Median nerve

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Median nerve

  • Median nerve is formed by the joining of branches from the lateral and medial cords of brachial plexus.
  • In the arm, the median nerve descends adjacent to the brachial artery.
  • Median nerve passes deep to the flexor retinaculum and enters the palm.
  • Anatomy of Median Nerve( A very High yield topic for USMLE,AIPGMEE)
    • Formed by
      • C5 to C7 roots from lateral cord of brachial plexus (MCQ)
      • C8 and T1 roots from medial cord of brachial plexus
    • Branches
      • Forearm: Muscular branches(MCQ)
        • Pronator teres
        • Flexor carpi radialis
        • Flexor carpi sublimis
      • Anterior interosseus (motor)(MCQ)
        • Flexor pollicislongus
        • Flexor digitorumprofundus to 2nd & 3rd fingers(lateral half)
        • Pronator quadratus
      • Palmar cutaneous
        • Sensory distribution: Skin over thenar eminence
        • Branch arises proximal to carpal tunnel
      • Terminal motor(MCQ)
        • Abductor pollicisbrevis
        • Opponenspollicis
        • Lumbricals: 1st & 2nd
        • ± Flexor pollicisbrevis: Also innervated by ulnar nerve
      • Terminal sensory
        • Sensory to palmar surface of thumb, 2nd, 3rd & lateral 1/2 of 4th finger(MCQ)
  • High median nerve palsy (injury proximal to the elbow):
    • This will cause paralysis of all the muscles supplied by the median nerve in the forearm and hand.
    • In addition, there will be sensory deficit in the skin of the hand.
  • Low median nerve palsy (injury in the distal third of the forearm):
    • There will be sparing of the forearm muscles, but the muscles of the hand will be paralysed.
    • In addition, there will be anaesthesia over the median nerve distribution in the hand.
  • Testing Median Nerve palsy
    • Flexor pollicislongus: (MCQ)
      • The patient is asked to flex the terminal phalanx of the thumb against
      • resistance while the proximal phalanx is kept steady by the examiner.
    • Pointing index :Flexordigitorumsuperficialis and lateral half offlexor digitorumprofundus: (MCQ)
      • If the patient isasked to clasp his hand, the index finger will remain straight, the so-called ‘pointing index’.(MCQ)
      • Thisoccurs because both the finger flexors,superficialis as well as the profundus of the indexfinger are paralysed; though the availablemedial-half of the flexor digitorumprofundus(supplied by the ulnar nerve) makes flexion ofthe other fingers possible.
    • Flexor carpi radialis:
      • Normally, the palmarflexion at the wrist occurs in the long axis of theforearm.
      • In a patient with paralysed flexorcarpi radialis, the wrist deviates to the ulnarside while palmar flexion occurs. (MCQ)
      • In addition,one cannot feel the tendon of the flexor carpiradialis getting taut.
    • Muscles of the thenar eminence:
      • Abductor pollicisbrevis: tested with ‘pen test’(MCQ)
        • Theaction of this muscle is to draw the thumb forwards at right angle to the palm. The patient is asked to lay his hand flat on the table with palm facing the ceiling.
        • A pen is held above the thumb and the patient is askedto touch the pen with tip of his thumb.
      • Opponenspollicis: (MCQ)
        • The function of thismuscle is to appose the tip of the thumb to otherfingers. Apposition is a swinging movement of thethumb across the palm and not a simple adduction. Adduction is by the adductor pollicismusclesupplied by the ulnar nerve.(don’t confuse !!!! )
  • Thenar muscles -Motor innervation (A frequent MCQ in AIPGMEE USMLE)
    • abductorpollicisbrevis
      • innervated by the median nerve
    • flexorpollicisbrevis
      • ulnar head –innervated by the ulnar nerve
      • radial head – innervated by both ulnar and median nerves
    • opponenspollicis –innervated by the median nerve
    • Adductor pollicis –innervated by the ulnar nerve












Median Nerve Test 1
abductor pollicis and brevis
abductor pollicis and brevis
Opponens Pollicis MMT.MP4
Applied Kinesiology – Manual Muscle Testing: Opponens Pollicis
From the book+DVD “Applied Kinesiology – Manual Muscle Testing: a practical guide
Muscle Testing: Opponens Pollicis
BYUH Anatomy Lab- Hand Muscles Opponens policus to Flexor digiti minimi brevis and some joints
Anatomy Of The Median Nerve – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing the anatomy of the median nerve.
Funky Anatomy EXAM ANSWERS Median Nerve
he Funky Professor introduces our new series of podcasts, designed to help you ace your exams. In conjunction with our 3 Step Process to exam success
Median Nerve Branches, Simple – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing simple review of the anatomy associated with the median nerve.
Median Nerve – Distribution, Innervation & Anatomy – Human Anatomy | Kenhub
he median nerve derives from the lateral and medial cords of the brachial plexus. Initially, it travels down on the medial side of the arm along with the brachial artery.
At the elbow, it will continue its course under the aponeurosis of the biceps and between the two heads of the pronator teres. Once it gives off the antebrachial interosseous branch, it will initiate its trajectory in the forearm between flexor digitorum profundus and the flexor digitorum superficialis muscles, serving as their supply.
Typical Characteristic of a Median nerve injury
In This Video it is expected to know:
1) what are the characteristics of Median nerve Injury.
2) What are the two nerve that Supply the Flexor Digitorum Profundus.
3) Motor and Sensory Supply of the Median nerve.
4) Why is it Called Ape Deformity. name the muscle that do the action.
Median Nerve Test
How to do Median Nerve test
Median Nerve Forearm Decompression – Extended Version
Median Nerve Forearm Decompression
Extended Version
The median nerve is decompressed in the forearm. A Z-plasty lengthening is performed on the pronator teres tendon. In addition, the tendon of the deep head of the pronator teres is transected and the flexor digitorum superficialis tendinous arch is released.
Median Nerve Repair
Median nerve surgery may become necessary when nerves are damaged or trapped as a result of trauma, though nerve problems most often occur spontaneously. Trapped or damaged nerves can cause pain, numbness, and even paralysis.
How to assess the peripheral nerves of the hand – Median, Ulna and Radial nerve tests
John Gibbons is a sports Osteopath and a lecturer for the ‘Bodymaster Method ®’ and in this video he is demonstrating how to test peripheral nerves of the hand. If you would like to learn these techniques and other aspects of Physical Therapy
Neural Glides for Ulnar, Median & Radial Nerves – Ask Doctor Jo
Doctor Jo shows you some simple neural glides (neural flossing) for your ulnar, median & radial nerves in your arms as well as some neural glides for your legs. If you have a nerve injury, you might be diagnosed with thoracic outlet syndrome, radiculopathy, nerve impingement, brachial plexus injury, sciatica, or nerve compression
Median nerve compression ,Supracondylar process – Everything You Need To Know – Dr. Nabil Ebraheim
Educational video describing entrapment of the median nerve by the supracondylar spur and Struthers ligament.
3D How To: Ultrasound Exam of the Median Nerve Entrapment – SonoSite Ultrasound
Using 3D animations we have come up with a new way of demonstrating how to perform portable ultrasound examinations. In this educational video you will see a demonstration of the Ultrasound Exam of the Median Nerve Entrapment.
Median Nerve: Incision & Dissection
his video demonstrates the carpal tunnel incision approach and subsequent dissection of the Median nerve at the wrist and forearm
Median Nerve Release in the Forearm – Extended
Compression neuropathy of the median nerve in the forearm, also known as pronator syndrome, typically presents with pain in the forearm +/- paresthesia/pain in the median nerve territory. The anterior interosseous nerve can be involved with a mononeuritis. While this usually resolves without surgery, occasionally will require this approach for reconstruction or release. Related anatomical structures include the lacertus fibrosus, deep head of pronator teres, arch of flexor digitorum superficialis, and fascia in the distal arm. Release of the median nerve in the forearm addresses these structures and decompresses the nerve in this area. This release is also a method for exposing the median nerve for reconstructive options. This patient presented with median nerve neuropathy in the forearm and hand. In addition to this forearm release, a carpal tunnel release was performed. This video portrays the median nerve decompression in the forearm. For acquiring adequate proximal exposure, a distal step-lengthening of the superficial head of pronator teres is performed. While surgical anatomy can differ from patient to patient, this patient had several tendinous fasciae as well as the deep head of pronator teres.
Carpal Tunnel Syndrome Median Nerve mobilisation in physical therapy
Manual treatment for Carpal Tunnel Syndrome
Clinical Examination of Median Nerve
Learn Clinical Examination of Median Nerve – CTsyn