scholarly journals Median Nerve Variation: A Complete Spin before Terminal Branching

2020 ◽  
Vol 15 (01) ◽  
pp. e1-e4
Author(s):  
Amgad S. Hanna ◽  
Zhikui Wei ◽  
Barbara A. Hanna
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Distal Forearm ◽  
Flexor Digitorum Superficialis ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Surgical Interventions ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

AbstractMedian nerve anatomy is of great interest to clinicians and scientists given the importance of this nerve and its association with diseases. A rare anatomical variant of the median nerve in the distal forearm and wrist was discovered during a cadaveric dissection. The median nerve was deep to the flexor digitorum superficialis (FDS) in the carpal tunnel. It underwent a 360-degree spin before emerging at the lateral edge of FDS. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel. This variant doesn't fall into any of Lanz's four groups of median nerve anomalies. We propose a fifth group that involves variations in the course of the median nerve. This report underscores the importance of recognizing variants of the median nerve anatomy in the forearm and wrist during surgical interventions, such as for carpal tunnel syndrome.

scholarly journals Anomalous Flexor Digitorum Superficialis Muscle Transposition for Vascular Coverage of the Median Nerve in Recurrent Carpal Tunnel Syndrome

2005 ◽  
Vol 13 (1) ◽  
pp. 27-30
Author(s):  
Michael W Neumeister ◽  
Arian Mowlavi ◽  
Robert C Russell ◽  
Bradon J Wilhelmi
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Excellent Result ◽  
Vascular Supply ◽  
Flexor Digitorum Superficialis ◽  
Palmar Fascia ◽  
Anomalous Muscle ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

Recurrent carpal tunnel syndrome is uncommon yet troublesome. Significant adhesions and scarring around the median nerve can render it relatively ischemic. A number of vascular flaps have been described to provide vascular coverage in attempts to decrease further cicatricial adhesions and to improve local blood supply around the median nerve. A rare case of an anomalous muscle in the distal forearm used as tissue to provide good vascularized coverage of the median nerve that was severely scarred in its bed is reported. The anomalous muscle was distal to the flexor digitorum superficialis tendon and inserted in the palmar fascia on the ulnar aspect of the hand. Referring branches from the ulnar artery provided vascular supply to the anomalous muscle. The muscle on these vascular pedicles was transposed over the median nerve, providing good, stable, unscarred coverage. The patient had an excellent result with resolution of the carpal tunnel symptoms. The redundant anomalous muscle provided a unique vascularized source for coverage of the median nerve in recurrent carpal tunnel syndrome.

Acute Carpal Tunnel Syndrome Produced by Anomalous Flexor Digitorum Superficialis Indicis Muscle

1985 ◽  
Vol 10 (1) ◽  
pp. 83-84 ◽  
Author(s):  
K. AMETEWEE ◽  
A. HARRIS ◽  
M. SAMUEL
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Nerve Compression ◽  
Flexor Digitorum Superficialis ◽  
Tunnel Syndrome ◽  
Early Exploration ◽  
Female Nurse ◽  
Flexor Digitorum ◽  
Acute Carpal Tunnel Syndrome

A 23 year old female nurse developed acute sensory symptoms of median nerve compression. Early exploration revealed abnormal flexor superficialis indicis muscle as the compressing structure. Symptoms were relieved by freeing the muscle from the nerve.

Changes in Tissue Substance P Levels in Patients With Carpal Tunnel Syndrome

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1655-1661 ◽  
Author(s):  
Niyazi Öztürk ◽  
Nuray Erin ◽  
Serdar Tüzüner
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Substance P ◽  
Connective Tissue ◽  
Median Nerve ◽  
Chronic Inflammation ◽  
Carpal Tunnel ◽  
Acid Extraction ◽  
Flexor Digitorum Superficialis ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

Abstract BACKGROUND: Although carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in adults, its etiology is not completely known. Chronic inflammation, fibrosis of the transverse carpal ligament (TCL), and altered sensory response contribute to the symptoms. OBJECTIVE: Because substance P (SP) is known to be involved in neuropathic pain, chronic inflammation, and fibrosis, the present study evaluated changes in SP levels in patients with CTS. METHODS: TCL, median nerve adventitia, and synovial connective tissue of the middle flexor digitorum superficialis tendon samples from patients (n = 42) with CTS and healthy control subjects (n = 13) who were operated on for hand wounds were obtained at surgery. A group of these patients with CTS (n = 9) had received meloxicam treatment for 10 days before surgery. A 2-step acetic acid extraction was used to determine changes in SP levels in free nerve endings (neuronal) and in nonneuronal cells. RESULTS: Changes in SP levels were observed in both neuronal and nonneuronal tissues. SP levels increased in extracts of the TCL and synovial connective tissue of the middle flexor digitorum superficialis tendon but not in the median nerve adventitia of patients with CTS. Meloxicam pretreatment increased SP levels in nonneuronal components of the TCL. CONCLUSION: These findings suggest that SP contributes to the pain and inflammation associated with CTS. Further studies are required to evaluate the therapeutic potentials of SP receptor (NK1R) antagonists in CTS.

scholarly journals The Palmar Cutaneous Branch Mimicking the Recurrent Motor Branch of the Median Nerve

2018 ◽  
Vol 10 (01) ◽  
pp. 052-053
Author(s):  
Feiran Wu ◽  
Chye Ng
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Transverse Carpal Ligament ◽  
Proximal Margin ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Iatrogenic Nerve Injury ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Tunnel Syndrome

AbstractWe report an unusual anatomical variant of the palmar cutaneous branch (PCB) of the median nerve in a 46-year-old man presenting with recurrent carpal tunnel syndrome. At surgery, after neurolysis, the PCB was visualized arising at the level of the proximal margin of the transverse carpal ligament, mimicking the appearance of the recurrent motor branch. To date, there has been no description of this branch arising at this level. We aim to remind surgeons of this variation and highlight the importance of maintaining vigilance to avoid iatrogenic nerve injury.

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