Median Nerve: Course & Branches

MEDIAN NERVEDEANATION:- Median nerve is the main nerve of the front offorearm It also supplies museles of thenar eminenceTYPE :- Mixed Nerve (Contains motor & Sensory fibres)ROOT VALUE C5,C6.C7. Cs &T,DIPANKAR RAYORIGIN:- Arises from Brachial plexus in axilla by 2 roots 1Lateral and Medial(i) LATERAL ROOT (C5,C6.C7) :- From lateral card of brachial plexus.(ii) MEDIAL ROOT (C8,TI):- From medial cord of brachial plexus.The medial root crosses in front of the 3rd part of axillaryartery to unite with lateral root in a Y shaped mannereither (i) in front of or (ii) on the lateral side of the arteryto form median nerve.COURSE and RELATIONHuman Analomy For ExamIN THE AXILLA :Median nerve lies:on theIt lateral side of the 3rd part of axillary artery.enters the arm at the lower barder ofTeres major.IN THE ARM :(a) b IN IN THE THE UPPER 1/2 :-It descends on the lateral Side of Brachial Artery.MIDDLE OF ARM:- (At the insertion of Coracobrachialis)It crosses infront of brachial a. from lateralto medial.(c) IN THE LOWER 1/2 OF ARM :- It deseends on the medial sideof the brachial artery.AT THE ELBOW :-@It where enters it lies the cubital fossa medial to the brachial arteryaponeurosis. infront of brachialis and behind the bicipital(b) It leaves the cabital fossa by passing between the 2 heads ofpronator teres muscle The Ulnar head of this muscleseparates the median n (Superficially) from Ulnar Artery (Deeply) MEDIAN NERVE2IN THE FOREARM :Human Anatomy For ExamIt descends along the middle line of the front of forearmbetween flexor digitarm superficialis & flexor digitorum profundasmuscles. being adherent to the deep surface of flexor digitationsuperficialis.DIPANKAR RAYAT THE WRIST: 5cm. above the wrist joint. the median nerveemerges from undercover the lateral border of the tendon offlexor digitorum superficialis to become superficial, lying in the intervalbetween the tendons of Flexor carpi radialis & palmaris longus.The THE HAND: the The median n. enters the hand by passing throughCarpal Tunnel (Just deep to Flexor Retinaculum)IT ENDS: At the distal border of the flexor retinaculum bythe hard.dividing into lateral and medial branches which supplyThe PSEUDOGANGLION" Median Nerve shows a swelling at its lower end calledLABORER'S NERVE:- Median nerve is also terred LABORER'S NERVEbecause the coarse movements of the handrequired by laborer's (e.g. digging the ground, lifting weight er) areperformed by long flexors of forearm which are mostly supplied bythe median nerveEYE OF THE HAND:- Median nerve is also termed 'Eye of the Hand'or PERIPHERAL EYE" because it providessensory which innervation used to the pulp of the thumb and Index fingerare to see the thinness and texture of cloth andare also used for performing fine movements eg. Buttoning of Coat. MEDIAN NERVE3BRANCHES OF MEDIAN NERVEIN THE AXILLA & ARM :- No BranchesHUMAN ANATOMY FOR Fram.IN THE FOREARM: - It gives :-(A) MUSCULAR BRANCHES :- Arise from the medial side of median nervein the cubival fossa to supply the muscles.-(i) Pronator teres (ii) Flexor Carpi radialis (iii) Plear digitorum superficialis:(iv) Palmaris longus(B) ARTICULAR BRANCHES :- To the elbow and Superior Radio-ulna joints.(c) ANTERIOR INTER OSSEOUS NERVE:-DIPANKARArise from median nerve in the upper part of forearm.Ends by entering the deep surface of pronator quadratus m.- It gives the following branches:-(i) MUSCULAR BRANCHES To 21/2 MusclesFlexor Policis longusPronator Quadratus(ii) ARTICULAR BRANCHES To the Wrist and Inferio-radio-whar joint.Lat 1/20 of Flexor digitorum Profund(D) PALMAR CUTENEOUS BRANCH :-Arises from median nerve 1 inch above the wrist.It supplies - The Skin of the lateral 2/3 of the palm.(F) COMMUNICATING BR WITH THE ULNAR NERVE:-Arises in the upper part of the forearm and passes downwardsand medially on flexor digitarum profundus to join the ulnar nerve.It carries fibres from C7 to the Ulnair Nerve. MEDIAN NERVE4BRANCHES OF MEDIAN N. IN THE HAND(1) THE LATERAL TERMINAL BRANCH:-(A) 3 Common Pahmar Digital BranchesHUMAN. ANATOMY FOR EXAM.- 2 of them pass to the sides of the thumb.-The 3rd : Supplies the 1st Lubribacial M. then passes to theradial side of index finger.B Recurrent Muscular Branch:DIPANKAR RAY- Curves upwards & laterally around the distal border of theflexor retinaculum. then piences the flexor pollicis brevis M.- It supplies 3 Thenar muscles - (i) Flexor pollicis brevis(ii) Abductor ""(iii) Opponers pollicis.(2) THE MEDIAL TERMINAL BRANCH : Gives 2 common palmar branch(i) Lateral branch Supplies the 2nd lumbricalis M. then dividesto supply the adjacent Sides of the(ii) Medial branch:- Divides to supply the adjacent sides of theIndex and Middle fingers.Middle and Ring fingers.COURSE & DISTRIBUTION OF THE COMMON PALMAR DIGITAL BRANCHES- The MedialThe lateral terminal " division ). of Median N. gives 3 They1,1pass to the lateral""2(ii) (i) At They the run distal deep to superficial patmararch & is br. ) but superfic. following relations.3 1/2 Fingers having thepatmar aponeurosis, part palm, palmar digital nerves pass between to long flexor oftendon(iii) fibrous enter flexor streaths fingers and continue distally on the side of theThey the infront of deep transverse metacarpal the ligaments. slips(iv They supply + the whole palmar surfaces of the lateral 31/2fingers distal 1/2 of their dorsal surfaces.