Recurrent branch of the median nerve

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Recurrent branch of the median nerve
Gray815.png
Superficial palmar nerves. (Recurrent branch labeled at center left as "Muscular to abductor, opponens, and flexor brevis pollicis.")
Details
From median nerve
Identifiers
Latin ramus recurrens nervi mediani
Anatomical terms of neuroanatomy

The recurrent branch of the median nerve is the branch of the median nerve which supplies the thenar muscles. [1] It is also occasionally referred to as the thenar branch of the median nerve, or the thenar muscular branch of the median nerve.

Contents

Anatomy

Course

It usually passes distal[ clarification needed ] to the transverse carpal ligament. [2] It ends in the opponens pollicis. [3]

Distribution

In the thenar eminence, the recurrent branch of the median nerve provides motor innervation to: [4]

A separate, more proximal branch of the median nerve additionally provides motor innervation to the 1st and 2nd lumbricals of the hand. All other intrinsic muscles of the hand receive motor innervation via the ulnar nerve. [2]

Clinical significance

The recurrent branch of the median nerve may be affected in carpal tunnel syndrome, or from its own separate peripheral neuropathies. [5]

Surgery

The recurrent branch of the median nerve is also colloquially called the "Million Dollar Nerve", because injury to this nerve during carpal tunnel surgery can lead to a million dollar lawsuit. Injury to this nerve can lead to loss of function of the thumb. Such injury can happen if the flexor retinaculum is transected too radially. The possibility of injury to this nerve is even greater when it runs through the ligament without any curling at the distal part of the ligament. [6]

See also

Related Research Articles

<span class="mw-page-title-main">Carpal tunnel syndrome</span> Medical condition

Carpal tunnel syndrome (CTS) is a nerve compression syndrome associated with the collected signs and symptoms of compression of the median nerve at the carpal tunnel in the wrist. Carpal tunnel syndrome is an idiopathic syndrome but there are environmental, and medical risk factors associated with the condition. CTS can affect both wrists.

<span class="mw-page-title-main">Median nerve</span> Nerve of the upper limb

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.

<span class="mw-page-title-main">Thenar eminence</span> Mound at the base of the thumb formed by the intrinsic group of muscles

The thenar eminence is the mound formed at the base of the thumb on the palm of the hand by the intrinsic group of muscles of the thumb. The skin overlying this region is the area stimulated when trying to elicit a palmomental reflex. The word thenar comes from Ancient Greek θέναρ (thenar) 'palm of the hand'.

<span class="mw-page-title-main">Ulnar nerve</span> Nerve which runs near the ulna bone

The ulnar nerve is a nerve that runs near the ulna, one of the two long bones in the forearm. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

<span class="mw-page-title-main">Upper limb</span> Consists of the arm, forearm, and hand

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

<span class="mw-page-title-main">Flexor pollicis brevis muscle</span> Muscle in the thenar compartment

The flexor pollicis brevis is a muscle in the hand that flexes the thumb. It is one of three thenar muscles. It has both a superficial part and a deep part.

The flexor pollicis longus is a muscle in the forearm and hand that flexes the thumb. It lies in the same plane as the flexor digitorum profundus. This muscle is unique to humans, being either rudimentary or absent in other primates. A meta-analysis indicated accessory flexor pollicis longus is present in around 48% of the population.

<span class="mw-page-title-main">Abductor pollicis brevis muscle</span> Muscle of the thumb

The abductor pollicis brevis is a muscle in the hand that functions as an abductor of the thumb.

<span class="mw-page-title-main">Opponens digiti minimi muscle of hand</span> Muscle in the hypothenar compartment

The opponens digiti minimi is a muscle in the hand. It is of a triangular form, and placed immediately beneath the palmaris brevis, abductor digiti minimi and flexor digiti minimi brevis. It is one of the three hypothenar muscles that control the little finger.

<span class="mw-page-title-main">Opponens pollicis muscle</span> Muscle in the thenar compartment

The opponens pollicis is a small, triangular muscle in the hand, which functions to oppose the thumb. It is one of the three thenar muscles. It lies deep to the abductor pollicis brevis and lateral to the flexor pollicis brevis.

<span class="mw-page-title-main">Hypothenar eminence</span> Group of three muscles of the palm

The hypothenar muscles are a group of three muscles of the palm that control the motion of the little finger.

The posterior compartment of the forearm contains twelve muscles which primarily extend the wrist and digits. It is separated from the anterior compartment by the interosseous membrane between the radius and ulna.

<span class="mw-page-title-main">Carpal tunnel</span> Structure of human wrist

In the human body, the carpal tunnel or carpal canal is a flattened body cavity on the flexor (palmar/volar) side of the wrist, bounded by the carpal bones and flexor retinaculum. It forms the passageway that transmits the median nerve and the tendons of the extrinsic flexor muscles of the hand from the forearm to the hand. The median artery is an anatomical variant. When present it lies between the radial artery, and the ulnar artery and runs with the median nerve supplying the same structures innervated.

<span class="mw-page-title-main">Cervical spinal nerve 8</span> Spinal nerve of the cervical segment

The cervical spinal nerve 8 (C8) is a spinal nerve of the cervical segment.

<span class="mw-page-title-main">Muscles of the hand</span> Muscles of the human hand

The muscles of the hand are the skeletal muscles responsible for the movement of the hand and fingers. The muscles of the hand can be subdivided into two groups: the extrinsic and intrinsic muscle groups. The extrinsic muscle groups are the long flexors and extensors. They are called extrinsic because the muscle belly is located on the forearm. The intrinsic group are the smaller muscles located within the hand itself. The muscles of the hand are innervated by the radial, median, and ulnar nerves from the brachial plexus.

<span class="mw-page-title-main">Pronator teres syndrome</span> Medical condition

Pronator teres syndrome is a compression neuropathy of the median nerve at the elbow. It is rare compared to compression at the wrist or isolated injury of the anterior interosseous branch of the median nerve.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

<span class="mw-page-title-main">Carpal tunnel surgery</span> Surgery to relieve carpal tunnel syndrome

Carpal tunnel surgery, also called carpal tunnel release (CTR) and carpal tunnel decompression surgery, is a nerve decompression in which the transverse carpal ligament is divided. It is a surgical treatment for carpal tunnel syndrome (CTS) and recommended when there is constant (not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms of pain in the carpal tunnel. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment. Approximately 500,000 surgical procedures are performed each year, and the economic impact of this condition is estimated to exceed $2 billion annually.

<span class="mw-page-title-main">Muscles of the thumb</span>

The muscles of the thumb are nine skeletal muscles located in the hand and forearm. The muscles allow for flexion, extension, adduction, abduction and opposition of the thumb. The muscles acting on the thumb can be divided into two groups: The extrinsic hand muscles, with their muscle bellies located in the forearm, and the intrinsic hand muscles, with their muscles bellies located in the hand proper.

<span class="mw-page-title-main">Palmaris profundus muscle</span>

Palmaris profundus is a rare anatomical variant in the anterior compartment of forearm. It was first described in 1908. It is usually found incidentally in cadaveric dissection or surgery.

References

  1. Median nerve
  2. 1 2 Kozin SH (1998). "The anatomy of the recurrent branch of the median nerve". J Hand Surg Am. 23 (5): 852–8. doi:10.1016/S0363-5023(98)80162-7. PMID   9763261.
  3. Ellis, Harold; Susan Standring; Gray, Henry David (2005). Gray's anatomy: the anatomical basis of clinical practice. St. Louis, Mo: Elsevier Churchill Livingstone. p.  728. ISBN   0-443-07168-3.
  4. Tonkin, Michael (2010-01-01), Sambrook, Philip; Schrieber, Leslie; Taylor, Thomas; Ellis, Andrew M. (eds.), "3 - NERVE COMPRESSION SYNDROMES", The Musculoskeletal System (Second Edition), Churchill Livingstone, pp. 33–45, ISBN   978-0-7020-3377-3 , retrieved 2021-01-11
  5. Bennett, J. B.; Crouch, C. C. (July 1982). "Compression syndrome of the recurrent motor branch of the median nerve". The Journal of Hand Surgery. 7 (4): 407–409. doi:10.1016/s0363-5023(82)80155-x. ISSN   0363-5023. PMID   7119403.
  6. Christian, de Virgilio; Paul N, Frank; Areg, Grigorian (10 January 2015). Surgery: A Case Based Clinical Review. Springer. p. 316. ISBN   9781493917266 . Retrieved 26 January 2018.