Axillary and Median Nerve

Musculoskeletal block - Anatomy - lecture 6

Editing file
 Color guide :
Only in boys slides in Blue
Objectives Only in girls slides in Purple
important in Red
By the end of the lecture, students should be able to: Doctor note in Green
Extra information in Grey
✓ Describe the origin, course, relations, branches
and distribution of the axillary & median nerves

✓ Describe the common causes and effects of

injury to the axillary and median nerves
 Brachial plexus

Remember To Drink Cold Beer

 Axillary Nerve

Origin Course Branches

(C 5 & 6) - It passes inferiorly and

Posterior cord of laterally along the
brachial plexus. posterior wall of the axilla
to exit.
‫أي ﻋﺻب ﻧﺎﺧذه ﻻزم ﻧﻌرف ﻣن أي ﻗطﻊ‬
‫ ﻷن أي ﺿرر‬، ‫ﻣن اﻟﺳﺑﺎﯾﻧل ﻛورد ﺟﺎء‬
.‫ﯾﺻﯾر ﻓﯾﮭم ھو أﯾﺿﺎ ً راح ﯾﺗﺄﺛر‬

-Then, it passes posteriorly (Motor) (Sensory)

around the surgical neck of to the deltoid and superior lateral cutaneous
the humerus. teres minor nerve of arm that loops
muscles. around the posterior
-It is accompanied by the margin of the deltoid
posterior muscle to innervate skin in
circumflex humeral artery. that region.
 Axillary Nerve

Lesions affects
The axillary nerve is usually injured due to:

● Fracture of
surgical neck of
the humerus

Motor: Sensory:
● Downward 1- Impaired abduction of the shoulder (15-90˚) Loss of
dislocation of the Note: the patient CANNOT raise his arm over 30˚. sensation
shoulder joint 2- Paralysis of the deltoid and teres minor over the lateral
muscles side of the
(The paralyzed deltoid wastes rapidly proximal part
As the deltoid atrophies, the rounded contour of the of the arm.
● Compression from shoulder is flattened compared to the uninjured
the incorrect use side).
of crutches
 Median Nerve

Origin

(C5,6,7, 8, T1)

The median nerve is formed

anterior to the third part of the
axillary artery by the union of
lateral and medial roots

• The lateral root (C5,6&7), arises

from the lateral cord of the
brachial plexus.
• The medial root (C8 & T1),
arises from the medial cord of
the brachial plexus.

originating from the lateral and

medial cords of the brachial
plexus.
Note: Axillary artery is named Brachial artery when it
reaches the arm
 Median Nerve
In the arm Note that
It enters the arm from the axilla at the ● The median nerve has NO
inferior margin of the teres major
major branches in the arm
muscle.
or axilla, but a branch to
It passes vertically down the medial
one of the muscles of the
Brachial artery

side of the arm in the anterior

compartment and is related to the forearms, the (Pronator
brachial artery throughout its course: Teres), this branch may
● In proximal regions (In upper 1⁄2 of the originate from the nerve
arm), it lies immediately lateral to the immediately proximal to
brachial artery.
the elbow joint.
● In more distal regions (In the middle of
the arm), it crosses the medial side of
the brachial artery.
● In the lower 1⁄2 it descends on the
medial side of the brachial artery.
● It descends anterior to the elbow joint.
Note: Flexor retinaculum is a fibrous tissue:
Retinaculum = Deep fascia
flexor = in the middle Median Nerve
In the forearm In the hand

Median nerve passes into the The median nerve continues into the
forearm anterior to the elbow hand by passing deep to the flexor
joint(between the 2 heads of retinaculum. It innervates:
pronator teres)
where it branches innervates most ● Three thenar eminence muscles
of the muscles in the anterior associated with the thumb.
compartment of the forearm (6.5 ● Lateral two lumbrical muscles
muscles) Except the: associated with movement of
● Flexor Carpi Ulnaris the index and middle finger.
● the medial half of the Flexor ● Skin over the palmar surface of
Digitorum Profundus the lateral three and one- half
(which are innervated by the digits and over the lateral side
ulnar nerve). of the palm and middle of the
wrist.
(The lateral 2/3rd of the palm
of the hand.)
 Median Nerve Lesions
Injury of the median nerve at different levels causes different syndromes -
In the arm and forearm the median nerve is usually not injured by trauma, why ?
Because of its relatively deep position.

Sites of damage Serious effects

Loss of opposition of the Loss of sensation:

thumb: from the thumb and lateral 3½
In the carpal tunnel (deep The delicate pincer- like action fingers & lateral ⅔ of the palm.
in the flexor retinaculum) is not possible.
‫اﺧﻄﺮ ﺷﻲ ﻻن ﻣﺎ ﻓﻲ ﻋﻀﻠﺔ ﺛﺎﻧﯿﺔ ﺗﺴﻮي ﻧﻔﺲ اﻟﺤﺮﻛﺔ أو ﻋﺼﺐ‬
‫ﺛﺎﻧﻲ ﯾﻌﻮض‬

At the wrist above the

flexor retinaculum

In the elbow region

(supracondylar fracture of
the humerus)
 Lesion About Motor Sensory and tropic
● Loss of pronation. Sensory:
● Hand is kept in supine position. Loss of sensation from:
● Wrist shows weak flexion, and
● The radial side ⅔ of the
ulnar deviation. (cause there is no
muscle to antagonise the action of the ulnaris) palm.
● Loss of flexion on the ● Palmar aspect of the
interphalangeal joints of the
Damaged in supracondylar fracture of index and middle fingers.
lateral 3½ fingers.
Median humerus ● Weak flexion of ring and little
● Distal part of the dorsal
fingers. surface of the lateral 3½
Nerve Muscles affected are: ● Thumb is adducted (cause the fingers.
Lesion in ● Pronator muscles of the forearm (they adductor muscle is not supplied by the median
nerve) and laterally rotated, with
the Elbow will always be supinated)
loss of flexion of terminal
Region ● All long flexors of the wrist and phalanx and loss of opposition.
fingers except flexor carpi ulnaris ● Wasting of thenar eminence.
Hand looks flattened and
and medial half of flexor ●
“apelike”,and presents an Trophic Changes:
digitorum profundus inability to flex the three most
radial digits when asked to
● Dry and scaly skin
make a fist. ● Easily cracking nails
Supinator
● Atrophy of the pulp of
The index and
Flex.Dig.
Superficialis
Pronator teres
middle fingers are the fingers
extended because of Wasting of
Flex.carpi the antagonist thenar eminence
radialis
muscle
Extra
Flex.pol.long
us
Flex.carpi
ulnaris
 Lesion About Motor Sensory
Often injured by penetrating wounds (stab Thenar muscles are Sensory:
wounds or broken glass) of the forearm. Loss of sensation from:
paralyzed and atrophy
(‫)ﻟﻤﺎ اﻟﺸﺨﺺ ﯾﺤﺎول ﯾﻨﺘﺤﺮ‬ happens with time so that
Median Nerve ● The radial side of the palm.

Lesion at the NOTE: You have to know each deformity and the thenar eminence ● Palmar aspect of the lateral
3½ fingers.
becomes flattened.
Wrist the muscles/nerves involved. ● Distal part of the dorsal
Opposition and abduction surface of the lateral 3½
of thumb are lost, and fingers.
thumb and lateral two
fingers are arrested in Trophic Changes:
adduction and
hyperextension position. ● Dry and scaly skin
● Easily cracking nails
“Apelike hand” ● Atrophy of the pulp of the
fingers
are the same as in the elbow region injuries.

Median Nerve The most common neurological problem Weak motor function of Burning pain or ‘pins
Lesion associated with the median nerve is the thumb, index & middle and needles’ along the
distribution of median nerve to
deep in flexor compression beneath the flexor retinaculum fingers. lateral 3½ fingers.
retinaculum at the wrist.
“Carpal Tunnel
The symptoms first appear as sensory but
Syndrome” when it progresses further the motor
No sensory changes over the palm
as the palmar cutaneous branch is
symptoms appear. given before the median nerve
enters the carpal tunnel.
most common in postmenopausal women
SUMMARY
 MCQs
Question 1: The median nerve continues into the hand by passing deep to the? Question 5: Loss of pronation is a motor effect of:
A. Flexor retinaculum A. Median nerve injury in elbow
B. Brachialis B. Median nerve injury at the wrist
C. Coracobrachialis C. Axillary nerve injury
D. Extensor digitorum longus D. Median nerve injury in the carpal tunnel
Question 2: The median nerve originate from: Question 6: A patient complaining of pins and needles sensation along the medial side of
A. Lateral cord the upper limb and the 3 lateral fingers, that would indicate:

B. Medial cord A.Median Nerve Lesion in the Elbow Region

C. Both B & A B. Carpal tunnel syndrome
D. Posterior cord C. Surgical neck fracture
Question 3: Which one of the following is a sensory supply of the median nerve? D.Median Nerve Lesion at the wrist
A. 3 thenar Muscles
B. 3 hypothenar Muscles
C. Palmer lateral 3 and a half digit
SAQ
D. Palmer medial 1 and a half digit Question 1: One of the trophic changes in Median Nerve Lesion in the Elbow

Question 4: A physician examined an X ray and saw that the patient had a Region?

fracture in the surgical neck, which nerve will he be worried about? Dry and scaly skin

A. brachial
B. Radial Question 2: Where are the axillary motor branches located?

C. Musculocutaneous In the deltoid and teres minor muscles.

D. Axillary Answers: Q1.A- Q2.C -Q3.C -Q4.D- Q5.A- Q6.B

 Team members
Girls team :
Boys team:
● Ajeed Al Rashoud
● Khalid AL-Dossari
● Taif Alotaibi
● Naif Al-Dossari
● Noura Al Turki
Special thank for
● Faisal Alqifari
● Amirah Al-Zahrani
● Salman Alagla
● Alhanouf Al-haluli

Anatomy team 436

● Ziyad Al-jofan
● Sara Al-Abdulkarem
● Suhail Basuhail
● Rawan Al Zayed
● Ali Aldawood
● Reema Al Masoud
● Khalid Nagshabandi
● Renad Al Haqbani
● Mohammed Al-huqbani
● Nouf Al Humaidhi
● Jehad Alorainy
● Fay Al Buqami
● Khalid AlKhani
● Jude Al Khalifah
● Omar Alammari
● Nouf Al Hussaini
● Alwateen Al Balawi
● Rahaf Al Shabri
● Danah Al Halees
Team leaders ● Haifa Al Waily
Rema Al Mutawa
Good luck
●
● Abdulrahman Shadid ● Amirah Al Dakhilallah
● Ateen Almutairi ● Maha Al Nahdi
● Renad Al Mutawa
Give us your feedback:
● Ghaida Al Braithen
● Reham Yousef
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