbourn. [6] [7]
Disuse is a common cause of muscle atrophy and can be local (due to injury or casting) or general (bed-rest). The rate of muscle atrophy from disuse (10–42 days) is approximately 0.5–0.6% of total muscle mass per day although there is considerable variation between people. [5]
In the thenar eminence, the recurrent branch of the median nerve provides motor innervation to: [4] opponens pollicis muscle; abductor pollicis brevis muscle; superficial part of flexor pollicis brevis muscle; A separate, more proximal branch of the median nerve additionally provides motor innervation to the 1st and 2nd lumbricals of the hand.