The Detailed Anatomy of the Palmar Cutaneous Nerves and its Clinical Implications

1998 ◽  
Vol 23 (3) ◽  
pp. 373-379 ◽  
Author(s):  
H. S. MATLOUB ◽  
J-G. YAN ◽  
A. B. MINK VAN DER MOLEN ◽  
L-L. ZHANG ◽  
J. R. SANGER
Keyword(s):  
Ulnar Nerve ◽  
Carpal Tunnel Release ◽  
Significant Risk ◽  
Sensory Nerves ◽  
Clinical Implications ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Fresh Frozen ◽  
Palmaris Longus Tendon ◽  
Open Carpal Tunnel Release

The forearms and hands of 40 fresh-frozen cadavers were dissected under the microscope to study the palmar cutaneous branch of the median nerve (PCBm) and the palmar cutaneous branch of the ulnar nerve (PCBu). Branches of the PCBm innervating the scaphoid were typically found, but in no specimen did we find a ‘typical’ cutaneous branch of the ulnar nerve. According to our findings, standard incisions for open carpal tunnel release carry a significant risk of damaging branches of the PCBm or PCBu. The chance of injury to these sensory nerves can be minimized by using a short incision in the proximal palm or a twin incision approach, which we describe. Because the PCBm is closely associated with the ulnar side of the flexor carpi radialis (FCR) sheath, this sheath should be opened on the radial side during harvest of the FCR tendon for transfer. When transferring the palmaris longus tendon, it should be cut proximal to the distal wrist crease to avoid possible damage to the PCBm.

Mini Open Carpal Tunnel Release Using Knifelight®: Evaluation of the Safety and Effectiveness of Using a Single Wrist Incision (Cadaveric Study)

2009 ◽  
Vol 34 (4) ◽  
pp. 506-510 ◽  
Author(s):  
K. K. TEH ◽  
E. S. NG ◽  
D. S. K. CHOON
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Superficial Palmar Arch ◽  
Palmar Arch ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
The Mean ◽  
Open Carpal Tunnel Release ◽  
Mini Open

This cadaveric study evaluates the margin of safety and technical efficacy of mini open carpal tunnel release performed using Knifelight® (Stryker Instruments) through a transverse 1 cm wrist incision. A single investigator released 32 wrists in 17 cadavers. The wrists were then explored to assess the completeness of release and damage to vital structures including the superficial palmar arch, palmar cutaneous branch and recurrent branch of the median nerve. All the releases were complete and no injury to the median nerve and other structures were observed. The mean distance of the recurrent motor branch to the ligamentous divisions was 5.7 ± 2.4 mm, superficial palmar arch was 8.7 ± 3.1 mm and palmar cutaneous branch to the ligamentous division was 7.2 ± 2.4 mm. The mean length of the transverse carpal ligament was 29.3 ± 3.7 mm. Guyon’s canal was preserved in all cases.

Palmar cutaneous branch of the ulnar nerve

1980 ◽  
Vol 5 (1) ◽  
pp. 26-29 ◽  
Author(s):  
William D. Engber ◽  
James G. Gmeiner
Keyword(s):  
Ulnar Nerve ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch

scholarly journals Shingles in palmar cutaneous branch of ulnar nerve

2020 ◽  
Author(s):  
Hong Ki Min ◽  
Se Hee Kim ◽  
Sang-Heon Lee ◽  
Hae-Rim Kim
Keyword(s):  
Ulnar Nerve ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch

scholarly journals The Effect of an Open Carpal Tunnel Release on Thumb CMC Biomechanics

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Marc A. Tanner ◽  
Bryan P. Conrad ◽  
Paul C. Dell ◽  
Thomas W. Wright
Keyword(s):  
Carpal Tunnel ◽  
Soft Tissues ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Before And After ◽  
Fresh Frozen ◽  
Rigid Body Mechanics ◽  
Thumb Carpometacarpal ◽  
Open Carpal Tunnel Release ◽  
Cmc Joint

Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics.Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined.Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly.Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint.

Anatomy of the palmar branch of the ulnar nerve: application to ulnar and median nerve decompressive surgery

2011 ◽  
Vol 114 (1) ◽  
pp. 263-267 ◽  
Author(s):  
R. Shane Tubbs ◽  
Jason M. Rogers ◽  
Marios Loukas ◽  
Ayhan Cömert ◽  
Mohammadali M. Shoja ◽  
...  
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Ulnar Artery ◽  
Medial Epicondyle ◽  
Palmar Arch ◽  
Medial Side ◽  
Fourth Digit ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
The Mean

Object The palmar cutaneous branch of the ulnar nerve (PCUN) has received little attention in the literature, and to the authors' knowledge, has received no attention in the neurosurgical literature. The present study was performed to help the surgeon minimize postoperative complications of nerve decompression at the wrist. Methods Forty cadaveric upper limbs underwent dissection of the ulnar nerve in the forearm, at the wrist, and in the palm. The PCUN was investigated and when identified, measurements were made and relationships documented between this cutaneous branch and the ulnar artery. The length and width of the PCUN were measured, as was the distance from the medial epicondyle of the humerus to the origin of the PCUN from the ulnar nerve. Results A PCUN was found on 90% of sides. The origin of the PCUN from the ulnar nerve was found to lay a mean of 14.3 cm distal to the medial epicondyle. The mean length and width of this branch were 13 and 0.08 cm, respectively. In the forearm, the PCUN traveled lateral to the ulnar artery on 75% of sides and on the medial side of this vessel on the remaining sides. The PCUN perforated the fascia of the anterior forearm just proximal to the distal wrist crease. In the palm, the PCUN traveled superficial to the superficial palmar arch on all but 5 sides, where it traveled deep to this vascular structure's distal extent. On 2 sides each, the PCUN communicated with the superficial and deep ulnar nerves. On 2 sides, the PCUN communicated with the palmar cutaneous branch of the median nerve. The majority of the terminal fibers of the PCUN were found on the ulnar side of a hypothetical line drawn longitudinally through the fourth digit and supplied an area roughly 3 × 3 cm over the proximal medial palm. Conclusions The authors hope that the present data may be useful to the surgeon during decompressive procedures at the wrist, such as carpal tunnel and the Guyon canal. Based on this study, skin incisions of the palm made longitudinally along a line through the middle of the fourth digit would minimize injury to the PCUN.

The Anatomical Relationship Between the Dorsal Cutaneous Branch of the Ulnar Nerve and the Ulnar Styloid Process with Variations in Forearm Position

2016 ◽  
Vol 21 (01) ◽  
pp. 64-67 ◽  
Author(s):  
Hyung Suk Jung ◽  
Yong Beom Lee ◽  
Jae Sung Lee
Keyword(s):  
Ulnar Nerve ◽  
Styloid Process ◽  
Skin Incision ◽  
Neutral Position ◽  
Ulnar Styloid ◽  
Position Change ◽  
Ulnar Side ◽  
Cutaneous Branch ◽  
Fresh Frozen ◽  
Ulnar Styloid Process

Background: There are significant variations in the anatomy of the dorsal cutaneous branch of the ulnar nerve (DCBUN). The DCBUN is at risk for iatrogenic injury during surgeries around the ulnar side of the wrist. The purpose of this study was to demonstrate the relationship between the ulnar styloid process and the DCBUN and to confirm the DCBUN's change in location with different forearm positions. Methods: We examined 9 fresh frozen cadaveric limbs to establish the course of this nerve. The DCBUN was dissected and traced around the ulnar border of the wrist. The distance from the tip of the ulnar styloid process to the origin of the DCBUN was measured. The distances from the ulnar styloid process to the DCBUN were measured in supination, pronation, and in a neutral position of the forearm. Results: The DCBUN originated on average 4.92 cm proximal to the ulnar styloid process. In all cases, the DCBUN crossed the ulnar distal to ulnar styloid process and it moved more closely to the ulnar styloid process with a forearm position change from supination to pronation. Conclusions: We recommend making a skin incision on the ulnar side around the styloid process with the forearm in supination or neutral position was another method to avoid injury of DCBUN.

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