median nerve injuries
DESCRIPTION
median nerve injuries, management, nerve transfers, tendon transfersTRANSCRIPT
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Median NerveInjuries, assessment & managemet
Mansoor KhanHMC Plastic & Reconstructive
Surgery deparment
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Anatomy of the median
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Anatomy of the median
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Anatomy of the median
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Anatomy of the median
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Anatomy of the median
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Anatomy of the median
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Anatomy of the median
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Anatomy of the median
Superficial layer of muscles:PT, FCR, PL FCU
Intermediate layer of muscles:FDS
Deep layer of muscles:PQ, FPL, FDP
Thener eminence muscles:OP, ABPb, FPB
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Clinical evaluation
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Clinical evaluation
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High median nerve palsy
Injury of the median nerve above the level of innervation of the forearm
muscles with paralysis of PT, PQ, FCR, FDS, FDP (2nd -3rd ), FPL, PL, Sensory
loss, opposition loss
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Low median nerve palsy
Injury of the median nerve below the level of innervation of the
forearm muscles with only Sensory & opposition loss
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Nerve transfers…?
To achieve opposition, sensations, flexion &
pronation
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AIN to Median recurrent transfer for lower median nerve palsy
Thumb opposition
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Median recurrent neurotisation for high median nerve palsy
Ulner-median nerve transfer (3rd lumbricle branch to recurrent median
nerve branch transfer)
Radial-median nerve transfer (PIN EDM or EIP branches to Recurrent median
nerve branch transfer)
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Sensory restoration for median nerve
Essential for fine motor tasks, motor recovery is dependant on the quality of sensations, some
believe it a prerequisite for motor restoration
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Sensory restoration for median nerve
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Sensory restoration for median nerve
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Nerve transfers for restoration of flexion in high median nerve palsy
ECRB branch of the radial nerve to the AIN transfer
without grafts
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Nerve transfers for restoration of flexion in high median nerve palsy
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Nerve transfers for restoration of flexion in high median nerve palsy
Isolated AIN injuries, nerves of FDS, PL & FCR can be utalized
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Nerve transfers for restoration of pronation in high median nerve palsy
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Tendon transfers…?? Goals; opposition, IP
flexion of 1st & 2nd digits,
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FDS opponensplasty (Bunnel type)
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EIP Opponensplasty
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ADM use in Huber transfer.
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Camitz Procedure
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Side tenorraphy of FDP & brachioradialis to FPL transfer in high median nerve palsy