Median nerve

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By: gopal2009 (62 month(s) ago)

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MEDIAN NERVE

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Mixed nerve (contain motor & sensory fibers). Type : Root value : C 5,6,7,8 & T1 . Origin : Arises in the axilla by 2 roots (lat &med): 1) lat .root : from the lat . Cord of the brachial plexus . 2) med .root : from the med . Cord of the brachial plexus .

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Course & Relations

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1)Course in the arm a) in the upper ½ b) in the middle of the arm c) in the lower ½ of the arm 2) At the elbow a) in the cubital fossa b) after leaving the cubital fossa 3) in the forearm 4) at the wrist

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The Cubital fossa

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5) In the hand

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6) Its End

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Branches of the median nerve 1) in the axilla & arm : NO branches 2) in the forearm : a) muscular branches B) articular branch C) anterior interosseous nerve D) palmer cutaneous branch E) communicating br .With the ulnar n It gives

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In the forearm

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3) Branches in the hand: 1) the lat .terminal branch : A) 3 common palmer digital branches. B) recurrent muscular branch. 2) the med . Terminal branch : it gives 2common palmer brs : -The lat. Branch. -The med. Branch.

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In the hand

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- In the forearm - In the hand Summary of the branches of the median nerve

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Motor branches (to 11 1/2 muscles) In the forearm : -Main trunk : - supplies 4 muscles : All superficial muscles of the front of the forearm except flex. Capri ulnaris. - Ant. Interosseous br.: - supplies 2 ½ muscles :

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All deep muscles of the front of forearm except the med. ½ of flex. Digit. Profound. In the hand : -Lat. Terminal br.: Supplies 4 muscles: i.e. the 1st lumbrical m + all thenar mm (except add .poll.) -Med. Terminal br.: Supplies : the 2nd lumbrical m.

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Sensory brs. (to lat. 2/3 of the hand) In the forearm : -the palmer cutaneous br.: Arises in the lower end of forearm & descends to the hand to supply the skin of the lat. 2/3 of the palm. -lat. Terminal br. Gives 3 palmer digital branches - In the hand :

-Med. Terminal br.:Gives 2 palmer digital brs. : 

-Med. Terminal br.:Gives 2 palmer digital brs. Articular brs. -main trunk Supplies elbow & sup. Radioulner joint . -ant. Interosseous Supplies wrist & inf . Radioulner joint In the forearm :

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Vasomotor brs. -To the radial & ulnar arteries.

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Injury of median nerve * Median injury produces (1) paralysis of the muscles supplied by it. (2) deformity of the hand. (3) loss of sensation.

Median nerve injury : 

Median nerve injury

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Above the Elbow Motor Affection (1) Paralysis of all muscles supplied . (2) loss of pronation of the forearm . (3)weak flexion of the wrist . (4) loss of the flexion & opposition pf the thumb.

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Deformity : Monkey (ape) hand deformity : (1) hyper-extended thumb . (2) adduction . (3) flat thenar eminence . Sensory loss : Loss of sensation from : - lat. 2/3 of the palm of the hand . -lat. 3 ½ fingers anteriorly & their distal halves posteriorly.

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Deformity : Sensory loss : Motor Affection : Below the Elbow Monkey (ape) hand deformity - lat. 2/3 of the palm of the hand . -lat. 3 ½ fingers anteriorly & their distal halves posteriorly. -Paralysis of the 5 hand muscles supplied by the nerve. -The forearm muscles escape the injury as they are supplied at elbow.

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Monkey (ape) hand deformity :

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Carpal tunnel syndrome Definition : It is compression of median n. as it passes through the carpal tunnel. causes : (1) dislocation of one of the carpal bones. (2) thickening of the tendons passing. (3) myxoedema or tumour inside the carpal tunnel .

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Effects : .As in the injury below the elbow but there is no sensory loss in the palm because the palmer cutaneous br . Passes outside the carpal tunnel. N.B : The characteristic deformity of all median n. injuries is monkey hand.

Atrophy : 

Atrophy

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