Medial Cutaneous Nerve of the Forearm

Atlas of Nerve Conduction Studies and

Electromyography (2 ed.)
A. Arturo Leis and Michael P. Schenk

Publisher: Oxford University Press Print Publication Date: Nov 2012

Print ISBN-13: 9780199754632 Published online: Sep 2013
DOI: 10.1093/med/
9780199754632.001.0001

Medial Cutaneous Nerve of the Forearm  

Chapter: Medial Cutaneous Nerve of the Forearm

Author(s): A. Arturo Leis and Michael P. Schenk

DOI: 10.1093/med/9780199754632.003.0009

(Medial Antebrachial Cutaneous Nerve)

THE MEDIAL CUTANEOUS NERVE OF THE FOREARM, also

known as the medial antebrachial cutaneous nerve, arises from the
medial cord of the brachial plexus. It derives its fibers from the eighth
cervical (C8) and first thoracic (T1) roots. It separates from the medial
cord proximal to the contribution to the median nerve and the formation
of the ulnar nerve. The medial cutaneous nerve of the forearm then
descends beneath the deep fascia in the anatomical arm before becoming
subcutaneous in the distal third of the arm (Sunderland, 1978). Above the
elbow, the nerve divides into anterior and posterior divisions that descend
down the anterior and posterior medial forearm, respectively, as far as
the wrist. The nerve is purely sensory in function, typically innervating a
portion of the medial arm via communications with the medial cutaneous
nerve of the arm, and the inner aspect of the forearm from the mid-line
ventrally to the midline dorsally. In some cases, the sensory distribution
may extend distally to the hypothenar eminence or ulnar dorsum of hand
(Sunderland, 1978).

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Medial Cutaneous Nerve of the Forearm

Figure 9-1
Medial cutaneous nerve of the forearm.

Lesion of the Medial Cutaneous Nerve of the

Forearm

Etiology

Trauma or deep penetrating wounds can cause a medial antebrachial

cutaneous nerve lesion.

Iatrogenic nerve injury can occur from invasive medical procedures,

including surgical implants (Prahlow and Buschbacher, 2006), surgeries
in the medial forearm, and cubital tunnel surgery (Dellon and Mackinnon,
1985).

Antecubital phlebotomy can cause isolated injury to the medial cutaneous

nerve of the forearm (Berry and Wallis, 1977).

General Comments

Lesions that affect the lower trunk or medial cord of the brachial plexus
will often be associated with injury to the medial cutaneous nerve of the
forearm.

Clinical Features

There is sensory loss over the medial aspect of the forearm. However,
even after complete section of this nerve, the area of numbness may be
limited to a narrow band along the inner forearm, due to extensive
overlap of adjacent cutaneous nerves (Sunderland, 1978).

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Medial Cutaneous Nerve of the Forearm

Electrodiagnostic Strategy

Sensory conduction studies of the medial cutaneous nerve of the forearm

may show reduced amplitude or absence on the affected side.

Perform additional nerve conduction studies mediated by the medial cord

of the brachial plexus (ulnar motor and sensory responses, median motor
response) to distinguish isolated medial antebrachial cutaneous
neuropathy from medial cord lesion.

EMG of C8 and T1 muscles and cervical paraspinal muscles may be

necessary to exclude lower trunk brachial plexopathy or cervical
radiculopathy.

Medial Cutaneous Nerve of the Forearm Conduction

Study

Figure 9-2
Medial cutaneous nerve of the forearm conduction study (antidromic)

Recording

Active electrode: Position over the medial forearm, 10 to 12 cm distal to

the cathode, on a line between stimulation site and ulnar styloid at the
wrist.

Reference electrode: Place 3 cm distal to the active electrode.

Ground electrode: Place on the anterior forearm between the stimulating

and recording electrodes.

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Medial Cutaneous Nerve of the Forearm

Stimulation

Medial arm: Place cathode 3 to 4 cm proximal to the midway point

between the biceps tendon and the medial epicondyle of the humerus. At
this stimulation site, the medial cutaneous nerve lies between the median
nerve anteriorly and the ulnar nerve posteriorly. The nerve is superficial,
so supramaximal stimulation is achieved at low stimulus intensities (e.g.,
< 20 mA). Higher stimulus intensities or inappropriate placement of the
cathode will coactivate the median or ulnar nerves, causing a mechanical
deflection or CMAP that can obscure the desired sensory response. The
anode is 3 cm proximal to cathode.

Normal Values

Latency (ms) ≤ 2.0 (onset latency at distance 10 cm); ≤ 2.6 (peak latency)

Amplitude (μν) ≥ 10

Conduction velocity (m/s) ≥ 50 m/s

Studies should be performed bilaterally, because side-to-side comparisons

are more useful than normal value tables that may not apply to your
patient. A relative amplitude ≤ 50 % of the unaffected side is evidence of
abnormality.

Comments

In C8, T1 root lesions, the medial cutaneous nerve of the forearm sensory
response will be normal.

In lesions of the medial cord or lower trunk, the medial cutaneous nerve
of the forearm sensory response will be reduced or absent.

In ulnar neuropathy at the elbow, the medial cutaneous nerve of the

forearm sensory response, and sensation in the medial forearm, will be
spared.

References
Berry PR, Wallis WE. Venepuncture nerve injuries. Lancet 1977;1:1236–
1237.

Dellon AL, MacKinnon SE. Injury to the medial antebrachial cutaneous

nerve during cubital tunnel surgery. J Hand Surg Br 1985;10:33–36.

Prahlow ND, Buschbacher RM. An antidromic study of the medial

antebrachial cutaneous nerve, with a comparison of the differences
between medial and lateral antebrachial cutaneous nerve latencies. J
Long-Term Effects Med Implants 2006;16:92.

Sunderland S. Nerves and Nerve Injuries. 2nd ed., Churchill Livingstone,

New York, 1978, p. 620.

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Medial Cutaneous Nerve of the Forearm

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