Radial and median nerves

 Radial nerve is the

largest branch of the
posterior cord of
brachial plexus and is
regarded as the
continuation of the
posterior cord.
 C5,6,7,8(T1)
 COURSE

 In the axilla - lies

posterior to 3rd part of
the axillary artery and
anterior to 3 muscles,
subscapularis,teres major
and latissimus dorsi.
 Passes the lower
triangular space to enter
the back of the arm.
Branches before entering the spiral
groove

 Muscular- to long head and medial head

of triceps (ulnar collateral nerve).
 Cutaneous branch - posterior cutaneous
nerve of the arm.
In the spiral (radial groove) groove
 Passes between medial
and lateral heads of
triceps in the groove.
 Supplies lateral and
medial heads and
anconeus (a detached
part of medial head).
 Cutaneous branches-
lower lateral cutaneous
branch of the arm and
posterior cutaneous
nerve of forearm.
 Accompanied by
profunda brachii artery.
 After leaving the groove
 Pierces the lateral
intermuscular septum
and comes to lie in
the radial tunnel.
 Radial tunnel is the
space between
brachialis and
brachioradialis.
 Can be trapped here.
 In the cubital fossa
(deep to brachioradialis)
 Lies between brachialis
and brachioradialis.
 Supplies brachioradialis
and ext.carpi.rad.longus.
 Gives proprioceptive
fibers (only) to
brachialis.(?)
 Divides into superficial
and deep branches.
(deep branch is called
posterior interosseous
nerve).
 Superficial branch is
purely sensory!!!
 Posterior interosseous nerve
 Supplies all the muscles in the extensor
compartment of forearm (back of forearm)
including supinator.
 Radial nerve injuries

Saturday night palsy?

Extension at the elbow
is not affected!!!
Why?
On the hand (sensory supply)
 1.Ulnar nerve
2.Median nerve
3.Radial nerve

The dorsum of the hand, sensory innervation

Part time job in the arm
Full time in the fore arm
Holiday in the hand!!
(regarding the muscular supply)
 Median nerve
 Arises by two roots from
the corresponding cords,
lateral root and medial
root.
 In the axilla lies in front of
the axillary artery.
 In the front of the arm, it
gradually crosses the
brachial artery from
lateral to medial
(superficially).
Roots of median nerve unite
in front of the axillary artery.
 In the cubital fossa

 From lateral to
medial:
 Tendon of biceps
 Artery (brachial)
 Nerve (median)
 under cover of
bicipital aponeurosis.
 (Essential to
remember!!!)
 In the forearm
 Enters the forearm between the two heads
of pronator teres (do remember!!!).
 It can be trapped here leading to
“PRONATOR SYNDROME”.
 Runs deep to the FDS till the wrist and
enters the carpal tunnel by curving medial
to Flexor carpi radialis.
 In the palm it divides into medial and
lateral branches.
 distribution
 No branches in the arm (holiday in the
arm!!)
 Supplies all the superficial flexors of the
forearm except Fl.Carpi ulnaris.
 Supplies the deep group (Fl.dig.profundus
(lateral half),FPL and Pronator quadratus
through its deep branch called “anterior
interosseous nerve”.
 (Full time job in the forearm!!!!)
 In the hand
 Supplies thenar
eminence (abductor Brachial plexus & median nerve
pollicis brevis,flexor
pollicis brevis and
opponens pollicis)
 and 1st and 2nd
lumbricals.
 Mostly it is sensory in
the hand.

Part time job in the hand!!!!

palm
 1.Ulnar nerve
2.Median nerve
3.Radial nerve

The dorsum of the hand, sensory innervation

 Clinical aspects
 Can be compressed between the two
heads of pronator teres.
 Usually compressed in the carpal tunnel-
CARPAL TUNEL SYNDROME(CTS).
Injury
Injury of median nerve at different levels
causes different syndromes
Injury of this nerve at a level above elbow
joint results in
loss of pronation and a decrease in flexion
of the hand at the wrist joint.
In the hand, thenar muscles are paralyzed and
atrophy in time. Opposition and flexion
movements of thumb are lost, and thumb and
index finger are arrested in adduction and
hyperextension position. This appearance of
the hand is collectively referred as ape hand
deformity. (ape thumb deformity)
In addition, in palmar side of the hand sensation of
lateral part of hand,
first three fingers and lateral half of the fourth
finger and in dorsal side sensation of distal
portions of first three fingers and lateral half of
distal portion of fourth finger is lost.
Which of the following muscles can perform
arm and elbow flexion along with forearm
supination?

(A) biceps brachii

(B) brachialis
(C) brachioradialis
(D) coracobrachialis
(E) supinator
Which of the following innervates the
muscle identified?

(A) median
(B) Musculocutaneous
(C) Radial
(D) suprascapular
(E) ulnar
A 24-year-old student is brought to the emergency
room after being found in a ditch where he had lain
overnight after being hit by a car. He complains of
severe pain in the left arm and examination reveals a
broken humerus. Neurological examination reveals
that the patient can extend the elbow but displays
inability to supinate the elbow when it is extended.
The patient also has wrist drop and very weak hand
grasp. The neurological lesion is likely localized at
which of the following locations?
(A) posterior cord of the brachial plexus
(B) posterior divisions of the brachial
plexus
(C) radial nerve at the distal third of the
humerus
(D) radial nerve at the mid forearm
(E) radial nerve at the wrist
In the above patient, when the elbow is
partially flexed, the patient can supinate the
left forearm. This is due to the function of
which of the following?

(A) biceps brachii

(B) brachialis muscle
(C) brachioradialis
(D) pronator teres
(E) anconeus
A 42-year-old man visits his doctor after his cousin,
who has not seen him for years, notices a change in
his appearance. Overgrowth of his frontal bones and
enlargement of his hands and feet have occurred. The
patient complains of a tingling sensation in the 1st,
2nd, and 3rd digits of the right hand and loss of
coordination and strength of the right thumb. Which of
the following nerves has most likely been affected?

A. Anterior interosseous nerve

B. Median nerve
C. Musculocutaneous nerve
D. Radial nerve
A patient complains to his physician that his
thumb "doesn't work right." The physician notes
weakness of the thumb in extension, although
rotation, flexion, abduction, adduction, and
opposition are normal. Which of the following
nerves is most likely involved?

A. Median and radial

B. Median and ulnar
C. Median only
D. Radial only
E. Ulnar only