This document discusses the anatomy and clinical evaluation of median nerve injuries as well as various management strategies. It describes the anatomy of the median nerve and its branches that innervate different muscle groups in the arm and hand. Clinical presentations of high and low median nerve palsies are outlined. Surgical techniques for restoring function are proposed, including nerve transfers to regain opposition, sensation, flexion and pronation. Tendon transfers are also mentioned to help with opposition and finger flexion.

1. Median Nerve
Injuries, assessment & managemet
Mansoor Khan
HMC Plastic & Reconstructive
Surgery deparment

2. Anatomy of the median

3. Anatomy of the median

4. Anatomy of the median

5. Anatomy of the median

6. Anatomy of the median

7. Anatomy of the median

8. Anatomy of the median

9. 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

10. Clinical evaluation

12. Clinical evaluation

13. 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

14. Low median nerve palsy
Injury of the median nerve below
the level of innervation of the
forearm muscles with only
Sensory & opposition loss

15. Nerve transfers…?
To achieve opposition,
sensations, flexion &
pronation

16. AIN to Median recurrent transfer for
lower median nerve palsy
Thumb opposition

17. 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)

18. 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

19. Sensory restoration for median nerve

20. Sensory restoration for median nerve

21. Nerve transfers for restoration of
flexion in high median nerve palsy
ECRB branch of the radial
nerve to the AIN transfer
without grafts

22. Nerve transfers for restoration of
flexion in high median nerve palsy

23. Nerve transfers for restoration of
flexion in high median nerve palsy
Isolated AIN injuries, nerves of
FDS, PL & FCR can be utalized

24. Nerve transfers for restoration of
pronation in high median nerve palsy

25. Tendon transfers…??
Goals; opposition, IP
flexion of 1st & 2nd digits,

26. FDS opponensplasty (Bunnel type)

27. EIP Opponensplasty

28. ADM use in Huber transfer.

29. Camitz Procedure

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