8 August 2011

Median Nerve, Course and Its Applied Anatomy

Introduction
The median nerve is the major nerve of the arm is formed in the axilla by the union of a lateral root and medial root from the lateral cord and medial cord of the brachial plexus. Arises by two roots, one from lateral cord ( C6, C7 fibers ) and one from medial cord ( C8, T1 fibers ) of the brachial plexus.

8 August 2011

Median Nerve, Course and Its Applied Anatomy

Course
 The median nerve run distally in the arm, initially on the lateral side of the brachial artery until it reaches the middle of the arm, where it crosses to the medial side and contacts the brachialis.  It then descend to the cubital fossa, where it lies deep to the bicipital aponeurosis, medial cubital vein, and passes between the heads of the pronator teres. It gives off the anterior interosseus branch.
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Course cont d
 Descends in fascial plane between FDS and FDP. Just above the wrist the nerve emerges to lie between the FDS and FCU. It gives palmar cutaneous branch that supplies the skin of the central portion of the palm.  Approaches flexor retinaculum to traverse carpal tunnel, it divides into a muscular branch and palmar digital branches.
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8 August 2011

Median Nerve, Course and Its Applied Anatomy

Applied Anatomy
 Lesions of the median nerve usually occur in two places: The forearm and The wrist. The most common site is where the nerve passes through the carpal tunnel.  Carpal tunnel syndrome.  Pronator syndrome.  Anterior interroseus nerve palsy.
Median Nerve, Course and Its Applied Anatomy

8 August 2011

Applied anatomy cont d

Carpal tunnel sydrome  Impaired sensation over tree and a half digits on the thumb side of the hand.  Wasting and weakness of the thenar muscles.  No sensory loss over the thenar eminence itself. Pronator syndrome  Patients are first seen clinically with pain and tenderness in the proximal aspect of the anterior forearm.
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8 August 2011

Median Nerve, Course and Its Applied Anatomy

Applied anatomy cont d

Anterior interosseus nerve palsy  Fractures of the radius midshafs, excessive exercise or penetrating injuries to the forearm.  It presents principally as weakness of the index finger and thumb.

8 August 2011

Median Nerve, Course and Its Applied Anatomy

APPLIED ANATOMY
Partial or complete surgical division of the flexor retinaculum must be extinguished from the median nerve damage at a higher level carpal tunnel release is necessary. The palmar cutaneous branch will be affected and weakness of the relevant flexor muscles in the forearm (e.g flexor pollicis longus) is a notable feature.
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