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Median nerve injuries

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median nerve injuries, management, nerve transfers, tendon transfers

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Median nerve injuries

  1. 1. Median NerveInjuries, assessment & managemet Mansoor Khan HMC Plastic & Reconstructive Surgery deparment
  2. 2. Anatomy of the median
  3. 3. Anatomy of the median
  4. 4. Anatomy of the median
  5. 5. Anatomy of the median
  6. 6. Anatomy of the median
  7. 7. Anatomy of the median
  8. 8. Anatomy of the median
  9. 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. 10. Clinical evaluation
  11. 11. Clinical evaluation
  12. 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. 13. Low median nerve palsyInjury of the median nerve below the level of innervation of the forearm muscles with only Sensory & opposition loss
  14. 14. Nerve transfers…? To achieve opposition, sensations, flexion & pronation
  15. 15. AIN to Median recurrent transfer for lower median nerve palsy Thumb opposition
  16. 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. 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. 18. Sensory restoration for median nerve
  19. 19. Sensory restoration for median nerve
  20. 20. Nerve transfers for restoration offlexion in high median nerve palsy ECRB branch of the radial nerve to the AIN transfer without grafts
  21. 21. Nerve transfers for restoration offlexion in high median nerve palsy
  22. 22. Nerve transfers for restoration offlexion in high median nerve palsy Isolated AIN injuries, nerves of FDS, PL & FCR can be utalized
  23. 23. Nerve transfers for restoration ofpronation in high median nerve palsy
  24. 24. Tendon transfers…?? Goals; opposition, IP flexion of 1st & 2nd digits,
  25. 25. FDS opponensplasty (Bunnel type)
  26. 26. EIP Opponensplasty
  27. 27. ADM use in Huber transfer.
  28. 28. Camitz Procedure
  29. 29. Side tenorraphy of FDP & brachioradialis to FPL transfer in high median nerve palsy

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