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Median nerve injuries

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median nerve injuries, management, nerve transfers, tendon transfers

median nerve injuries, management, nerve transfers, tendon transfers

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  • 1. Median NerveInjuries, 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 medianSuperficial layer of muscles:PT, FCR, PL FCUIntermediate layer of muscles:FDSDeep layer of muscles:PQ, FPL, FDPThener eminence muscles:OP, ABPb, FPB
  • 10. Clinical evaluation
  • 11. Clinical evaluation
  • 12. High median nerve palsyInjury of the median nerve above the level of innervation of the forearmmuscles with paralysis of PT, PQ, FCR, FDS, FDP (2nd -3rd ), FPL, PL, Sensory loss, opposition loss
  • 13. Low median nerve palsyInjury of the median nerve below the level of innervation of the forearm muscles with only Sensory & opposition loss
  • 14. Nerve transfers…? To achieve opposition, sensations, flexion & pronation
  • 15. AIN to Median recurrent transfer for lower median nerve palsy Thumb opposition
  • 16. 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)
  • 17. 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
  • 18. Sensory restoration for median nerve
  • 19. Sensory restoration for median nerve
  • 20. Nerve transfers for restoration offlexion in high median nerve palsy ECRB branch of the radial nerve to the AIN transfer without grafts
  • 21. Nerve transfers for restoration offlexion in high median nerve palsy
  • 22. Nerve transfers for restoration offlexion in high median nerve palsy Isolated AIN injuries, nerves of FDS, PL & FCR can be utalized
  • 23. Nerve transfers for restoration ofpronation in high median nerve palsy
  • 24. Tendon transfers…?? Goals; opposition, IP flexion of 1st & 2nd digits,
  • 25. FDS opponensplasty (Bunnel type)
  • 26. EIP Opponensplasty
  • 27. ADM use in Huber transfer.
  • 28. Camitz Procedure
  • 29. Side tenorraphy of FDP & brachioradialis to FPL transfer in high median nerve palsy