scholarly journals A foregoing thenar muscular branch of the median nerve

2010 ◽  
Vol 43 (01) ◽  
pp. 106-107
Author(s):  
Samet Vasfi Kuvat ◽  
Levent Özçakar ◽  
Memet Yazar
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Anatomic Variation ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Left Hand ◽  
Medial Side ◽  
Muscular Branch ◽  
High Level ◽  
Proximal Border

ABSTRACTWe present a 62-year-old female patient who had an anatomic variation in the median nerve of the left hand. During surgery for releasing the left carpal tunnel, an abnormally high level of origin of the thenar muscular branch of the median nerve was detected, at 2.5 cm above the proximal border of transverse carpal ligament. It traveled between the medial side of the flexor carpi radialis tendon and median nerve and entered the carpal tunnel. After exiting the carpal tunnel distally, the nerve, was noted to course towards the thenar area. Such variations in the median nerve should be kept in mind while performing carpal tunnel release.

scholarly journals Aberrant Positioning of the Ulnar Nerve Found During Carpal Tunnel Release: A Case Report

2019 ◽  
Author(s):  
David R. Veltre ◽  
Kelvin Naito ◽  
Xinning Li ◽  
Andrew B. Stein
Keyword(s):  
Case Report ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Distal Forearm ◽  
Anatomic Variations ◽  
Transverse Carpal Ligament ◽  
Iatrogenic Injuries ◽  
Flexor Retinaculum

Introduction: Aberrant positioning of the ulnar nerve volar to the transverse carpal ligament is a rare anatomic variation.Case Presentation: We present the case of a 55-year-old female with unique ulnar nerve anatomy that was discovered introperatively during carpal tunnel release.  The ulnar nerve was running directly adjacent to the median nerve in the distal forearm and as the median nerve traversed dorsal to the transverse carpal ligament (flexor retinaculum) to enter the carpal tunnel the ulnar nerve continued directly volar to this structure before angling towards Guyon’s Canal.  The unique ulnar nerve anatomy was successfully identified, carefully dissected and managed with a successful patient outcome.Conclusion: Variations of the anatomy at the level of the carpal tunnel are rare but do exist.  Awareness of these anatomic variations and adequate visualization of the ulnar nerve along with the surrounding structures is crucial to avoid iatrogenic injuries during carpal tunnel release. 

scholarly journals Report of a Transligamentous Ulnar Nerve Sensory Branch

Hand ◽  
2019 ◽  
Vol 15 (1) ◽  
pp. NP11-NP13
Author(s):  
Christina R. Vargas ◽  
Kyle J. Chepla
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Variation ◽  
Dominant Male ◽  
Transverse Carpal Ligament ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Right Hand

Background: Several anatomical variations of the median nerve recurrent motor branch have been described. No previous reports have described the anatomical variation of the ulnar nerve with respect to transverse carpal ligament. In this article, we present a patient with symptomatic compression of the ulnar nerve found to occur outside the Guyon canal due to a transligamentous course through the distal transverse carpal ligament. Methods: A 59-year-old, right-hand-dominant male patient presented with right hand pain, subjective weakness, and numbness in both the ulnar and the median nerve distributions. Electromyography revealed moderate demyelinating sensorimotor median neuropathy at the wrist and distal ulnar sensory neuropathy. At the time of planned carpal tunnel and Guyon canal release, a transligamentous ulnar nerve sensory common branch to the fourth webspace was encountered and safely released. Results: There were no surgical complications. The patient’s symptoms of numbness in the median and ulnar nerve distribution clinically improved at his first postoperative visit. Conclusions: We have identified a case of transligamentous ulnar nerve sensory branch encountered during carpal tunnel release. To our knowledge, this has not been previously reported. While the incidence of this variant is unknown, hand surgeons should be aware of this anatomical variant as its location puts it at risk of iatrogenic injury during open and endoscopic carpal tunnel release.

Quick Reference: Chapter 3: The Musculoskeletal System

2000 ◽  
Vol 5 (2) ◽  
pp. 4-5
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Motor Nerve ◽  
Carpal Tunnel Release ◽  
Trial Court ◽  
Left Hand ◽  
Work Related ◽  
Medical Evaluation ◽  
Carpal Tunnel Release Surgery ◽  
Clinical Records

Abstract The November/December 1996 issue of The Guides Newsletter included an article regarding the challenges faced by those who evaluate carpal tunnel syndrome (CTS) impairment. A recent case highlights some of these challenges: Ms Kirby presented for an independent medical evaluation to address two issues, the work-relatedness of her left CTS and the percentage of anatomic impairment due to her surgically treated left CTS. Relevant clinical records noted nonspecific complaints of left-hand pain and paresthesia but no abnormalities of the peripheral neuromusculoskeletal system. Motor nerve conduction velocities were normal and showed relative prolonged latencies in the left vs right median nerve at the wrist. Left carpal tunnel release surgery was recommended and performed, but Ms Kirby reported no improvement in her symptoms and had a self-perception of substantial occupational incapacity. The evaluating physician determined that Ms Kirby had neither the specific hand/wrist symptoms nor the median nerve slowing necessary to establish a diagnosis of CTS and, therefore, could not have work-related CTS according to the criteria in the AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition. The parties involved could not reach a settlement, and the case went to trial; the trial court relied on the testimony of the treating surgeon in finding that Ms Kirby's CTS was caused by her work and awarded her a substantial percentage of occupational disability.

scholarly journals Revision of Carpal Tunnel Release due to Palmaris Longus Profundus

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Lyrtzis Christos ◽  
Natsis Konstantinos ◽  
Pantazis Evagelos
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Postoperative Course ◽  
Palmaris Longus ◽  
Tunnel Syndrome

Purpose. The palmaris longus profundus has been documented throughout the literature as a cause of carpal tunnel syndrome. We present a case of palmaris profundus tendon removal during the revision of carpal tunnel release.Method. During a carpal tunnel release in a 66-year-old woman, palmaris profundus tendon was found inside the tunnel under the transverse carpal ligament, just above the median nerve, but it was left intact. The patient complained of pain in the hand at night and weakness of her hand one month after surgery. We decided on a revision of the carpal tunnel release. The palmaris profundus tendon was found and was removed.Results. The patient had a normal postoperative course. Two months later she returned to her normal activities and was asymptomatic.Conclusions. When a palmaris profundus muscle is located in carpal tunnel, we recommend its excision during carpal tunnel release. This excision will eliminate the possibility of recurrent compression over the median nerve.

scholarly journals Acute progressive bilateral carpal tunnel syndrome associated with remitting seronegative symmetrical synovitis with pitting edema syndrome: A case report

2019 ◽  
Vol 28 (1) ◽  
pp. 230949901989307
Author(s):  
Kentaro Okuma ◽  
Ryogo Furuhata ◽  
Yasuhiro Kiyota ◽  
Aki Kono ◽  
Teppei Hayashi ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Sudden Onset ◽  
Left Hand ◽  
Urgent Surgery ◽  
Rs3pe Syndrome ◽  
Tunnel Syndrome ◽  
Pitting Edema

The association between carpal tunnel syndrome (CTS) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, an elderly onset rheumatic disease, is not fully understood. Here, we describe a case of acute CTS caused by RS3PE syndrome. An 84-year-old man visited the hospital with sudden onset of severe neuralgia in the median nerve and pitting edema in both hands. Computed tomography showed low-density areas around the flexor tendons and median nerve compression in the carpal tunnel. Rapidly progressing intolerable neuralgia and paralysis required urgent carpal tunnel release in the left hand. After surgery, we considered the possibility of RS3PE syndrome and started the administration of prednisolone. The pitting edema and neuralgia improved. In this case, imaging and intraoperative findings suggest that the effusion generated from flexor tenosynovitis associated with RS3PE syndrome increased the internal pressure in the carpal tunnel rapidly, which led to acute CTS and urgent surgery.

Effectiveness and Safety in Closed Mini-Transverse Incision with Hydro-Dissection Technique in Carpal Tunnel Release: A Cadaveric Study

2019 ◽  
Vol 24 (02) ◽  
pp. 224-228
Author(s):  
Jirapong Leeyaphan ◽  
Rosarin Ratanalekha
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Ulnar Artery ◽  
Cadaveric Study ◽  
Transverse Carpal Ligament ◽  
Transverse Incision ◽  
Special Instrument ◽  
Dissection Technique ◽  
Neurovascular Structures

Background: Closed mini-wrist transverse incision for carpal tunnel release has been reported in decreasing surgical scar problems, but there were few cadaveric studies that proved the effectiveness and safety in this technique without protective instrument to the median nerve. Hydro-dissection was previously showed to separate median nerve and deep structures during percutaneous ultrasound guided transverse carpal ligament release. This cadaveric study aims to demonstrated effectiveness and safety of closed transverse carpal ligament (TCL) release though the mini-transverse incision at distal wrist crease combined with hydrodissection technique. Neither special instrument nor retractor was used to protect neurovascular structures. Methods: Twelve fresh frozen cadaveric wrists were included in this study. Completeness of TCL release and injury to the adjacent neurovascular structures were assessed by direct visualization. Thickness of TCL, TCL length and distance from incision to adjacent neurovascular structures were also recorded. Results: Complete release of TCL was demonstrated in all 12 (100%) wrists underwent the mini-transverse incision TCL release at distal wrist crease and hydro-dissection technique. No injury to the adjacent neurovascular structures was found in all 12 wrists. Mean of thickness of TCL and TCL length were 3 mm and 28.7 mm, respectively. The ulnar artery was the nearest structure to the incision (mean = 3.7 mm). Conclusions: The closed mini-transverse incision TCL release at distal wrist crease with hydro-dissection technique demonstrated completeness of TCL division and safety to the neurovascular structures without protecting retractor or special instrument.

scholarly journals Carpal Tunnel Syndrome Secondary to Acute Thrombosis of Persistent Median Artery and Review of the Literature

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Antoine Lessard
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Upper Extremity ◽  
Carpal Tunnel ◽  
Anatomic Variation ◽  
Carpal Tunnel Release ◽  
Review Of The Literature ◽  
Acute Thrombosis ◽  
Tunnel Syndrome ◽  
Median Artery

Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper extremity.1 We report a case in which a twenty-eight-year-old manual labourer presented with acute thrombosis in a persistent median artery which triggered acute carpal tunnel symptoms. A bifid median nerve was found upon carpal tunnel release. The knowledge of the existence of this anatomic variation is important in order to prevent inadvertent injury. We further discuss the possible aetiologies for CTS as well as neurovascular anomalies which may lead to median nerve compression at the wrist.

High Bifurcation of Median Nerve at the Wrist Causing Common Digital Nerve Injury in Endoscopic Carpal Tunnel Release

2002 ◽  
Vol 27 (6) ◽  
pp. 580-582 ◽  
Author(s):  
I. H. JEON ◽  
P. T. KIM ◽  
I. H. PARK ◽  
B. C. PARK ◽  
J. C. IHN
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Electric Shock ◽  
Local Anaesthetic ◽  
Carpal Tunnel Release ◽  
Digital Nerve ◽  
Proximal Half ◽  
Endoscopic Carpal Tunnel Release ◽  
Middle Ring ◽  
High Level

A 45-year-old right-handed woman was treated by endoscopic carpal tunnel release under local anaesthetic. When cutting the proximal half of the flexor retinaculum with the retrograde blade, she complained of an electric shock-like pain in her middle and ring fingers. Open exploration of the carpal tunnel was performed and a laceration of the middle/ring common digital nerve, which bifurcated at the unusually high level of the wrist crease, was found.

Anomalous Thenar Musculature Associated with Aberrant Median Nerve Motor Branch Take-off: An Anatomic and Clinical Study

2012 ◽  
Vol 2 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Gary M Lourie ◽  
R Glenn Gaston ◽  
Allan E Peljovich ◽  
Jason J Marshall ◽  
Lee Patterson
Keyword(s):  
Clinical Study ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Anatomic Study ◽  
Thenar Muscle ◽  
High Association ◽  
Motor Branch ◽  
Endoscopic Techniques

ABSTRACT Introduction Iatrogenic laceration of the median nerve motor branch during carpal tunnel release is a devastating complication that has been reported with both open and endoscopic techniques. The purpose of this study is to highlight a previously underreported relationship between an aberrant course of the median nerve motor branch and an anomalous thenar muscle that places the motor branch at high risk. Materials and methods This was a two part study. The first part was a retrospective review of over 500 cases of carpal tunnel release over a 7 year period. There were 530 carpal tunnel releases performed and 20/530 cases were found to have a characteristic anomalous thenar muscle associated with a consistent aberrant course of the motor branch of the median nerve. Part two was an anatomic study in which 42 cadaveric wrists were dissected to determine median nerve branching patterns, dimensions of the transverse carpal ligament, and thenar musculature dimensions. Results Twenty patients (3.8%) in the clinical arm were found to have anomalous musculature. In each case, the characteristics of the muscle were similar; the muscle was triangular in shape, was distal to the FPB, and had minimal fascial covering. In 100% of the cases the motor branch was found to be more anterior/central or ulnar in its take-off. In the anatomic study, two hands (5%) had aberrant musculature extending distal to the transverse carpal ligament (TCL). Both were associated with an anterior/central or ulnar median motor branch take-off with recurrent course. Larger thenar musculature dimensions and anomalous thenar muscle were associated with more anterior and ulnar motor branch take-off. Conclusion There appears to be a high association between anomalous thenar musculature and an aberrant course of the motor branch of the median nerve placing it a greater potential risk for iatrogenic injury. Lourie GM, Gaston RG, Peljovich AE, Marshall JJ, Patterson L. Anomalous Thenar Musculature Associated with Aberrant Median Nerve Motor Branch Take-off: An Anatomic and Clinical Study. The Duke Orthop J 2012;2(1):18-22.

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

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