Low Median Nerve Palsy
- Loss of the abductor pollicis brevis (APB)
- Loss of the opponens of the thumb
High Median Nerve Palsy
This is a very disabling condition.
- Loss of index and long finger flexion
- Loss of wrist flexors
- Loss of forearm pronation
- Loss of thumb flexion
- Sensory Loss
- There is almost complete loss of grasp except in the ring and little fingers. If the ulnar-supplied half of the profundus (FDP)is strong and active, the profundus tendons of the index and long fingers can be connected to the tendons of the ring and little finger in the forearm, proximal to the wrist using a side to side repair. This will allow the ulnar-supplied profundus to flex all four fingers. If needed, the FDP of index & long fingers may be reinforced by transfer of extensor carpi radialis longus (ECRL) to give them more strength. (photo credit)
- To balance the wrist flexion, the flexor carpi ulnaris (FCU) tendon can be split and attached half to the flexor carpi radialis (FCR) and half to its own FCU insertion.
- The thumb flexion can be restored by using the ECRL can be detaches at its insertion, pulled out halfway up the forearm, and tunneled anteriorly to be anastomosed to the flexor pollicis longus (FPL). Alternatively, the FPL can be reinforced by using the Brachioradialis.
- Abduction of the thumb can be restored using the extensor carpi ulnaris (ECU). The ECU is brought around the ulnar side of the forearm and extended by means of a free graft. This will also help with pronation of the forearm. Other options include the Burkhalter (as above) EIP to the APB
Tendon Transfers by Linda L Zeineh, MD--eMedicine Article
Tendon Transfer Principles and Mechanics by Premal Sanghavi, MD --eMedicine Article
High Median Nerve Lesions--Wheeless' Orthopaedics Online
Tendon Transfers for Low Median Nerve Lesions: Camitiz Procedure--Wheeless' Orthopaedics Online
Atlas of Hand Surgery By Sigurd Pechlaner--Google eBooks