Median NerveInjuries, assessment & managemet

Mansoor KhanHMC Plastic & Reconstructive

Surgery deparment

Anatomy of the median

Anatomy of the median

Anatomy of the median

Anatomy of the median

Anatomy of the median

Anatomy of the median

Anatomy of the median

Anatomy of the median

Superficial layer of muscles:PT, FCR, PL FCU

Intermediate layer of muscles:FDS

Deep layer of muscles:PQ, FPL, FDP

Thener eminence muscles:OP, ABPb, FPB

Clinical evaluation

Clinical evaluation

High median nerve palsy

Injury of the median nerve above the level of innervation of the forearm

muscles with paralysis of PT, PQ, FCR, FDS, FDP (2nd -3rd ), FPL, PL, Sensory

loss, opposition loss

Low median nerve palsy

Injury of the median nerve below the level of innervation of the

forearm muscles with only Sensory & opposition loss

Nerve transfers…?

To achieve opposition, sensations, flexion &

pronation

AIN to Median recurrent transfer for lower median nerve palsy

Thumb opposition

Median recurrent neurotisation for high median nerve palsy

Ulner-median nerve transfer (3rd lumbricle branch to recurrent median

nerve branch transfer)

Radial-median nerve transfer (PIN EDM or EIP branches to Recurrent median

nerve branch transfer)

Sensory restoration for median nerve

Essential for fine motor tasks, motor recovery is dependant on the quality of sensations, some

believe it a prerequisite for motor restoration

Sensory restoration for median nerve

Sensory restoration for median nerve

Nerve transfers for restoration of flexion in high median nerve palsy

ECRB branch of the radial nerve to the AIN transfer

without grafts

Nerve transfers for restoration of flexion in high median nerve palsy

Nerve transfers for restoration of flexion in high median nerve palsy

Isolated AIN injuries, nerves of FDS, PL & FCR can be utalized

Nerve transfers for restoration of pronation in high median nerve palsy

Tendon transfers…?? Goals; opposition, IP

flexion of 1st & 2nd digits,

FDS opponensplasty (Bunnel type)

EIP Opponensplasty

ADM use in Huber transfer.

Camitz Procedure

Side tenorraphy of FDP & brachioradialis to FPL transfer in high median nerve palsy