Median Nerve Examination
Not to miss following points during the examination
Attitute of the limb or hand
cascade of fingers
Look -
any scars on arm , forarm
wasting on forearm and thenar region
Feel - temperature
any soft tissue or bony tenderness
tinel's sign ,scar tenderness , scar pliability
lymph nodes
Movement
active and passive -rapidly test it
Measurement if any angulation or bony deformity or bony shortening
Neurovascular examination
sensation of autonomous zones of hand and direct the examination to the nerve affected
Power of muscles - Examine both the weaker muscles and donor group of muscles
Forearms - Brachioradialis , Pronator Teres , Supinator
Wrist FCU, FCR , PL,Pronator Quadratus , ECRL
Hand FDS
FDP , FPL
Lumbricals
Opponens Pollicis
Abductor Pollicis Brevis
FPB
Reflexes
Pulsation and Allen's test
History of injury, scars or muscle wasting supplied by median nerve , loss of sensation and muscle
weakness suggest median nerve injury.
How do you treat them ?
It's treated same as other nerve injuries. See on previous section for nerve injuries management.
Its true for all other nerves.
If time period of nerve repair does not allow then tendon transfer is an option.
What are choices for tendon repairs in Median nerve injury ?
High Median Nerve Injury
losses - Forearm pronation
radial flexion of wrist
thumb flexion
2nd and 3rd finger flexion
opponens function of thumb
Choices of tendon to supplement the function
Brachiolradialis to FPL
EIP to Opponens Pollicis
FDP to 2nd and 3rd finger
sensory flap for thenar region
pnemonic for tendon options - BEF
Low Median Nerve Injurry
losses - Opposition
sensation of thenar region
Donor tendons
EIP , PL and FDS RF
Mnemonic - PEF
Never forget Post operative physiotherapy after tendon transfer.
suture removal after 3 weeks
splint removal in 3 weeks
start training like pen holding in 3 weeks
eating with the hand after 4 weeks
heavy work not done till 2 months after surgery
Attitute of the limb or hand
cascade of fingers
Look -
any scars on arm , forarm
wasting on forearm and thenar region
Feel - temperature
any soft tissue or bony tenderness
tinel's sign ,scar tenderness , scar pliability
lymph nodes
Movement
active and passive -rapidly test it
Measurement if any angulation or bony deformity or bony shortening
Neurovascular examination
sensation of autonomous zones of hand and direct the examination to the nerve affected
Power of muscles - Examine both the weaker muscles and donor group of muscles
Forearms - Brachioradialis , Pronator Teres , Supinator
Wrist FCU, FCR , PL,Pronator Quadratus , ECRL
Hand FDS
FDP , FPL
Lumbricals
Opponens Pollicis
Abductor Pollicis Brevis
FPB
Reflexes
Pulsation and Allen's test
History of injury, scars or muscle wasting supplied by median nerve , loss of sensation and muscle
weakness suggest median nerve injury.
How do you treat them ?
It's treated same as other nerve injuries. See on previous section for nerve injuries management.
Its true for all other nerves.
If time period of nerve repair does not allow then tendon transfer is an option.
What are choices for tendon repairs in Median nerve injury ?
High Median Nerve Injury
losses - Forearm pronation
radial flexion of wrist
thumb flexion
2nd and 3rd finger flexion
opponens function of thumb
Choices of tendon to supplement the function
Brachiolradialis to FPL
EIP to Opponens Pollicis
FDP to 2nd and 3rd finger
sensory flap for thenar region
pnemonic for tendon options - BEF
Low Median Nerve Injurry
losses - Opposition
sensation of thenar region
Donor tendons
EIP , PL and FDS RF
Mnemonic - PEF
Never forget Post operative physiotherapy after tendon transfer.
suture removal after 3 weeks
splint removal in 3 weeks
start training like pen holding in 3 weeks
eating with the hand after 4 weeks
heavy work not done till 2 months after surgery
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