Diagnostic Biopsy of the Pronator Teres and a Motor Branch of the Median Nerve: Indications and Technique

2012 ◽  
Vol 37 (12) ◽  
pp. 2570-2575 ◽  
Author(s):  
Christopher J. Dy ◽  
Dale J. Lange ◽  
Kristofer J. Jones ◽  
Rohit Garg ◽  
Edward F. DiCarlo ◽  
...  
Keyword(s):  
Median Nerve ◽  
Motor Branch ◽  
Pronator Teres ◽  
Diagnostic Biopsy

scholarly journals Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

2020 ◽  
pp. 1-7
Author(s):  
Jayme Augusto Bertelli ◽  
Sushil Nehete ◽  
Elisa Cristiana Winkelmann Duarte ◽  
Neehar Patel ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Median Nerve ◽  
Radial Nerve ◽  
Full Range ◽  
Medial Epicondyle ◽  
Wrist Extension ◽  
Motor Branch ◽  
Nerve Paralysis ◽  
Pronator Teres ◽  
Flexion Extension ◽  
Anterior Side

OBJECTIVEThe authors describe the anatomy of the motor branches of the pronator teres (PT) as it relates to transferring the nerve of the extensor carpi radialis brevis (ECRB) to restore wrist extension in patients with radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer technique in several patients followed for at least 24 months postoperatively.METHODSThe authors dissected both upper limbs of 16 fresh cadavers. In 6 patients undergoing nerve surgery on the elbow, they dissected the branches of the median nerve and confirmed their identity by electrical stimulation. Of these 6 patients, 5 had had a radial nerve injury lasting 7–12 months, underwent transfer of the distal PT motor branch to the ECRB, and were followed for at least 24 months.RESULTSThe PT was innervated by two branches: a proximal branch, arising at a distance between 0 and 40 mm distal to the medial epicondyle, responsible for PT superficial head innervation, and a distal motor branch, emerging from the anterior side of the median nerve at a distance between 25 and 60 mm distal to the medial epicondyle. The distal motor branch of the PT traveled approximately 30 mm along the anterior side of the median nerve; just before the median nerve passed between the PT heads, it bifurcated to innervate the deep head and distal part of the superficial head of the PT. In 30% of the cadaver limbs, the proximal and distal PT branches converged into a single trunk distal to the medial epicondyle, while they converged into a single branch proximal to it in 70% of the limbs. The proximal and distal motor branches of the PT and the nerve to the ECRB had an average of 646, 599, and 457 myelinated fibers, respectively.All patients recovered full range of wrist flexion-extension, grade M4 strength on the British Medical Research Council scale. Grasp strength recovery achieved almost 50% of the strength of the contralateral side. All patients could maintain their wrist in extension while performing grasp measurements.CONCLUSIONSThe distal PT motor branch is suitable for reinnervation of the ECRB in radial nerve paralysis, for as long as 7–12 months postinjury.

Origination of the Muscular Branches of the Median Nerve

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Bin Xu ◽  
Zhen Dong ◽  
Cheng-Gang Zhang ◽  
Yi Zhu ◽  
Dong Tian ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Brachial Plexus Injury ◽  
Electrophysiological Study ◽  
Nerve Roots ◽  
Motor Branch ◽  
Lower Trunk ◽  
Pronator Teres ◽  
Finger Flexion ◽  
Flexor Digitorum

ABSTRACT BACKGROUND: In lower brachial plexus injury, finger flexion after brachialis motor branch transfer is relatively weak. We sought to screen potential branches of the median nerve from the upper trunk for strengthening finger flexion in addition to the brachialis motor branch. However, the spinal origin of the muscular branches of the median nerve based on electrophysiological study was unclear. OBJECTIVE: To determine the spinal origin of the muscular branches of the median nerve. METHODS: An intraoperative electrophysiological study was carried out in 18 patients who underwent contralateral C7 nerve transfer. After exposure of the brachial plexus nerve roots on the healthy side, the amplitude of the compound muscle action potential of each median nerve-innervated muscle was recorded while the different nerve roots were stimulated. RESULTS: The pronator teres received fibers from C5, C6, and C7. It had more contribution from C5 and C6 than from C7 (P < .05). The flexor carpi radialis was innervated mainly by C6 and C7. The nerve branches of the palmaris longus and flexor digitorum superficialis stemmed primarily from C7 and the lower trunk, and no significant difference was found between them (P > .05). The flexor digitorum profundus, flexor pollicis longus, pronator quadratus, and abductor pollicis brevis were innervated predominantly by the lower trunk (P < .05). CONCLUSION: This electrophysiological study indicates that the pronator teres branch might be the most feasible alternative donor nerve to supplement the brachialis motor branch and strengthen finger flexion after lower brachial plexus injury.

Compression neuropathy of the motor branch of the median nerve caused by palmar ganglion

1991 ◽  
Vol 16 (4) ◽  
pp. 751-752 ◽  
Author(s):  
Hiroyuki Kato ◽  
Toshihiko Ogino ◽  
Toshikazu Nanbu ◽  
Kazutaka Nakamura
Keyword(s):  
Median Nerve ◽  
Motor Branch ◽  
Compression Neuropathy

„Dangerous” Anatomic Varieties of Recurrent Motor Branch of Median Nerve

2013 ◽  
Vol 85 (8) ◽  
Author(s):  
Ahmed Elsaftawy ◽  
Bohdan Gworys ◽  
Jerzy Jabłecki ◽  
Tobiasz Szajerka
Keyword(s):  
Median Nerve ◽  
Motor Branch

scholarly journals The Palmar Cutaneous Branch Mimicking the Recurrent Motor Branch of the Median Nerve

2018 ◽  
Vol 10 (01) ◽  
pp. 052-053
Author(s):  
Feiran Wu ◽  
Chye Ng
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Transverse Carpal Ligament ◽  
Proximal Margin ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Iatrogenic Nerve Injury ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Tunnel Syndrome

AbstractWe report an unusual anatomical variant of the palmar cutaneous branch (PCB) of the median nerve in a 46-year-old man presenting with recurrent carpal tunnel syndrome. At surgery, after neurolysis, the PCB was visualized arising at the level of the proximal margin of the transverse carpal ligament, mimicking the appearance of the recurrent motor branch. To date, there has been no description of this branch arising at this level. We aim to remind surgeons of this variation and highlight the importance of maintaining vigilance to avoid iatrogenic nerve injury.

Transient Proximal Median Nerve Entrapment in a Tetraplegic Hand Cyclist Following a 24-Hour Endurance Race

2021 ◽  
Author(s):  
Søren Bruno Elmgreen
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Unusual Case ◽  
Endurance Athlete ◽  
Nerve Entrapment ◽  
Pronator Teres ◽  
Anterior Interosseous Nerve ◽  
Tunnel Syndrome ◽  
Anterior Interosseous Nerve Syndrome

ABSTRACT Median nerve entrapment is a frequent disorder encountered by all clinicians at some point of their career. Affecting the distal median nerve, entrapment occurs most frequently at the level of the wrist resulting in a carpal tunnel syndrome. Median nerve entrapment may also occur proximally giving rise to the much less frequent pronator teres syndrome and even less frequent anterior interosseous nerve syndrome, which owing to the paucity of cases may prove challenging to diagnose. An unusual case of anterior interosseous syndrome precipitated by extraordinary exertion in a tetraplegic endurance athlete is presented with ancillary dynamometric, electrodiagnostic, ultrasonographic, and biochemical findings.

scholarly journals Median Nerve Variation: A Complete Spin before Terminal Branching

2020 ◽  
Vol 15 (01) ◽  
pp. e1-e4
Author(s):  
Amgad S. Hanna ◽  
Zhikui Wei ◽  
Barbara A. Hanna
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Distal Forearm ◽  
Flexor Digitorum Superficialis ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Surgical Interventions ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

AbstractMedian nerve anatomy is of great interest to clinicians and scientists given the importance of this nerve and its association with diseases. A rare anatomical variant of the median nerve in the distal forearm and wrist was discovered during a cadaveric dissection. The median nerve was deep to the flexor digitorum superficialis (FDS) in the carpal tunnel. It underwent a 360-degree spin before emerging at the lateral edge of FDS. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel. This variant doesn't fall into any of Lanz's four groups of median nerve anomalies. We propose a fifth group that involves variations in the course of the median nerve. This report underscores the importance of recognizing variants of the median nerve anatomy in the forearm and wrist during surgical interventions, such as for carpal tunnel syndrome.

Topographic Localization of the Motor Branch of the Median Nerve

2005 ◽  
Vol 30 (4) ◽  
pp. 803-807 ◽  
Author(s):  
Metin Manouchehr Eskandari ◽  
Cengiz Yilmaz ◽  
Volkan Oztuna ◽  
Fehmi Kuyurtar
Keyword(s):  
Median Nerve ◽  
Motor Branch
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