FirstRanker Logo

FirstRanker.com - FirstRanker's Choice is a hub of Question Papers & Study Materials for B-Tech, B.E, M-Tech, MCA, M.Sc, MBBS, BDS, MBA, B.Sc, Degree, B.Sc Nursing, B-Pharmacy, D-Pharmacy, MD, Medical, Dental, Engineering students. All services of FirstRanker.com are FREE

📱

Get the MBBS Question Bank Android App

Access previous years' papers, solved question papers, notes, and more on the go!

Install From Play Store

Download MBBS Anatomy PPT 97 Median & Ulnar Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Human Anatomy ppt lectures Topic 97 Median & Ulnar Notes. - anatomy ppt free download human anatomy ppt lectures, medicine notes ppt, anatomy handwritten notes pdf, mbbs 1st year anatomy notes pdf download, best anatomy notes pdf, human anatomy notes pdf, anatomy easy notes pdf, anatomy notes online, anatomy short notes, Anatomy ppt, Powerpoint Presentations and lecture notes.

This post was last modified on 05 April 2022

--- Content provided by‌ FirstRanker.com ---


? Motor & sensory distribution

? Carpal tunnel syndrome

--- Content provided by‍ FirstRanker.com ---

? Claw hand

? Motor & sensory effects in cases of lesion of median

& ulnar nerves

--- Content provided by⁠ FirstRanker.com ---


? Clinical signs/tests



--- Content provided by⁠ FirstRanker.com ---

Median & Ulnar nerves

3
Ulnar & Median nerves - Brachial plexus

--- Content provided by‌ FirstRanker.com ---

Median Nerve

Origin : (C5,6,7, & 8, T1)
? median nerve is formed
? by union of lateral and medial roots

--- Content provided by FirstRanker.com ---

? originating from lateral and medial

cords of brachial plexus.

? anterior to third part of axillary artery

--- Content provided by​ FirstRanker.com ---






--- Content provided by FirstRanker.com ---


Median Nerve

Origin : C5,C6,C7 & C8, T1
? median nerve is

--- Content provided by​ FirstRanker.com ---


formed anterior to
third part of axillary
artery by union of
lateral and medial

--- Content provided by​ FirstRanker.com ---

roots originating
from lateral and
medial cords of
brachial plexus.

--- Content provided by​ FirstRanker.com ---




Median Nerve in Arm

--- Content provided by‍ FirstRanker.com ---

? At inferior margin of teres major muscle.
? Passes vertically down on medial side of arm in anterior

compartment and is related to brachial artery throughout
its course:

--- Content provided by FirstRanker.com ---


? proximal region lateral to brachial artery;
? distal region at mid point it crosses to medial side

of brachial artery and lies anterior to elbow joint.

--- Content provided by‍ FirstRanker.com ---


Median nerve has NO major branches in arm, but a branch
to one of muscles of the forearm, pronator teres muscle,
may originate from it immediately proximal to elbow joint.

--- Content provided by‍ FirstRanker.com ---




Median Nerve in Arm

--- Content provided by​ FirstRanker.com ---

Median nerve - C5,C6,C7 +
C8,T1

Origin: 2 roots - medial &
lateral cords of brachial plexus.

--- Content provided by‍ FirstRanker.com ---


medial root crosses 3rd part of
axillary artery & join lateral
root , runs down on lateral
side of brachial artery.

--- Content provided by‌ FirstRanker.com ---


Mid of arm, it crosses brachial
artery from lateral to medial
and continues down on its
medial side.

--- Content provided by​ FirstRanker.com ---


At elbow, it lies medial to
tendon of biceps & is crossed
by bicipital aponeurosis.
? no branches in arm.

--- Content provided by⁠ FirstRanker.com ---


9


Median Nerve in Forearm

--- Content provided by​ FirstRanker.com ---


? Median nerve passes

into forearm anterior to
elbow joint, where

--- Content provided by⁠ FirstRanker.com ---

branches innervate most
of muscles in anterior
compartment of forearm
(except for flexor carpi
ulnaris muscle and

--- Content provided by‍ FirstRanker.com ---

medial half of flexor
digitorum profundus
innervated by ulnar
nerve).

--- Content provided by​ FirstRanker.com ---



Median nerve

In cubital fossa - lies deep to

--- Content provided by‍ FirstRanker.com ---

bicipital aponeurosis.
Leaves cubital fossa & runs
b/w two heads of pronator
teres.
Descends b/w flexor

--- Content provided by​ FirstRanker.com ---

digitorum superficialis &
flexor digitorum profundus.
It reach palm deep to flexor
retinaculum or through
carpal tunnel deep to tendon

--- Content provided by​ FirstRanker.com ---

of palmaris longus & lateral
to tendon of flexor digitorum
superficialis.

11

--- Content provided by‍ FirstRanker.com ---



Muscular: Pronator teres,

Median nerve in forearm Flexor carpi radialis , Palmaris

--- Content provided by FirstRanker.com ---


longus & Flexor digitorum
superficialis.
Palmar cutaneous branch: at
distal part of forearm &

--- Content provided by⁠ FirstRanker.com ---

superficial to flexor
retinaculum - skin of
lateral 2/3 of palm.
Articular: elbow joint.
Anterior interosseous nerve:

--- Content provided by​ FirstRanker.com ---

between FPL & FDP, anterior
to interosseous membrane.
It supplies : FPL+PQ+ lateral
half of FDP.
Articular branches: wrist &

--- Content provided by⁠ FirstRanker.com ---

distal radioulnar joint.



12

--- Content provided by‍ FirstRanker.com ---




Median Nerve in Hand

--- Content provided by FirstRanker.com ---

? Median nerve continues into hand by

passing deep to flexor retinaculum.

? It innervates: Three thenar muscles of

--- Content provided by FirstRanker.com ---


thumb , Lateral 2 lumbrical muscles
associated with movement of index and
middle fingers;

--- Content provided by⁠ FirstRanker.com ---

? Skin over palmar surface of lateral three &

half digits and over lateral side of palm
and middle of wrist.

--- Content provided by‌ FirstRanker.com ---




Median Nerve in Hand

--- Content provided by FirstRanker.com ---

? Enters palm through carpal

Median n in hand

tunnel, deep to flexor

--- Content provided by‌ FirstRanker.com ---

retinaculum & divides
lateral & medial branches.

? Lies a fingerbreadth distal to

--- Content provided by‌ FirstRanker.com ---

tubercle of scaphoid.

? Muscular: Thenar ? Muscles 5 .
? Abductor pollicis brevis.
? Flexor pollicis brevis. Thenar

--- Content provided by⁠ FirstRanker.com ---

? Opponens pollicis

Emi

nenec

--- Content provided by‌ FirstRanker.com ---


e



--- Content provided by FirstRanker.com ---

Ms.

(deep to the above 2 ms.).

? Lateral 2 lumbricals (1st & 2nd ).

--- Content provided by​ FirstRanker.com ---

? Digital cutaneous branches : to

palmar aspect of lateral 3 ?
fingers

--- Content provided by‌ FirstRanker.com ---



15


--- Content provided by⁠ FirstRanker.com ---



Median Nerve Lesion

? Injury of median nerve at different levels

--- Content provided by⁠ FirstRanker.com ---


cause different syndromes.

? In arm and forearm the median nerve is

--- Content provided by‌ FirstRanker.com ---

usually not injured by trauma because of
its relatively deep position.

? Median nerve can be damaged:

--- Content provided by​ FirstRanker.com ---

Elbow region
At wrist above flexor retinaculum
In carpal tunnel


--- Content provided by‍ FirstRanker.com ---


Median Nerve Lesion in Elbow Region

? Damaged in

--- Content provided by FirstRanker.com ---

supracondylar fracture
of humerus

? Muscles affected are:
? Pronator muscles of

--- Content provided by⁠ FirstRanker.com ---


the forearm

? All long flexors of

--- Content provided by‌ FirstRanker.com ---

wrist and fingers
except FCU and
medial half of FDP


--- Content provided by‍ FirstRanker.com ---

Median Nerve Lesion at Wrist

? Often injured by penetrating wounds (stab wounds or

broken glass) of the forearm.

--- Content provided by‍ FirstRanker.com ---


? Motor:
? Thenar muscles are paralyzed and atrophy in time so thenar

eminence becomes flattened

--- Content provided by⁠ FirstRanker.com ---


? Opposition & abduction of thumb are lost, and thumb and

lateral two fingers are arrested in adduction & hyperextension
position .

--- Content provided by FirstRanker.com ---


? Apelike hand
? Sensory & trophic changes are same as in elbow

region injuries

--- Content provided by​ FirstRanker.com ---


Carpal Tunnel Syndrome

? The commonest neurological

--- Content provided by FirstRanker.com ---

problem associated with median
nerve is compression beneath
flexor retinaculum at wrist.

? Motor: Weak motor function of

--- Content provided by‍ FirstRanker.com ---


thumb, index & middle finger

? Sensory: Burning pain or pi s

--- Content provided by‍ FirstRanker.com ---

a d eedles along distribution
of median nerve to lateral 3?
fingers

No sensory changes over palm as palmer cutaneous branch

--- Content provided by‌ FirstRanker.com ---


is given before median nerve enters carpal tunnel.


Lesion of median nerve - above elbow

--- Content provided by‌ FirstRanker.com ---


? Weakness of flexion - wrist due

to paralysis of FCR & PL.

--- Content provided by⁠ FirstRanker.com ---

? Loss of pronation - paralysis of

pronator teres & quadratus.

? Loss of flexion of middle

--- Content provided by‍ FirstRanker.com ---


phalanges of medial 4 fingers -
paralysis of FDS.

? Loss of flexion of terminal

--- Content provided by‍ FirstRanker.com ---


phalanges of index & middle
fingers - paralysis of lateral ? of
? FDP.

--- Content provided by​ FirstRanker.com ---



? The most serious

disability of median

--- Content provided by‍ FirstRanker.com ---

nerve injuries is:

? Loss of opposition

of the thumb. The

--- Content provided by‍ FirstRanker.com ---

delicate pincer-like
action is not
possible

? Loss of sensation

--- Content provided by‍ FirstRanker.com ---


from thumb and
lateral 3? fingers &

lateral of the pal

--- Content provided by‌ FirstRanker.com ---





Median Nerve

--- Content provided by​ FirstRanker.com ---

? Origin: Medial and lateral cords

Motor

All muscles in anterior compartment of forearm

--- Content provided by‍ FirstRanker.com ---

(except flexor carpi ulnaris and medial half of flexor
digitorum profundus), three thenar muscles of the
thumb and two lateral lumbrical muscles

Sensory

--- Content provided by FirstRanker.com ---


Skin over palmar surface of lateral three and one-half
digits and over lateral side of the palm and middle of
wrist

--- Content provided by⁠ FirstRanker.com ---

Motor Effects:

Wasting
of thenar

--- Content provided by‍ FirstRanker.com ---

? Loss of pronation. Hand is kept in

eminence

supine position

--- Content provided by FirstRanker.com ---


? Wrist shows weak flexion, and

ulnar deviation

--- Content provided by FirstRanker.com ---

? Loss of flexion on interphalangeal

joints of the index and middle
fingers

--- Content provided by FirstRanker.com ---

? Weak flexion of ring and little

Ulnar deviation

finger

--- Content provided by‍ FirstRanker.com ---


? Thumb is adducted and laterally

rotated, with loss of flexion of
terminal phalanx and loss of

--- Content provided by⁠ FirstRanker.com ---

opposition

? Wasting of thenar eminence

? Hand looks flattened and

--- Content provided by‍ FirstRanker.com ---


apelike , and presents an inability

to flex three most radial digits
when asked to make a fist.

--- Content provided by​ FirstRanker.com ---



? Sensory Effects: Loss of

sensation from:

--- Content provided by‍ FirstRanker.com ---


? The radial side of the palm
? Palmar aspect of the lateral

3? fingers

--- Content provided by​ FirstRanker.com ---


? Distal part of the dorsal

surface of the lateral 3?
fingers

--- Content provided by FirstRanker.com ---


? Trophic Changes:

? Dry and scaly skin
? Easily cracking nails

--- Content provided by‌ FirstRanker.com ---

? Atrophy of the pulp of

fingers

Lesion of median nerve -above elbow

--- Content provided by‌ FirstRanker.com ---


Loss of flexion of thumb - Flexor pollicis
longus & brevis

Loss of opposition of thumb - Opponens

--- Content provided by​ FirstRanker.com ---

pollicis.

Flatting/Wasting of Thenar eminence -
atrophy.
Ape ha d - Ape thumb deformity

--- Content provided by​ FirstRanker.com ---

Thenar eminence is flattened and thumb
is adducted & hyperextended.

Loss of cutaneous sensations - hollow of
palm + palmar surfaces of lateral 3 ?

--- Content provided by⁠ FirstRanker.com ---

fingers.




--- Content provided by‍ FirstRanker.com ---

Lesion of median nerve -

above wrist

Loss of opposition of thumb

--- Content provided by​ FirstRanker.com ---

paralysis - opponens pollicis.

Flattening of thenar
eminence - atrophy of thenar
muscles.

--- Content provided by⁠ FirstRanker.com ---


Ape ha d or Ape thu b

Deformity.

--- Content provided by​ FirstRanker.com ---

Loss of cutaneous sensations
- palmar surfaces of the
lateral 3 ? fingers.

Carpal tunnel syndrome

--- Content provided by​ FirstRanker.com ---


? Compression of median nerve - carpal tunnel.
? Slight flattening of thenar eminence due to

wasting of thenar eminence muscles.

--- Content provided by‌ FirstRanker.com ---


? Accompanied by bur i g pai or pi & eedles

with diminished cutaneous sensations on palmar
aspect of lateral 3 ? fingers.

--- Content provided by FirstRanker.com ---


? No paresthesia occurs over the thenar eminence

(because this area is supplied by palmar
cutaneous branch of median N) , arises in distal

--- Content provided by‌ FirstRanker.com ---

part of forearm & descends superficial to flexor
retinaculum.


Carpal tunnel syndrome

--- Content provided by‍ FirstRanker.com ---


Carpal tunnel syndrome



--- Content provided by‍ FirstRanker.com ---




Ulnar nerve C8T1

--- Content provided by FirstRanker.com ---

Origin : medial cord of
brachial plexus , runs
medial to brachial artery -
middle of arm.

--- Content provided by​ FirstRanker.com ---

At coracobrachialis
insertion, - pierces medial
intermuscular septum, is
accompanied by superior
ulnar collateral artery ? and

--- Content provided by‍ FirstRanker.com ---

enter posterior
compartment of arm.

At elbow - posterior to
medial epicondyle.

--- Content provided by‍ FirstRanker.com ---


No branches in arm.

30

--- Content provided by⁠ FirstRanker.com ---

Ulnar nerve in forearm

? It continues downward

to enter in forearm

--- Content provided by‍ FirstRanker.com ---


? b/w two heads of

flexor carpi ulnaris.

--- Content provided by FirstRanker.com ---

? It runs down forearm

between FCU and FDP.

? In lower half of forearm

--- Content provided by FirstRanker.com ---


it lies medial to ulnar
artery.


--- Content provided by⁠ FirstRanker.com ---


31


? Muscular: FCU & FDP

--- Content provided by‌ FirstRanker.com ---


Ulnar nerve in Forearm

? Flexor carpi ulnaris.

--- Content provided by⁠ FirstRanker.com ---

? Medial ? of FDP

? Articular: elbow joint.

? Dorsal or posterior

--- Content provided by⁠ FirstRanker.com ---


cutaneous branch:

? Dorsal surface - medial

--- Content provided by​ FirstRanker.com ---

1/3rd of hand 1? fingers.

? Palmar cutaneous

branch : to supply skin of

--- Content provided by​ FirstRanker.com ---

palm of hand and medial
1? fingers.

? FDP ? lateral ? Median N

--- Content provided by⁠ FirstRanker.com ---

? Medial ? Ulnar N




--- Content provided by⁠ FirstRanker.com ---


32



--- Content provided by‌ FirstRanker.com ---

Ulnar nerve in Hand

33
Ulnar nerve in Hand

--- Content provided by FirstRanker.com ---

? Enters the palm superficial to flexor

retinaculum,

? close to lateral border of pisiform bone.

--- Content provided by​ FirstRanker.com ---

? Then it divides into superficial & deep

branches.

? Superficial branch:

--- Content provided by​ FirstRanker.com ---

? It supplies palmaris brevis
? palmar aspect of medial 1? fingers.



--- Content provided by​ FirstRanker.com ---

34



Ulnar nerve in Hand

--- Content provided by⁠ FirstRanker.com ---


Deep branch:
? Runs b/w abductor digiti minimi & flexor digiti minimi.

? pierces opponens digiti minimi.

--- Content provided by⁠ FirstRanker.com ---


? Then passes laterally within concavity of deep palmar

arch.

--- Content provided by‌ FirstRanker.com ---

? lies deep to flexor tendons.

? It supplies 14 muscles :

? Three hypothenar muscles.

--- Content provided by​ FirstRanker.com ---


? Adductor pollicis.

? All dorsal & palmar interossei.

--- Content provided by FirstRanker.com ---

? Medial 2 lumbricals.




--- Content provided by⁠ FirstRanker.com ---

35
Lesion of ulnar nerve above elbow - atrophy of
hypothenar muscles


--- Content provided by FirstRanker.com ---

Lesion of ulnar nerve above elbow

? Weakness of flexion at wrist paralysis of FCU
? Loss of flexion of terminal phalanges of ring & little

--- Content provided by FirstRanker.com ---

fingers paralysis of medial ? of FDP

? Paralysis of all interossei & medial 2 lumbricals (3rd &

4th).

--- Content provided by FirstRanker.com ---


? Characteristic deformity is - partial claw hand.
? Atrophy of hypothenar muscles.
? Fingers - hyperextended at metacarpophalangeal joints

--- Content provided by FirstRanker.com ---

& flexed at interphalangeal joints - ring & little finger.

? Loss of adduction of hand & thumb due to paralysis of

flexor carpi ulnaris & adductor pollicis.

--- Content provided by‌ FirstRanker.com ---



Lesion of ulnar

nerve above

--- Content provided by FirstRanker.com ---


elbow - Loss of

cutaneous sensations

--- Content provided by FirstRanker.com ---

on front & dorsum of

medial 1/3 of hand +

medial 1 ? fingers.

--- Content provided by​ FirstRanker.com ---




? It leads to paralysis of

--- Content provided by⁠ FirstRanker.com ---

Lesion of ulnar

intrinsic muscles of hand as

nerve above

--- Content provided by‌ FirstRanker.com ---


described above.

wrist

--- Content provided by‍ FirstRanker.com ---

? deformity claw hand
? Loss of cutaneous sensations

of medial 1 ? fingers.

--- Content provided by‌ FirstRanker.com ---

Test for Palmar interossei

Test for adductor &

for adduction of fingers.

--- Content provided by​ FirstRanker.com ---


opponens pollicis.


Test for Palmar interossei for

--- Content provided by‍ FirstRanker.com ---


Test for adductor &

adduction of fingers.

--- Content provided by FirstRanker.com ---

opponens pollicis.

1. Which one of these nerves is concerning with the carpal tunnel
syndrome ?
a.ulnar nerve.

--- Content provided by‍ FirstRanker.com ---

b.radial nerve.
c.median nerve.
d.axillary nerve.


--- Content provided by FirstRanker.com ---

2. Which muscle has double nerve supply ?
A Biceps.
B Extensor digitorum superficialis.
C flexor digitorum profundus.
D Triceps.

--- Content provided by‍ FirstRanker.com ---


3. Ape hand is the characteristic deformity due to lesion of :
A Radial nerve.
B Ulnar nerve.
C Median nerve.

--- Content provided by⁠ FirstRanker.com ---

D Axillary nerve.


41
Pattern of injury

--- Content provided by‌ FirstRanker.com ---


Pattern of root contribution to plexus:



--- Content provided by‍ FirstRanker.com ---

Upper trunk lesion: Sensory loss in C5 & C6



Middle trunk lesion: Sensory loss in C7

--- Content provided by‌ FirstRanker.com ---




Lower trunk lesion: Sensory loss in the combined C8
& T1 dermatomes

--- Content provided by⁠ FirstRanker.com ---




Principles of localization

--- Content provided by‌ FirstRanker.com ---

Certain sites
Ulnar nerve & median nerve at elbow
Carpal tunnel ? median nerve
Single nerve - Elbow extension ~ Radial
Multiple nerves - Elbow flexion ~

--- Content provided by​ FirstRanker.com ---


Musculo cutaneous, Median


Complete claw

--- Content provided by‍ FirstRanker.com ---


hand

Affection of:

--- Content provided by​ FirstRanker.com ---

1- Most of the small muscles of the hand (T1)

2- Ulnar flexors of the flexor compartment of forearm are partially

affected (C8)

--- Content provided by‍ FirstRanker.com ---




WINGING OF

--- Content provided by⁠ FirstRanker.com ---

SCAPULA


Injury to axillary nerve

--- Content provided by​ FirstRanker.com ---

Anterior

Shoulder Dislocation

Dislocated Head

--- Content provided by‍ FirstRanker.com ---


Normal Head


WRIST DROP

--- Content provided by FirstRanker.com ---




Median nerve injury at elbow

--- Content provided by‌ FirstRanker.com ---

(hand of benediction)

Median nerve injury

A- Above Elbow:

--- Content provided by FirstRanker.com ---


B- Above Wrist:

1- Loss of pronation

--- Content provided by​ FirstRanker.com ---

1- No Loss of pronation

2- Week flexion

2- No Week flexion

--- Content provided by⁠ FirstRanker.com ---


3- Ulnar deviation

3- No Ulnar deviation

--- Content provided by‍ FirstRanker.com ---

4- Inability to flex thumb

4- No Inability to flex thumb

5- Inability to oppose fingers

--- Content provided by​ FirstRanker.com ---


5- Inability to oppose fingers

6- Inability to flex middle digits

--- Content provided by‌ FirstRanker.com ---

6- No Inability to flex middle digits

7- Inability to flex Index

7- No Inability to flex index and middle fingers

--- Content provided by​ FirstRanker.com ---


middle fingers

-Sensory loss

--- Content provided by​ FirstRanker.com ---

- Sensory loss

-Ape hand deformity

- Ape hand deformity

--- Content provided by⁠ FirstRanker.com ---


Adducted &

Extended

--- Content provided by​ FirstRanker.com ---

extended

index and

thumb

--- Content provided by⁠ FirstRanker.com ---


middle

Flat thenar

--- Content provided by⁠ FirstRanker.com ---

eminence

Flexed little and ring


--- Content provided by​ FirstRanker.com ---

CARPAL TUNNEL

SYNDROME


--- Content provided by‌ FirstRanker.com ---




Ulnar nerve injury

--- Content provided by FirstRanker.com ---

A - Above Elbow:
1- Week flexion
2- Loss of adduction
3- Inability to adduct thumb
4- Inability to put hand in writing position

--- Content provided by⁠ FirstRanker.com ---

- Sensory loss
- Partial claw hand deformity

B - Above Wrist:
1- No Week flexion

--- Content provided by​ FirstRanker.com ---

2- No Loss of adduction
3- Inability to adduct thumb
4- Inability to put hand in writing position
- Sensory loss to fingers only
- Partial claw hand deformity is more

--- Content provided by​ FirstRanker.com ---

prominent (Ulnar paradox)

Ulnar canal syndrome/Guyon tunnel syndrome


--- Content provided by‍ FirstRanker.com ---

Handlebar neuropathy

? Symptoms
? Tingling
? Numbness

--- Content provided by‌ FirstRanker.com ---

? Pain on the outside or middle of the forearm; this

sensation of discomfort may run all the way to the
little finger.

--- Content provided by​ FirstRanker.com ---

? Treatment
? Anti-inflammatory medications
? Wrist splints
? Therapeutic exercises

--- Content provided by FirstRanker.com ---



An inability to oppose the thumb to the little

finger can result from damage to the

--- Content provided by FirstRanker.com ---

________ nerve.

a) Axillary

b) Musculocutaneous

--- Content provided by​ FirstRanker.com ---


c) Radial

d) Ulnar

--- Content provided by⁠ FirstRanker.com ---

e) Median


Hyperextension of the proximal phalanges of

--- Content provided by‌ FirstRanker.com ---

the little and ring fingers can result from
damage to the ________ nerve.

a) Ulnar

--- Content provided by⁠ FirstRanker.com ---

b) Axillary

c) Radial

d) Median

--- Content provided by​ FirstRanker.com ---


e) Musculocutaneous



--- Content provided by FirstRanker.com ---

Wrist drop can result from damage to the

________ nerve.

a) Median

--- Content provided by⁠ FirstRanker.com ---


b) Ulnar

c) Radial

--- Content provided by‌ FirstRanker.com ---

d) Anterior interosseous

e) Axillary


--- Content provided by​ FirstRanker.com ---