A 50-year-old male with diabetic nephropathy and renal failure on maintenance haemodialysis through a left arterio-venous fistula was referred to the Neuroscience Clinic with pain, numbness and tingling over the lateral 3 fingers of the left hand of a few days duration. The pain increased when the fistula was used for haemodialysis. On clinical examination, the patient was unable to oppose the thumb and flex the thumb, Digit I and Digit II. He also had weakness of wrist flexion and forearm pronation, suggesting a proximal median neuropathy.
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