The Median Nerve

Chapter 13 of Volume 1, Hand & Upper Limb. Revision notes and examiner-style viva questions with model answers for the FRCS (Plast).

21 viva questions in this chapter

1. A 54-year-old woman is referred with a numb hand. Take me through it.
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2. What clinical tests would you do, and how good are they?
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3. When would you request a nerve conduction study or an ultrasound?
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4. How would you manage her non-operatively, and when does she cross the line to surgery?
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5. You have decided to operate. Consent her.
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6. Talk me through your open carpal tunnel release.
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7. Open or endoscopic?
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8. She comes back at four months. It is no better. What now?
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9. She has obvious thenar wasting. Would you add an opponensplasty?
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10. Draw me Kaplan’s cardinal line and tell me what is under it.
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11. Tell me about the recurrent motor branch.
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12. What median–ulnar interconnections do you know, and why do they matter?
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13. Where can the median nerve be compressed proximal to the carpal tunnel?
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14. What do you know about lacertus syndrome?
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15. A 40-year-old man cannot make an O sign with his thumb and index. No trauma.
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16. What is the difference between a high and a low median nerve palsy?
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17. This patient has lost opposition. How do you restore it?
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18. High median palsy, no prospect of recovery. What do you transfer?
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19. What about nerve transfers?
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20. How late is too late?
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21. How do you counsel these patients?
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