The current method for treatment of median nerve palsy after a brachial
plexus injury is unpredictable. On the basis of an anatomic study of the
median nerve in the arm, we present a new method of selective neurotization of
the median nerve.
Internal topographic features of the fascicular groups of the median nerve
were observed in seventeen cadavera. On the basis of the anatomical results,
selective neurotization of the posterior fascicular group of the median nerve
in the arm was performed in one patient with a complete brachial plexus
In the distal half of the arm, the branches of the median nerve
consistently collect into three fascicular groups, which are located at the
anterior, middle, and posterior parts of the median nerve trunk. The anterior
fascicular group is composed of the branches to the pronator teres and the
flexor carpi radialis, the posterior fascicular group is composed mainly of
the anterior interosseous nerve and the branches to the palmaris longus, and
the middle fascicular group is made up mostly of the branches to the hand and
the flexor digitorum superficialis. A transfer of the full length of the
phrenic nerve was used to selectively reinnervate the posterior fascicular
group of the median nerve in a patient with a complete brachial plexus palsy.
The muscles supplied by the posterior fascicular group regained Grade-4 power,
according to the system of the Medical Research Council, sixteen months after
The typical arrangement of the fascicular groups of the median nerve in the
arm favors the technique of selective neurotization, which has been used
effectively in one patient to date.