Median Nerve is a continuation of lateral and medial cord of brachial plexus

1. A AY U S H A B H A N D A R I , I N T E R N
MEDIAN NERVE INJURY

2. A continuation of lateral and medial cord of brachial plexus

4. Superficial layers of muscles
 PT,PL,FCR
Intermediate layers
 FDS
Deep layers
 PQ,FPL,FDP(2nd and 3rd )
Thenar muscles
 OP,FPB,ABPB

5. MOTOR FUNCTIONS
• Forearm pronation
• Wrist flexion and abduction
• Thumb flexion and opposition
• Flexion of digit 2nd and 3rd

7. TYPES
1. High median nerve palsy
2. Low median nerve palsy

11. EXAMINATIONS

12. HAND OF BENEDICTION

13. POINTING INDEX

14. FPL

15. APB

16. APE HAND DEFORMITY

18. OTHER TESTS
 Tinel’s sign
 Phalen’s maneuver
 Nerve conduction studies
Measure of velocity of conduction of impulse in a nerve
 Electromyography
Graphical recording of the electrical activity of a muscle at rest
and during activity

19. TREATMENT
Conservative management
Analgesics
Oral or injection steroids
Splintage of the paralysed limb (first line of treatment)
Preserve mobility of the joints
Physiotherapy
Ergonomic interventions, such as keyboard modification, allow the hand to be
used while the wrist is positioned in a straight position (neither flexed,
extended or deviated to either side).
Yoga
Therapeutic ultrasound (involves applying a round-headed instrument to the
skin of the painful area, to deliver sound waves that are absorbed by the
underlying tissues, to help relieve pain and lessen disability)

20. Operative management
Patients with severe pain of >4-6 months and no relief from
conservative treatments may be offered
surgical decompression.
Nerve repair
(primary and secondary repair)
Nerve graft
Nerve transfer
The principle of nerve transfer is that a less essential function is
sacrificed to reinstate a more vital one
Tendon transfer

21. TREATMENT CONTINUE..
• In case of open injuries
Nerve exploration and repair done
• In case of irreparable lesions of nerve at wrist level, restoration
of opponens power of thumb done by tendon transfer
operation..
• The flexor power of thumb and index finger can also be
restored by appropriate tendon transfer operation.

22. MEDIAN NERVE COMPRESSION
CARPAL TUNNEL SYNDROME
Symptoms can localize to the wrist or the entire hand as well as
radiate into the forearm
Pain(burning type) and paraesthesia in the distribution of the median
nerve ,thenar weakness, numbness in the radial three and one-half
fingers
Awakens the patient at night.
Tinel’s sign and Phalen’s maneuver positive
T/t: splint to prevent wrist flexion
Analgesics
Steroid injection
Carpal tunnel release

23. PRONATOR SYNDROME
Occurs when the pronator teres compresses the median nerve(most
common)
Symptoms similar to those of CTS
Patients often complain of discomfort in their forearm with activity.
An extended elbow and repetitive pronation can often reproduce the
symptoms of pronator syndrome, numbness and tingling of the thumb,
and first two digits
Intact sensation in the forearm but Loss of sensation over the thenar
eminence
Phalen’s maneuver and tinel’s sign often negative.
Commonly seen in professional cyclists.
T/t :conservative treatment or Surgical decompression

24. Anterior Interosseous Neuropathy
The anterior interosseous branch of the median nerve located at
the elbow.
Innervates the FPL ,PQ and the deep flexors of digits two and
three.
neuropathy presents with muscle weakness, no sensory deficits
Patients are unable to pinch objects or make and "OK" sign with
their index finger and thumb

25. PROGNOSIS
1. Delay to repair : best outcomes with immediate repair
2.Age of patent: children do better than adults
3.Nature of nerve injury :clean cut > crush > traction
4.Length of injured segment :graft of 10cm is unlikely to work
5.Distal > proximal level of lesion : the more proximal the injury is ,the
worst the prognosis
6. Associated vascular injury : both nerve and its target organ requires
adequate blood supply

26. 7. Associated conditions like infection, ischemia indicates poor
prognosis
8. Type of nerve : pure motor or pure sensory recover better than
mixed
9.Surgical techniques

27. REFERENCES
• Essentials of Orthopedics by Maheshwari 6th Edition
• Apley & Solomon's System of Orthopaedics and
Trauma
• Atlas of Human Anatomy (Netter Basic Science) 7th
Edition
• https://www.ncbi.nlm.nih.gov/books/NBK553109/

28. Thank you !