Median nerve

Reverse Carpal Tunnel Syndrome

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Genetic testing

NCV/EMG

Laboratory

Imaging

Biopsy

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Median NerveUltrasound Median Nerve Carpal Tunnel

Fig. 8. Section at the distal end of the carpal tunnel. 1 Median nerve. 2 Ulnar nerve. 3 Deep ulnar nerve. 4 Flexor retinaculum. 5 Flexor tendons. 6 Flexor pollicis longus. 7 Abductor dig-iti minim) muscle

Fig. 9. Transsection of the median nerve and sural nerve inter-plantate in a 24 month follow up. A Orators hand prior to operation, B after 24 months the long flexors of the thumb and particularily the index finger show increased mobility

Paralysis Klumpke
Fig. 10. Acute carpal tunnel syndrome. A Local painful swelling of the left volar wrist, sensory loss in median nerve distribution. B After confirmation with ultrasound the median nerve was released. C Residual deficits were a sensory loss of the volar sides of the fingers (marked with a ball pen)

Fig. 11. Trophic changes after a median nerve transsection and nerve implantation. A Shows "orators hand", with thenar atrophy. B Shows glossy skin over index finger, and trophic changes of the nailbed

Fig. 12. Complete transsection of the median nerve at the upper arm. A Handposition trying to make a fist. Inability to flex index finger and thumb. Ulcer due to sensory loss at the tip of the index finger. B Sensory loss is accentuated at the tip of the fingers, but also palm is involved. C Dorsal view of the hand, delineating the sensory impairment

Fig. 12. Complete transsection of the median nerve at the upper arm. A Handposition trying to make a fist. Inability to flex index finger and thumb. Ulcer due to sensory loss at the tip of the index finger. B Sensory loss is accentuated at the tip of the fingers, but also palm is involved. C Dorsal view of the hand, delineating the sensory impairment

Hand And Palm Table

Fig. 13. Carpal tunnel syndrome. Typical atrophy of the thenar eminence

Interosseus Atrophy

Fig. 14. Neuropathic pain. This patient suffered from a complete median nerve transsection at the upper arm. 2 years later his hand felt uncomfortably and painfully cold. Touch could elicit neuropathic pain. The patient wears a glove to avoid these sensations

Fibers for the median nerve are found in the lateral and medial cord of the brachial plexus, C5-T1. The nerve runs along the lateral wall of the axilla, adjacent to the axillary artery, continuing through the upper arm close to the brachial artery, and then medial to the biceps tendon. In the forearm, it is found between the superficial and deep heads of the pronator teres muscle, which it supplies. The nerve sends branches to the flexor carpi radialis, palmaris longus, and flexor digitorum superficial is muscles, then divides into a pure motor branch, the anterior interosseus nerve, innervating the flexor pollicis longus, pronator quadratus, and the flexor digitorum profundus I and II. The main branch enters the hand through the carpal tunnel and innervates the abductor pollicis brevis, opponens pollicis, the lateral half of the flexor pollicis brevis, and the first and second lumbrical muscles. There are also sensory palmar digital branches (see Figs. 7 and 8).

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