A Study on Distribution and Mode of Origin of Median Nerve and its Relation to the Flexor Retinaculum

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Abstract

Introduction:The precise knowledge of level of origin of muscular branches of median nerve are essential in free muscular transfers to restore the mobility of fingers after trauma and to understand the various presentations of nerve entrapment. The anatomical knowledge and variations of recurrent nerve is important to prevent the complications during the release of transverse carpal ligament.Aim & Objectives: To study the points of origin of muscular branches with respect to IEL and number of branches to muscles of forearm and also learn the mode of origin of recurrent nerve and its relation to the flexor retinaculum.Subjects and Methods:Dissection 40 upper limbs procured from embalmed cadavers of Dr. VRK Womens Medical College, Hospital and Research Centre, Hyderabad, for the study.Results:The mean of point of origin of NPT was 1.21 cm proximal and 1.20 cm distal to IEL whereas for NFCR, NPL, NFDS and AIN nerve it was 2.12 cm, cm, 4.54 cm and 3.29 cm distal to IEL respectively. The number of branches to muscles of forearm varied from 1 to 3. The recurrent nerve was arising from lateral and intermediate branches of median nerve in 39 (97.5%) and 1 specimens (6%) respectively. Its relationship with flexor retinaculum was extra ligamentous in 33 specimens (82.5%) and transligamentous in 7 specimens (17.5%). It innervated APB, FPB and OP in 19 specimens (47.5%), only APB, FPB in 16 specimens (45%) and only APB, OP in 3 specimens (7.5%).Conclusion:All the muscular branches of median nerve were arising predominantly distal to IEL except nerve to pronator teres. The number of branches varied from 1 to 3. In majority of the specimens, the recurrent nerve was arising from the lateral terminal branch of median nerve and its relation with flexor retinaculum was extraligamentous.