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

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