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Excursion and Strain of the Median Nerve*
THOMAS W. WRIGHT, M.D.†; FRANK GLOWCZEWSKIE, JR., B.A.†; DONNA WHEELER, PH.D.†; GARY MILLER, PH.D.†; DAVID COWIN, B.A.†, GAINESVILLE, FLORIDA
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Investigation performed at the University of Florida, Gainesville
J Bone Joint Surg Am, 1996 Dec 01;78(12):1897-1903
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Abstract

Five fresh-frozen transthoracic cadaver specimens (ten upper extremities) were dissected in order to measure excursion and strain of the median nerve at the wrist and the elbow in association with different positions of the shoulder, elbow, wrist, and fingers. The relationships between motions of the joints and excursion and strain at the wrist and the elbow as well as between excursion and strain were also determined.When the wrist was moved from 60 degrees of extension to 65 degrees of flexion, the median nerve at the wrist underwent a mean total excursion of 19.6 millimeters (9.2 ± 1.38 millimeters [mean and standard deviation] in extension and 10.4 ± 1.50 millimeters in flexion). The change in strain was not measurable secondary to nerve-wrinkling. Motion of the fingers from hyperextension to full flexion caused a mean total excursion of 9.7 millimeters (6.3 ± 1.31 millimeters in hyperextension and 3.4 ± 1.04 millimeters in flexion) and a change in strain of 19.0 per cent. This change in strain became more pronounced when the wrist and the fingers moved in synergy. Such strain, if constant, has been shown to decrease microvascular perfusion and nerve conduction in rabbits.With motion of the shoulder, the mean total excursion of the median nerve at the elbow was 9.1 millimeters (4.4 ± 1.64 millimeters in abduction and 4.7 ± 1.81 millimeters in adduction) and the change in strain was 13.3 per cent. With motion of the elbow, the mean total excursion was 12.3 millimeters (12.3 ± 4.20 millimeters in flexion and zero millimeters in the resting position) and the change in strain was not measurable because of the wrinkle effect in flexion. With motion of the wrist, the mean total excursion was 5.6 millimeters (4.3 ± 1.95 millimeters in extension and 1.25 ± 0.81 millimeters in flexion) and the change in strain was 14.8 per cent. With motion of the fingers, the mean total excursion was 3.4 millimeters (2.6 ± 1.13 millimeters in hyperextension and 0.80 ± 0.92 millimeter in flexion) and the change in strain was 10.3 per cent.Motion of the wrist and the fingers induced profound excursion of the median nerve at the wrist, whereas motion of the shoulder and the elbow induced marked excursion of the median nerve at the elbow. These excursions were much more pronounced when a number of joints were moved in a composite manner. Any factor that might limit normal excursion, such as scarring, could induce strains that could adversely affect the function of the median nerve.The finding that the position and movement of the limb had a profound effect on excursion and strain of the median nerve at the wrist and the elbow may aid in the understanding of the pathophysiology of median-nerve neuropathy.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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