3.14 Nerve Supply of hand

Question 1

Describe the sensory nerve supply of the hand

Answer 1

Four Nerves

1. Ulnar
2. Median
3. Radial
4. Musculocutaneous

Question 2

1. Ulnar

Answer 2

C8-T1 root
Medial cord

Dorsal
Palmar cutaneous branches
arise above the wrist

Palmar branch
supply medial aspect palm
Hypothenar eminence

Dorsal Branch
Dorsal Ulnar border

Question 3

1. Ulnar

Path and divides

Answer 3

Wrist lies lateral to FCU tendon

Hand divides into superficial and deep terminal branches

Superficial
Senosry to Ulnar 1.5 fingers

Deep is motor

Question 4

2. Median

Answer 4

C6-T1 Nerve Roots
Medial and lateral roots of median N
Medial and lat cord BP

Palmar cutaneous N
arises several cm above wrist
Radial side palm

Question 5

2. Median

Answer 5

Nerve lies under palmaris longus tendon
@ wrist
Ends distal to flex retinaculum

Palmar digital nerves
sensory branches to radial 3.5 fingers and thenar eminence

Question 6

3. Radial

Answer 6

C5-T1 Roots
Posterior cord

Nerve deep tendon brachioradialis
reach dorsum hand

cross superficial to tendon of snuffbox

Divides into multiple dig branches
supply dorsal thumb base
Radial side back of hand
Back radial 3.5 fingers

Question 7

4. Musculocutaneous

Answer 7

C5-C7 Root values
Continuation lateral cord BP

Term Branch

Lateral Antebrachial Cutaneous N

Divides into posterior and anterior branches
Supply skin along radial forearm and wrist

Question 8

Nerve blocks

Answer 8

US
SLIMRAG

Elbow
UMR

Wrist
UMR

Question 9

Elbow

Ulnar

Answer 9

Ulnar
LA injection
prox to fibrous tunnel @ medial epicondyle

Avoid injection at sulcus
tight fibrous sheath
aw high incidence post block Nerve damage

Question 10

Elbow

Median

Answer 10

Directing needle medial to brachial pulse in ACF

Question 11

Elbow

Radial

Answer 11

Palpate groove
lateral border bicep
brachioradialis
1-2cm prox to elbow crease
aiming for lateral epicondyle

Question 12

Wrist

Ulnar

Answer 12

Approach from ulnar border
reduce arterial puncture risk

ID medial border
Flexi carpi ulnaris tendor
inject LA 2cm proxial to wrist crease

May miss dorsal and palmar branch - off earlier in foremarm

Question 13

Wrist Median

Answer 13

Advance 2-4cm prox to wrist crease
between:

flex carpi radialis
+
Palmaris longus tendon

Inject LA

Question 14

Wrist Radial

Answer 14

Terminal branch block ring block
around radial border of wrist

LA injected at tip radial styloid
Further injection around surrounding area
Cover branches nerve