Recurrent branch of the median nerve

The recurrent branch of the median nerve is the branch of the median nerve which supplies the thenar muscles.[1] It is also occasionally referred to as the thenar branch of the median nerve, or the thenar muscular branch of the median nerve.

Recurrent branch of the median nerve
Superficial palmar nerves. (Recurrent branch labeled at center left as "Muscular to abductor, opponens, and flexor brevis pollicis.")
Details
Frommedian nerve
Identifiers
Latinramus recurrens nervi mediani
Anatomical terms of neuroanatomy

Anatomy

Course

It usually passes distal to the transverse carpal ligament.[2] It ends in the opponens pollicis.[3]

Distribution

In the thenar eminence, the recurrent branch of the median nerve provides motor innervation to:[4]

A separate, more proximal branch of the median nerve additionally provides motor innervation to the 1st and 2nd lumbricals of the hand. All other intrinsic muscles of the hand receive motor innervation via the ulnar nerve.[2]

Clinical significance

The recurrent branch of the median nerve may be affected in carpal tunnel syndrome, or from its own separate peripheral neuropathies.[5]

Surgery

The recurrent branch of the median nerve is also colloquially called the "Million Dollar Nerve", because injury to this nerve during carpal tunnel surgery can lead to a million dollar lawsuit. Injury to this nerve can lead to loss of function of the thumb. Such injury can happen if the flexor retinaculum is transected too radially. 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.[6]

References
  1. Median nerve
  2. Kozin SH (1998). "The anatomy of the recurrent branch of the median nerve". J Hand Surg Am. 23 (5): 852–8. doi:10.1016/S0363-5023(98)80162-7. PMID 9763261.
  3. Ellis, Harold; Susan Standring; Gray, Henry David (2005). Gray's anatomy: the anatomical basis of clinical practice. St. Louis, Mo: Elsevier Churchill Livingstone. p. 728. ISBN 0-443-07168-3.
  4. Tonkin, Michael (2010-01-01), Sambrook, Philip; Schrieber, Leslie; Taylor, Thomas; Ellis, Andrew M. (eds.), "3 - NERVE COMPRESSION SYNDROMES", The Musculoskeletal System (Second Edition), Churchill Livingstone, pp. 33–45, ISBN 978-0-7020-3377-3, retrieved 2021-01-11
  5. Bennett, J. B.; Crouch, C. C. (July 1982). "Compression syndrome of the recurrent motor branch of the median nerve". The Journal of Hand Surgery. 7 (4): 407–409. doi:10.1016/s0363-5023(82)80155-x. ISSN 0363-5023. PMID 7119403.
  6. Christian, de Virgilio; Paul N, Frank; Areg, Grigorian (10 January 2015). Surgery: A Case Based Clinical Review. Springer. p. 316. ISBN 9781493917266. Retrieved 26 January 2018.
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