Median Nerve

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five
main nerves originating from the brachial plexus. The median nerve originates from the lateral
and medial cords of the brachial plexus, and has contributions from ventral roots of C5, C6 & C7
(lateral cord) and C8 & T1 (medial cord). The median nerve is the only nerve that passes through
the carpal tunnel. Carpal tunnel syndrome is the disability that results from the median nerve
being pressed in the carpal tunnel.

After receiving inputs from both the lateral and medial cords of the brachial plexus, the median
nerve enters the arm from the axilla at the inferior margin of the teres major muscle. It then
passes vertically down and courses with the brachial artery on the medial side of the arm
between biceps brachii and brachialis. At first it is lateral to the artery and lies anterior to the
elbow joint; it then crosses anteriorly to run medial to the artery in the distal arm and into the
cubital fossa. Inside the cubital fossa the median nerve passes medial to the brachial artery, in
front of the point of insertion of the brachialis muscle and deep to the biceps. The median nerve
gives off an articular branch in the upper arm as it passes the elbow joint. A branch to pronator
teres may arise from the median nerve immediately proximal to the elbow joint.

In arm, the median nerve has no voluntary motor or cutaneous function in the brachium. It gives
vascular branches to the wall of the brachial artery. These vascular branches carry sympathetic
fibers.
It innervates all of the flexors in the forearm except flexor carpi ulnaris and that part of flexor
digitorum profundus that supplies the 4th and 5th digits. The latter two muscles are supplied by
the ulnar nerve (specifically the Muscular branches of ulnar nerve).

The main portion of the median nerve supplies the following muscles:

 Superficial group:
a) Pronator teres
b) Flexor carpi radialis
c) Palmaris longus
 Intermediate group:
a) Flexor digitorum superficialis muscle
b) The anterior interosseus branch of the median nerve supplies the following muscles:
 Deep group:
a) Flexor digitorum profundus (only the lateral half)
b) Flexor pollicis longus
c) Pronator quadratus

For palm, the median nerve innervated the cutaneous of the right palm. Areas colored are
supplied by the median nerve. In the palm, the median nerve supplies motor innervation to the
1st and 2nd lumbrical muscles. It also supplies the muscles of the thenar eminence by a recurrent
thenar branch. The rest of the intrinsic muscles of the hand are supplied by the ulnar nerve.

The median nerve innervates the skin of the palmar side of the thumb, the index and middle
finger, half the ring finger, and the nail bed of these fingers. The lateral part of the palm is
supplied by the palmar cutaneous branch of the median nerve, which leaves the nerve proximal
to the wrist creases. This palmar cutaneous branch travels in a separate fascial groove adjacent to
the flexor carpi radialis and then superficial to the flexor retinaculum. It is therefore spared in
carpal tunnel syndrome.

The muscles of the hand supplied by the median nerve:

a) Lumbricals 1 & 2
b) Opponens pollicis
c) Abductor pollicis brevis
d) Flexor pollicis brevis

Why the pain radiates?

Explain about electromyogram?

Electromyography, or EMG, involves testing the electrical activity of muscles. Often, EMG
testing is performed with another test that measures the conducting function of nerves. This is
called a nerve conduction study. Because both tests are often performed at the same office visit
and by the same personnel, the risks and procedures generally apply to both tests.

Muscular movement involves the action of muscles and nerves and needs an electrical current.
This electrical current is much weaker than the one in household wiring. In some medical
conditions the electrical activity of the muscles or nerves is not normal. Finding and describing
these electrical properties in the muscle or nerve may help the doctor diagnose the patient's
condition.

During EMG, small pins or needles are inserted into muscles to measure electrical activity. The
needles are different than needles used for injection of medications. They are small and solid, not
hollow like hypodermic needles. Because no medication is injected, discomfort is much less than
with shots.

 The patient will be asked to contract his or her muscles by moving a small amount during
the testing.
 With nerve conduction studies, small electrodes will be taped to the skin or placed around
the fingers. The patient typically will experience a mild and brief tingling or shock, which
may be a bit unpleasant.
 The person who administers the test will explain the procedure. Often muscle activity is
monitored through a speaker during the test, which may make a popping or soft roaring
noise. The EMG technician will be looking at an oscilloscope, which looks like a small
TV set during the procedure.
 Testing may take 30 to 60 minutes.

RESOURCES
http://www.healthline.com/human-body-maps/median-nerve

http://teachmeanatomy.info/upper-limb/nerves/the-median-nerve/

http://www.emedicinehealth.com/electromyography_emg/article_em.htm

http://www.emedicinehealth.com/electromyography_emg/page3_em.htm#emg_preparation