In the thenar eminence it provides motor innervation to: An earlier branch of the median nerve also supplies the lumbricals 1 & 2. It is also occasionally referred to as the thenar branch, or the thenar muscular branch, of the median nerve. The importance of a careful dissection of the median nerve in this condition is emphasized. Primary surgical release of median nerve compression at the wrist usually affords good symptomatic relief, but a small but significant number of surgical failures exist. In the thenar eminence it provides motor innervation to: The median nerve arises from the branches from lateral and medial cords of the brachial plexus, courses through the anterior part of arm, forearm, and hand, and terminates by supplying the muscles of the hand. NIH An earlier branch of the median nerve also supplies the lumbricals 1 & 2. It usually passes distal to the transverse carpal ligament.. J Neurosurg. Background: Recurrent carpal tunnel syndrome is often associated with perineural scarring around the median nerve. Carpal tunnel release for compression of the median nerve at the wrist is one of the most common and successful procedures in hand surgery. Get the latest research from NIH: https://www.nih.gov/coronavirus. All other intrinsic muscles of the hand receive their motor innervation from branches of the ulnar nerve. Clipboard, Search History, and several other advanced features are temporarily unavailable. [1] It is also occasionally referred to as the thenar branch, or the thenar muscular branch, of the median nerve. Carpal tunnel syndrome is a specific condition that is caused by compression of the median nerve as it passes through the carpal canal at the level of the wrist joint. [2], This particular nerve is also called "Million Dollar Nerve" because injury to this nerve during carpal tunnel surgery can lead to a million dollar lawsuit. 1996 Oct;189 ( Pt 2)(Pt 2):445-9. Patients with continued complaints after carpal tunnel release … It ends in the opponens pollicis.. After giving off the anterior interosseous and palmar cutaneous branches, the median nerve enters the hand via the carpal tunnel – where it terminates by dividing into two branches: Recurrent branch – innervates the thenar muscles. Hand (N Y). 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. Carpal tunnel decompression in- volves division of the transverse carpal ligament (TCL) to increase the carpal tunnel volume and de- crease the pressure on the median nerve.1 Recently, endoscopy has been used to divide the TCL.2-4 From the Department of Orthopaedic Surgery, Temple University School of Medicine, Shriners Hospital for Children, Philadelphia, PA. Attention should be directed to the inspection and decompression of the motor branch of the median nerve in those cases that present thenar muscle pathology either clinically or electrodiagnostically. After passing through the carpal tunnel, the median nerve gives a branch on the radial side called t h e recurrent motor branch. The time interval to recurrent symptoms can vary widely from patient to patient. A case is discussed in which carpal tunnel syndrome with an unusual course of the motor recurrent branch was discovered at operation. These cases can be subdivided into cases presenting with or without carpal tunnel symptomatology, as well as into two types of independent compression patterns: the first being a direct fascial penetration and entrapment and the second being an acute angulation of the recurrent branch with apparent impingement by the transverse carpal retinaculum. Motor branch anomalies of the median nerve have also been documented in the literature. Eight presentations of concomitant or independent compression of the recurrent motor branch of the median nerve have been reviewed. Epub 2016 Dec 12. Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression. Such injury can happen if the transverse carpal tunnel ligament (flexor retinaculum) is transected too radially. HHS Please enable it to take advantage of the complete set of features! It usually passes distal to the transverse carpal ligament. 2002 Jun;96(6):1046-51. doi: 10.3171/jns.2002.96.6.1046. The recurrent branch of the median nerve is the branch of the median nerve which supplies the thenar muscles. Motor branch anomalies of the median nerve have also been documented in the literature. You don't lose thenar eminence sensation in median nerve damage at the carpal tunnel. High-resolution ultrasound visualization of the recurrent motor branch of the median nerve: normal and first pathological findings. Carpal tunnel compression and its surgical release has been well described. The importance of a careful dissection of the median nerve in this condition is emphasized. Cudlip SA, Howe FA, Clifton A, Schwartz MS, Bell BA. Morphometric studies of the muscular branch of the median nerve. the nerve then enters the hand via the carpal tunnel, along with the tendons of the FDS, FDP and FPL; Terminal branches anterior interosseous branch (AIN) innervates the deep volar compartment of forearm except the ulnar half of the FDP; palmar cutaneous branch . 2017 Oct 15;31(10):1236-1239. doi: 10.7507/1002-1892.201704125. Injury to this nerve can lead to loss of function of the thumb.  |  Independent recurrent motor branch compression of the median nerve appears to exist in the presence of carpal tunnel symptomatology or as an independent entity. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. [4], Superficial palmar nerves. Complications, though rare, are potentially devastating and may include intraoperative technical errors, postoperative infection and pain, and persistent or recurrent symptoms. 2006 Dec;1(2):102-5. doi: 10.1007/s11552-006-9006-2. [Effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist]. 2004 Feb;54(2):397-9; discussion 399-400. doi: 10.1227/01.neu.0000103669.45726.51. Surgical options include relatively invasive procedures, such as fat pad grafting, ligament reconstruction, muscle transfer, and nerve wraps. Riegler G, Pivec C, Platzgummer H, Lieba-Samal D, Brugger P, Jengojan S, Vierhapper M, Bodner G. Eur Radiol. Olave E, Prates JC, Gabrielli C, Pardi P. J Anat. Epub 2016 Apr 5. (Recurrent branch labeled at center left as "Muscular to abductor, opponens, and flexor brevis pollicis. All other intrinsic muscles of the hand receive their motor innervation from branches of the ulnar nerve.. Get the latest public health information from CDC: https://www.coronavirus.gov. 2017 Jan;12(1):60-63. doi: 10.1177/1558944716643095. Bifid median nerve in a patient with carpal tunnel syndrome--correlation of clinical, diagnostic and intraoperative findings: case report and review of the literature. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel. "), https://en.wikipedia.org/w/index.php?title=Recurrent_branch_of_the_median_nerve&oldid=931357761, Creative Commons Attribution-ShareAlike License, This page was last edited on 18 December 2019, at 12:41. 2017 Jul;27(7):2941-2949. doi: 10.1007/s00330-016-4671-1. Hand (N Y). Yang H, Wang B, Li R, Liu Z, Zhang J, Jia S. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. USA.gov.  |  A case is discussed in which carpal tunnel syndrome with an unusual course of the motor recurrent branch was discovered at operation. NLM This site needs JavaScript to work properly. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The carpal canal is formed by the small bones of the wrist on one side and a ligament called the transverse carpal ligament on the other side. Carpal tunnel compression and its surgical release has been well described. Frequency of Incidental Median Thenar Motor Nerve Branch Visualization During Mini-Open and Endoscopic Carpal Tunnel Release. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. This variant doesn't fall into any of Lanz's four groups of median nerve …  |  The recurrent branch of the median nerve is the branch of the median nerve which supplies the thenar muscles. supplies sensory innervation to lateral palm The reason it atrophies is because the muscles making up the thenar eminence (abductor/flexor pollicis brevis and opponens pollicis) are deinnervated by median nerve traction at the level of the wrist in carpal tunnel syndrome. 2017. Lutsky KF, Jones CM, Kim N, Medina J, Matzon JL, Beredjiklian PK. Neurosurgery. Isolated fascial compression of the recurrent motor branch of the median nerve: a case report. COVID-19 is an emerging, rapidly evolving situation.