MEDIAN NERVE

(Fatima Tariq)

➢ Introduction:
→ It is the main nerve of the front of the forearm. It also supplies the muscles of the
thenar eminence.
→ The median nerve controls coarse movements of the hand, as it supplies most of
the long muscles of the front of the forearm. It is therefore, called “Labourer’s
Nerve”.

➢ Root Value
C6 – T1 (also contains fibers from C5 in some individuals).

➢ Course:
→ Up to the cubital fossa, the median nerve is related to the Brachial Artery.
→ In the arm, it is lateral to the brachial artery.
→ In the middle of the arm, it crosses the artery from lateral to medial side and
remains on the medial side of the artery right up to the elbow
→ At the cubital fossa, it is the most medial structure.
 → It enters the forearm in between the two muscles, Flexor Digitorum Superficialis
and Flexor Digitorum Profundus.
→ It reaches down to the region of the wrist, where it lies deep and lateral to Palmaris
Longus tendon.
→ It passes deep to the Flexor Retinaculum through Carpel Tunnel to enter the palm.
→ Soon it terminates by dividing into muscular and cutaneous branches.

➢ Relations:
In the arm: -
▫ In the UPPER part- lateral to the brachial artery
▫ In the MIDDLE part- anterior to the brachial artery
▫ In the LOWER part- medial to the brachial artery

In the Cubital Fossa: -

▫ median nerve lies Medial to the brachial artery, behind the biccipital aponeurosis
and in front of the Brachialis
In the Forearm: -

▫ median nerve enters the forearm by passing between the heads of Pronator Teres.
▫ It passes beneath the fibrous arch of Flexor Digitorum Superficialis and runs deep to
this muscle on the surface of Flexor Digitorum Profundus.
▫ At the lower end of Forearm, 5cm above the Flexor Retinaculum, it becomes
superficial and lies between the tendons of Flexor Carpi Radialis (Laterally) and
Flexor Digitorum Superficialis (Medially).
▫ It lies Lateral to Palmaris Longus.
In the Wrist: -
▫ It lies deep to the Flexor Retinaculum.

➢ Branches: -
Branches of median nerve begin from Cubital Fossa.

▫ Muscular branch to Pronator Teres, Flexor Carpi Radialis (FCR), FDS, Palmaris
Longus
 ▫ Muscular branch to Brachial Artery
▫ Articular branch to Elbow Joint

After entering Forearm:

• Muscular Branches:
▫ FDS, FCR, Palmaris longus
▫ Deep branch (anterior interosseous nerve) which supplies deep muscles
▫ lateral half of Flexor digitorum profundus
▫ flexor pollicis longus
▫ pronator quadratus
• Vascular Branch:
▫ Radial artery
▫ Ulnar artery
• Communicating Branch:
▫ To ulnar nerve
• Palmer cutaneous branch:
▫ Arises from median nerve above wrist
▫ Passes above the flexor retinaculum and supplies lateral 2/3rd of skin of palm.
• Articular branch:
▫ Wrist and radioulnar joints
Branches in the Palm -lateral and medial divisions

• Lateral Division gives:

▫ A muscular branch to thenar muscles
▫ 3 digital branches to lateral 1½ digits including thumb
▫ Out of 3, 2 supply the thumb and 1 the lateral side of the index finger, as well as the
first lumbrical
• Medial Division:
▫ Divides into 2 common digital branches for the 2 nd and 3rd interdigital clefts,
supplying the adjoining side of index, middle and ring fingers.

➢ Clinical Anatomy:
The median nerve is also called the “Labourer’s Nerve” as well as the “Eye of the Hand”. It
controls coarse movements of the hand as it supplies the front of forearm.
 • Carpal Tunnel Syndrome:

Involvement of the median nerve in carpal tunnel syndrome at wrist has become a very
common entity.
▫ Compression of median nerve under the flexor retinaculum that results in wasting
of thenar muscles, loss of sensation of lateral 2/3rd of palm and lateral 3½ digits.
▫ Results in Ape Hand Deformity; inability to oppose thumb.
▫ Tinel’s sign – tapping the nerve in the carpal tunnel to elicit pain in median nerve
distribution.
▫ Phalen’s maneuver – holding the wrist in flexion for 60 seconds to elicit
numbness/pain in median nerve distribution