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  1. An unusual case of additional branches of median nerve innervating the corachobrachialis muscle and its clinical implications
    Das S, Maatoq Sulaiman I, Hussan F, Haji Suhaimi F, Latiff AA, Othman F
    Clin Ter, 2009;160(1):25-7.
    PMID: 19290409
    The flexor compartment muscles of the arm comprising of biceps brachii, brachialis and the coracobrachialis are innervated by the musculocutaneous nerve arising from the lateral cord of the brachial plexus. In the present study, we report a case of anomalous innervation of the corachobrachialis muscle on the left side of a 45-year-old male cadaver. The musculocutaneous nerve originated from the lateral cord, as usual and pierced the corachobrachialis muscle. The median nerve was formed by a contribution from both lateral and medial roots, both of which took origin from the lateral and medial cords, respectively. In addition to the usual musculocutaneous nerve which pierced the corachobrachialis muscle and innervated it, two more anomalous branches from the median nerve were observed to innervate the corachobrachialis. The anatomical knowledge of the variations of the innervations of the corachobrachialis muscle may be important not only for surgeons performing coracoid transfer but also for clinicians diagnosing nerve lesions.
    Matched MeSH terms: Median Nerve/abnormalities; Median Nerve/anatomy & histology*
  2. An anomalous muscle in the distal half of the arm
    Dharap AS
    Surg Radiol Anat, 1994;16(1):97-9.
    PMID: 8047976
    During dissection an anomalous muscle was found on the medial aspect in the distal half of one left upper extremity. This muscle arose from the humerus between the m. coracobrachialis and the m. brachialis, passed obliquely across the front of the brachial artery and median nerve and blended with the common origin of the forearm flexor muscles. It does not appear to be an additional head of the biceps brachii or the brachialis muscles. The existence of this anomalous muscle should be kept in mind in a patient presenting with a high median nerve palsy together with symptoms of brachial artery compression.
    Matched MeSH terms: Median Nerve/pathology
  3. Anatomical variations of median nerve formation, distribution and possible communication with other nerves in preserved human cadavers
    Mat Taib CN, Hassan SN, Esa N, Mohd Moklas MA, San AA
    Folia Morphol (Warsz), 2016 09 26;76(1):38-43.
    PMID: 27665953 DOI: 10.5603/FM.a2016.0045
    Formation, distribution and possible communication of the median nerve are essential to know in treatment and surgeries of various conditions of injuries e.g. repair or reconstruction of the median nerve post traumatic accident. In the present study, 44 upper limbs were dissected. Root forming the median nerve, the median nerve in relation with the axillary artery and communication of the median nerve with other nerves were noted.
    Matched MeSH terms: Median Nerve/anatomy & histology*
  4. Fulltext A Palmar Lipoma with Median and Ulnar Nerve Compressive Symptoms
    Azwa, N., Shalimar, A., Jamari, S.
    Malays Orthop J, 2007;1(2):33-35.
    MyJurnal
    Although lipoma is common in the upper limbs, it rarely occurs in the palm, and usually does not compress the surrounding structures. Here, we report a patient presenting with compressive neuropathy of the ulna and median nerves secondary to a palmar lipoma. Surgical excision led to full neurological recovery.
    Matched MeSH terms: Median Nerve
  5. Fulltext End-to-side nerve transfer in neuropathic pain post brachial plexus injury
    Nur Dina, A., Shalimar, A.
    JUMMEC, 2013;21(2):71-73.
    MyJurnal
    We report a case of a 59-year-old gentleman with complete left brachial plexus injury. He presented with
    chronic pain over the dorsum of his left hand since the injury eight years ago. Medical treatment had been
    optimised but the pain still persist. End-to-side nerve transfer was done involving superficial sensory radial
    nerve and median nerve to alleviate the pain. The surgery was considered successful as the patient claimed
    that the pain score had reduced a few weeks postoperatively. However, there was no sensory recovery and
    functionally no improvement was observed.
    Matched MeSH terms: Median Nerve
  6. Carpal tunnel syndrome: between conservative treatment and those treated surgically after failed conservative treatment
    Omar MI
    JUMMEC, 2005;8:50-55.
    A retrospective study of 102 hands with carpal tunnel syndrome which were treated conservatively initially. Patients who were successfully treated with this method were then compared with those who had failed with this method and had to be treated with surgical decompression. This study found that it took a mean period of about 5.1 months of conservative treatment before deciding on surgery. Generally, the study shows a predominant involvement of the right hand and the female sex as full-time homemakers. Those who finally needed surgery had a longer duration of symptoms prior to consultation. Surgery brought a faster relief from both pain and numbness. It is recommended that conservative treatment be abandoned after a trial period of at least three to five months in order to encourage a speedier recovery.
    Matched MeSH terms: Median Nerve
  7. Multiple arterial, neural and muscular variations in upper limb of a single cadaver
    Vollala VR, Nagabhooshana S, Bhat SM, Potu BK, Rodrigues V, Pamidi N
    Rom J Morphol Embryol, 2009;50(1):129-35.
    PMID: 19221659
    During routine dissection classes to undergraduate medical students, we have observed some important anatomic variations in the right upper limb of a 45-year-old cadaver. The anomalies were superficial ulnar artery, persistent median artery, variant superficial palmar arch, third head for biceps brachii, accessory head for flexor pollicis longus, variant insertion of pectoralis major, absence of musculocutaneous nerve, coracobrachialis muscle supplied by lateral root of median nerve and anomalous branching of median nerve in arm and forearm. Although there are individual reports about these variations, the combination of these variations in one cadaver has not previously been described in the literature consulted. Awareness of these variations is necessary to avoid complications during radiodiagnostic procedures or surgeries in the upper limb.
    Matched MeSH terms: Median Nerve/abnormalities; Median Nerve/pathology
  8. Fulltext Unusual variations of the lateral and posterior cords in a female cadaver
    Thwin SS, Zaini F, Than M, Lwin S, Myint M
    Singapore Med J, 2012 Jun;53(6):e128-30.
    PMID: 22711051
    The presence of anatomical variations of the peripheral nervous system often accounts for unexpected clinical signs and symptoms. We report unusual variations of the lateral and posterior cords of the brachial plexus in a female cadaver. Such variations are attributed to a faulty union of divisions of the brachial plexus during the embryonic period. The median nerve lay medial to the axillary artery (AA) on both sides. On the right, the lateral root of the median nerve crossing the AA and the median nerve in relation to the medial side of the AA was likely the result of a faulty development of the seventh intersegmental artery. We discuss these variations and compare them with the findings of other researchers. Knowledge of such rare variations is clinically important, aiding radiologists, anaesthesiologists and surgeons to avoid inadvertent damage to nerves and the AA during blocks and surgical interventions.
    Matched MeSH terms: Median Nerve/abnormalities; Median Nerve/anatomy & histology
  9. Fulltext Median nerve stimulation induces analgesia via orexin-initiated endocannabinoid disinhibition in the periaqueductal gray
    Chen YH, Lee HJ, Lee MT, Wu YT, Lee YH, Hwang LL, et al.
    Proc Natl Acad Sci U S A, 2018 11 06;115(45):E10720-E10729.
    PMID: 30348772 DOI: 10.1073/pnas.1807991115
    Adequate pain management remains an unmet medical need. We previously revealed an opioid-independent analgesic mechanism mediated by orexin 1 receptor (OX1R)-initiated 2-arachidonoylglycerol (2-AG) signaling in the ventrolateral periaqueductal gray (vlPAG). Here, we found that low-frequency median nerve stimulation (MNS) through acupuncture needles at the PC6 (Neiguan) acupoint (MNS-PC6) induced an antinociceptive effect that engaged this mechanism. In mice, MNS-PC6 reduced acute thermal nociceptive responses and neuropathy-induced mechanical allodynia, increased the number of c-Fos-immunoreactive hypothalamic orexin neurons, and led to higher orexin A and lower GABA levels in the vlPAG. Such responses were not seen in mice with PC6 needle insertion only or electrical stimulation of the lateral deltoid, a nonmedian nerve-innervated location. Directly stimulating the surgically exposed median nerve also increased vlPAG orexin A levels. MNS-PC6-induced antinociception (MNS-PC6-IA) was prevented by proximal block of the median nerve with lidocaine as well as by systemic or intravlPAG injection of an antagonist of OX1Rs or cannabinoid 1 receptors (CB1Rs) but not by opioid receptor antagonists. Systemic blockade of OX1Rs or CB1Rs also restored vlPAG GABA levels after MNS-PC6. A cannabinoid (2-AG)-dependent mechanism was also implicated by the observations that MNS-PC6-IA was prevented by intravlPAG inhibition of 2-AG synthesis and was attenuated in Cnr1-/- mice. These findings suggest that PC6-targeting low-frequency MNS activates hypothalamic orexin neurons, releasing orexins to induce analgesia through a CB1R-dependent cascade mediated by OX1R-initiated 2-AG retrograde disinhibition in the vlPAG. The opioid-independent characteristic of MNS-PC6-induced analgesia may provide a strategy for pain management in opioid-tolerant patients.
    Matched MeSH terms: Median Nerve/drug effects; Median Nerve/physiology*
  10. Median nerve compression by gouty tophi: a case report
    Raffael, I., Rajesh, S.
    International Medical Journal Malaysia, 2015;14(1):87-91.
    MyJurnal
    We describe a case of median nerve compression by gouty tophi. This is a rare condition and presented with loss of function with paraesthesia of both hands in addition to multiple tophis. Surgery was chosen for immediate relief, where a debulking of left flexor digitorum superficialis with decompression of carpal tunnel was done and resulted in improvement of symptoms but became complicated due to inadequate physiotherapy.
    Matched MeSH terms: Median Nerve
  11. Incidental Trifid Median Nerve Unveiled in a Lactating Mother
    Siddiq MAB, Hossain Parash MT
    Cureus, 2019 Sep 30;11(9):e5809.
    PMID: 31728251 DOI: 10.7759/cureus.5809
    Several anatomical variations concerning the median nerve have surfaced in the medical literature. Among them, bifid median nerve or median nerve bifurcation with or without persistent median artery has been widely reported. Sporadic case reports describe median nerve trifurcation (trifid median nerve) as well. In the present report, we describe carpal tunnel syndrome manifestations in association with trifid median nerve unveiled incidentally under high-frequency musculoskeletal ultrasonogram in a lactating mother-a first in the medical literature.
    Matched MeSH terms: Median Nerve
  12. Partial anterior interosseous nerve palsy: isolated neuropraxia of the branch to flexor pollicis longus
    Haflah NH, Rashid AH, Sapuan J
    Hand Surg, 2010;15(3):221-3.
    PMID: 21089198
    Anterior interosseous nerve palsy is rare. Isolated neuropraxia of its branch to the flexor pollicis longus is even rarer. We present a case of a 24-year-old man who presented with weakness of his left thumb flexion after sustaining closed fracture of the proximal third of his left radius. On exploration, the anterior interosseous nerve and its branches was found to be intact as was the flexor pollicis longus. Electrophysiological studies demonstrated acute left anterior interosseous nerve neuropathy. Electromyography showed discrete motor unit at the flexor pollicis longus. Two months later the patient had full recovery of the flexor pollicis longus. We would like to highlight this rare occurrence and present a detailed history of this case to increase awareness amongst clinicians regarding this condition.
    Matched MeSH terms: Median Nerve/injuries*
  13. Fulltext Delayed chronic polyneuropathy following organophosphate poisoning: a case report
    Low ET, Loh TG
    Med J Malaysia, 1987 Jun;42(2):113-4.
    PMID: 2845234
    A patient with organophosphate poisoning who survived the acute phase and subsequently developed delayed neuropathy is presented. The features of this form of delayed neuropathy are described and the implications in our local context discussed.
    Matched MeSH terms: Median Nerve/physiopathology
  14. Fulltext Has the median nerve involvement in rheumatoid arthritis been overemphasized?
    Sakthiswary R, Singh R
    Rev Bras Reumatol Engl Ed, 2016 09 30;57(2):122-128.
    PMID: 28343616 DOI: 10.1016/j.rbre.2016.09.001
    Rheumatoid arthritis (RA) is a well and widely recognized cause of carpal tunnel syndrome (CTS). In the rheumatoid wrist, synovial expansion, joint erosions and ligamentous laxity result in compression of the median nerve due to increased intracarpal pressure. We evaluated the published studies to determine the prevalence of CTS and the characteristics of the median nerve in RA and its association with clinical parameters such as disease activity, disease duration and seropositivity. A total of 13 studies met the eligibility criteria. Pooled data from 8 studies with random selection of RA patients revealed that 86 out of 1561 (5.5%) subjects had CTS. Subclinical CTS, on the other hand, had a pooled prevalence of 14.0% (30/215). The cross sectional area of the median nerve of the RA patients without CTS were similar to the healthy controls. The vast majority of the studies (8/13) disclosed no significant relationship between the median nerve findings and the clinical or laboratory parameters in RA. The link between RA and the median nerve abnormalities has been overemphasized throughout the literature. The prevalence of CTS in RA is similar to the general population without any correlation between the median nerve characteristics and the clinical parameters of RA.
    Matched MeSH terms: Median Nerve/pathology*
  15. Fulltext Melorheostosis of the hand affecting the c6 sclerotome and presenting with carpal tunnel syndrome
    Abdullah S, Mat Nor NF, Mohamed Haflah NH
    Singapore Med J, 2014 Apr;55(4):e54-6.
    PMID: 24763843
    Melorheostosis is a rare, progressive bone disease accompanied by hyperostosis and soft tissue fibrosis. While affected adults present with contracture and pain, children present with limb length discrepancy and deformity. We report the case of a 20-year-old woman with melorheostosis since childhood who presented with right hand deformity and numbness. Radiographs showed not only a combination of dense sclerosis and opacities, but also the classic 'flowing candle wax' appearance. Radiography can be used to identify melorheostosis, thus preventing unnecessary bone biopsies. Carpal tunnel release revealed the presence of a thickened flexor retinaculum and a degenerated median nerve distal to the retinaculum, but did not show hyperostosis. This case highlights the role of nerve decompression in melorheostosis and the importance of early identification of the disease to prevent unnecessary bone biopsies.
    Matched MeSH terms: Median Nerve/surgery
  16. Fulltext Carpal tunnel syndrome in pregnancy : is there really oedema in the carpal tunnel?
    Mohamed Faizal Sikkandar, Shalimar Abdullah, Rajesh Singh, Parminder Singh Gill, Nur Azuatul Akmal Kamaludin, Tan Jin Aun, et al.
    Malaysian Journal of Medicine and Health Sciences, 2020;16(1):191-195.
    MyJurnal
    Introduction: Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ul- trasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm ie larger, while non-CTS patients had a mean of 0.797 cm inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were sta- tistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.
    Matched MeSH terms: Median Nerve
  17. Fulltext Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies
    Tunku-Naziha TZ, Wan-Yuhana W, Hadizie D, Muhammad-Paiman, Abdul-Nawfar S, Wan-Azman WS, et al.
    Malays Orthop J, 2017 Mar;11(1):12-17.
    PMID: 28435568 MyJurnal DOI: 10.5704/MOJ.1703.005
    The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.
    Matched MeSH terms: Median Nerve
  18. A model to predict the probability of acute inflammatory demyelinating polyneuropathy
    Tan CY, Sekiguchi Y, Goh KJ, Kuwabara S, Shahrizaila N
    Clin Neurophysiol, 2020 01;131(1):63-69.
    PMID: 31751842 DOI: 10.1016/j.clinph.2019.09.025
    OBJECTIVE: We aimed to develop a model that can predict the probabilities of acute inflammatory demyelinating polyneuropathy (AIDP) based on nerve conduction studies (NCS) done within eight weeks.

    METHODS: The derivation cohort included 90 Malaysian GBS patients with two sets of NCS performed early (1-20days) and late (3-8 weeks). Potential predictors of AIDP were considered in univariate and multivariate logistic regression models to develop a predictive model. The model was externally validated in 102 Japanese GBS patients.

    RESULTS: Median motor conduction velocity (MCV), ulnar distal motor latency (DML) and abnormal ulnar/normal sural pattern were independently associated with AIDP at both timepoints (median MCV: p = 0.038, p = 0.014; ulnar DML: p = 0.002, p = 0.003; sural sparing: p = 0.033, p = 0.009). There was good discrimination of AIDP (area under the curve (AUC) 0.86-0.89) and this was valid in the validation cohort (AUC 0.74-0.94). Scores ranged from 0 to 6, and corresponded to AIDP probabilities of 15-98% at early NCS and 6-100% at late NCS.

    CONCLUSION: The probabilities of AIDP could be reliably predicted based on median MCV, ulnar DML and ulnar/sural sparing pattern that were determined at early and late stages of GBS.

    SIGNIFICANCE: A simple and valid model was developed which can accurately predict the probability of AIDP.

    Matched MeSH terms: Median Nerve/physiopathology*
  19. Median Nerve Stimulation as a Nonpharmacological Approach to Bypass Analgesic Tolerance to Morphine: A Proof-of-Concept Study in Mice
    Lee MT, Chen YH, Mackie K, Chiou LC
    J Pain, 2021 03;22(3):300-312.
    PMID: 33069869 DOI: 10.1016/j.jpain.2020.09.003
    Analgesic tolerance to opioids contributes to the opioid crisis by increasing the quantity of opioids prescribed and consumed. Thus, there is a need to develop non-opioid-based pain-relieving regimens as well as strategies to circumvent opioid tolerance. Previously, we revealed a non-opioid analgesic mechanism induced by median nerve electrostimulation at the overlaying PC6 (Neiguan) acupoint (MNS-PC6). Here, we further examined the efficacy of MNS-PC6 in morphine-tolerant mice with neuropathic pain induced by chronic constriction injury (CCI) of the sciatic nerve. Daily treatments of MNS-PC6 (2 Hz, 2 mA), but not electrostimulation at a nonmedian nerve-innervated location, for a week post-CCI induction significantly suppressed established mechanical allodynia in CCI-mice in an orexin-1 (OX1) and cannabinoid-1 (CB1) receptor-dependent fashion. This antiallodynic effect induced by repeated MNS-PC6 was comparable to that induced by repeated gabapentin (50 mg/kg, i.p.) or single morphine (10 mg/kg, i.p.) treatments, but without tolerance, unlike repeated morphine-induced analgesia. Furthermore, single and repeated MNS-PC6 treatments remained fully effective in morphine-tolerant CCI-mice, also in an OX1 and CB1 receptor-dependent fashion. In CCI-mice receiving escalating doses of morphine for 21 days (10, 20 and 50 mg/kg), single and repeated MNS-PC6 treatments remained fully effective. Therefore, repeated MNS-PC6 treatments induce analgesia without tolerance, and retain efficacy in opioid-tolerant mice via a mechanism that involves OX1 and CB1 receptors. This study suggests that MNS-PC6 is an alternative pain management strategy that maybe useful for combatting the opioid epidemic, and opioid-tolerant patients receiving palliative care. PERSPECTIVE: Median nerve stimulation relieves neuropathic pain in mice without tolerance and retains efficacy even in mice with analgesic tolerance to escalating doses of morphine, via an opioid-independent, orexin-endocannabinoid-mediated mechanism. This study provides a proof of concept for utilizing peripheral nerve stimulating devices for pain management in opioid-tolerant patients.
    Matched MeSH terms: Median Nerve*
  20. Nerve conduction study of healthy Asian Malays: the influence of age on median, ulnar, and sural nerves
    Awang MS, Abdullah JM, Abdullah MR, Tahir A, Tharakan J, Prasad A, et al.
    Med Sci Monit, 2007 Jul;13(7):CR330-2.
    PMID: 17599028
    Nerve conduction study is essential in the diagnosis of focal neuropathies and diffuse polyneuropathies. There are many factors that can affect nerve conduction velocity, and age is one of them. Most of the many studies of this effect, and the values from them, were on Caucasian subjects. Therefore, this study was designed to investigate the effect of age on conduction velocity among healthy Asian Malay subjects by analyzing its influence on the median, ulnar, and sural nerves.
    Matched MeSH terms: Median Nerve/metabolism
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