What’s wrong to her right palm?
Median nerve
Objectives
At the end of the class learners will be able to-
• Explain the root value, disposition and distribution
of median nerve with proper diagrams
• Explain the clinical features of median nerve injury
at different sites with help of proper diagrams
How a spinal nerve is formed?
Cross section of spinal cord
Dorsal root
(Sensory)
Dorsal root ganglion
Dorsal ramus
Ventral ramus
Spinal nerve
Ventral root
(Motor)
Formation of Median nerve
C5
C6
C7
C8
T1
Schematic diagram of left side
Dissection of axilla ( Right side)
Identify the Median nerve in this picture
1 Axillary artery
2 Median Nerve , 3 Ulnar nerve, 4 Radial nerve,
5 Musculocutaneous nerve, 6 Coracobrachialis
Classwork A
Median nerve in axilla
and arm
• two roots which
embrace the third part
of the axillary artery
Median nerve
– lateral (C5, 6, 7)
Axillary artery
– medial (C8, T1) cords,
• It gives off vascular
branches to the brachial
artery.
No muscle of arm is supplied by Median nerve
Left side (Anterior view)
Dissection of right side
Mn-Median nerve
Mcn- Musculocutaneous nerve
Cn- Connection
Bb- Biceps brachi
Lcnf-Lateral cutaneous nerve
of fore arm
• Connection with musculocutaneous nerve
• Lateral root of median nerve is smaller
Median nerve in cubital fossa
Biceps brachii
Radial
Brachialis
Median nerve nerve
Brachial artery NA T
Bicipital aponeurosis
Pronator teres
Ulnar artery
Radial artery
Cannulation of brachial artery in cubital
fossa may damage median nerve
Left side
Median nerve in cubital fossa
• usually enters the
forearm between the 2
Biceps brachii
Brachialis
heads of pronator teres
Median nerve
Brachial artery
• Ulnar artery is
separated by deep head
Radial artery of pronator teres
Ulnar artery
Pronator teres
Classwork B
Median nerve in forearm
Median nerve
Humeroulnar head Radial head
Brachioradialis
Flexor digitorum superficialis
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Left side
Median nerve in forearm
• Passes behind the tendinous
Median nerve
bridge between humero-
Humeroulnar head
ulnar and radial head of
Radial head
flexor digitorum
Flexor digitorum superficialis superficialis (FDS)
• Descends adherent to the
posterior surface of FDS
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Median nerve in forearm
• Become superficial close to
Median nerve
the wrist joint
Humeroulnar head • In between flexor carpi
Radialhead radialis laterally, FDS
Flexor digitorum superficialis medially
• Tendon of palmaris longus is
superficial and medial
Median nerve
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Median nerve in forearm
• Branches
Median nerve • Muscular
Humeroulnar head – Pronator teres
Radialhead – Flexor carpi radialis
Flexor digitorum superficialis – FDS
– Palmaris longus
• Articular
– Elbow joint
Flexor carpi radialis – Proximal radioulnar joint
Flexor carpi ulnaris
Palmaris longus
Median nerve in forearm
• Branches (cont.)
Median nerve • Anterior interosseous
Humeroulnar head – Flexor pollicis longus
Radialhead – Flexor digitorum profundus to
Flexor digitorum superficialis index and middle finger
– Pronator quadratus
• Palmar cutaneous
• Communicating to ulnar
Flexor carpi radialis nerve
Flexor carpi ulnaris
Palmaris longus
Classwork C
Ulnar nerve
Median nerve
Flexor retinaculum
in hand
Median nerve
Median nerve passes deep to
the flexor retinaculum Flexor
through carpal tunnel
retinaculam
Ulnar nerve
Median nerve
Left hand (Anterior view)
Median nerve in hand
Palmar digital branches
• Muscular branches
• Thenar muscles
– Flexor pollicis brevis
– Abductor pollicis brvis
– Opponens pollicis
• Palmar digital branch
• 1st and 2nd lumbrical
Flexor retinaculam
Thenar muscles
Ulnar nerve
Left hand Median nerve
Cutaneous supply of Median nerve in hand
Palmar surface Dorsal surface
Left hand
What’s wrong to her right palm?
Carpal tunnel syndrome
Summary
Classwork D
Home assignment
• Summarize the distribution of Median nerve.
• What are the other clinical features of Median
nerve injury?
THANK YOU
