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

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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THE DORSAL CUTANEOUS BRANCH OF THE ULNAR NERVE: AN ANATOMICAL STUDY

Hand Surgery ◽

10.1142/s021881041000493x ◽

2010 ◽

Vol 15 (03) ◽

pp. 165-168 ◽

Cited By ~ 17

Author(s):

Akira Goto ◽

Oka Kunihiro ◽

Tsuyoshi Murase ◽

Hisao Moritomo

Keyword(s):

Ulnar Nerve ◽

Anatomical Study ◽

Styloid Process ◽

Ulnar Styloid ◽

Ulnar Side ◽

Risk Of Injury ◽

Cutaneous Branch ◽

Ulnar Styloid Process

There are significant variations in the anatomy of the dorsal cutaneous branch of the ulnar nerve. The dorsal cutaneous branch is at a risk of injury during a therapy for the ulnar side of the wrist. The purpose of this study is to measure the variations of the dorsal cutaneous branch. We studied 30 embalmed cadaver specimens. In its course, two division patterns of the dorsal cutaneous branch were identified, namely proximal and distal types. The proximal type went around the ulna proximal to the ulnar styloid process, and directed toward the ulnodorsal aspect. The distal type went around to the ulnodorsal aspect, distal to the styloid process. The proximal type was found in 21 of 30 cadavers, and the distal type was found in nine of 30 cadavers.

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Surgical anatomy of the dorsal cutaneous branch of the ulnar nerve and its clinical significance in surgery at the ulnar side of the wrist

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418815800 ◽

2018 ◽

Vol 44 (3) ◽

pp. 263-268 ◽

Cited By ~ 2

Author(s):

Chairoj Uerpairojkit ◽

Piyabuth Kittithamvongs ◽

Dechporn Puthiwara ◽

Navapong Anantaworaskul ◽

Kanchai Malungpaishorpe ◽

...

Keyword(s):

Ulnar Nerve ◽

Vertical Axis ◽

Styloid Process ◽

Safe Zone ◽

Surgical Anatomy ◽

Ulnar Styloid ◽

Ulnar Side ◽

Median Distance ◽

Cutaneous Branch ◽

Cartesian Coordinate

The dorsal cutaneous branch of the ulnar nerve can be easily injured during surgery at the ulnar side of the wrist. We sought to identify the surgical anatomy, the pathway around the ulnar styloid process and the safe zone of the dorsal cutaneous branch of the ulnar nerve. In 44 forearm dissections, we found that the dorsal cutaneous branch of the ulnar nerve originated at a median distance of 6.8 cm proximal to the tip of the ulnar styloid. We classified the crossing pattern of the dorsal cutaneous branch of the ulnar nerve at a vertical axis into three types. The most common type featured the dorsal cutaneous branch of the ulnar nerve crossing the vertical axis at a median distance of 10.0 mm distal to the tip of the ulnar styloid. In 14% of specimens, the dorsal cutaneous branch of the ulnar nerve crossed the vertical axis at the level of the tip of the ulnar styloid. By mapping the course of the nerve using a Cartesian coordinate system, it was found that the areas located proximal and palmar to the tip of the ulnar styloid had a very high density of dorsal cutaneous branches of the ulnar nerve. We were unable to establish a safe zone. We recommend identifying the dorsal cutaneous branch of the ulnar nerve in every patient undergoing surgery at the ulnar side of the wrist.

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The anatomy of the dorsal cutaneous branch of the ulnar nerve

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193410373186 ◽

2010 ◽

Vol 35 (7) ◽

pp. 583-585 ◽

Cited By ~ 28

Author(s):

R. Puna ◽

P. Poon

Keyword(s):

Ulnar Nerve ◽

Styloid Process ◽

Upper Limbs ◽

Ulnar Styloid ◽

Dorsal Aspect ◽

Cutaneous Branch ◽

Ulnar Styloid Process

We investigated the anatomy of the dorsal cutaneous branch of the ulnar nerve in 32 upper limbs in cadavers. The dorsal cutaneous branch of the ulnar nerve originated on average 5.1 cm proximal to the ulnar styloid process and 1.9 cm palmar and radial to the subcutaneous border of the ulna. It crossed the subcutaneous border 0.2 cm proximal to the ulnar styloid process. In all cases it displaced further away in full pronation. We recommend cautious dissection when approaching within 2.5 cm of the ulnar styloid process. We also recommend making the initial incision in full pronation and just along the dorsal aspect of the subcutaneous border of the ulna.

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The Anatomy of the Dorsal Cutaneous Branch of the Ulnar Nerve – a Safe Zone for Positioning of the 6r Portal in Wrist Arthroscopy

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.10.005 ◽

2006 ◽

Vol 31 (2) ◽

pp. 203-205 ◽

Cited By ~ 23

Author(s):

A. TINDALL ◽

M. PATEL ◽

A. FROST ◽

I. PARKIN ◽

A. SHETTY ◽

...

Keyword(s):

Ulnar Nerve ◽

Clinical Relevance ◽

Styloid Process ◽

Safe Zone ◽

Iatrogenic Injury ◽

Wrist Arthroscopy ◽

Ulnar Styloid ◽

Dorsal Branch ◽

Cutaneous Branch ◽

Web Space

The dorsal branch of the ulnar nerve passes close to the 6 Radial portal used in wrist arthroscopy. We examined 20 cadaveric limbs to establish the course of this nerve. We found it consistently crossed a line between the ulnar styloid and the fourth web space at an average of 2.4 cm from the ulnar styloid (range 1.8–2.8 cm). This represented 23% (+/−2.5 STD range 19–27%) of the distance from the styloid process to the fourth web space. Recommendations are made to help avoid iatrogenic injury to the nerve during arthroscopy. The literature on the anatomy of this nerve and its variations and the clinical relevance of this knowledge are discussed.

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True Symphalangism of All Bilateral Proximal Interphalangeal Joints with Multi-carpal Coalition and Hypoplasia of the Ulnar Styloid Process

Indian Journal of Surgery ◽

10.1007/s12262-021-02900-4 ◽

2021 ◽

Author(s):

Hao Yu ◽

Chongjie Li

Keyword(s):

Case Report ◽

Range Of Motion ◽

Styloid Process ◽

Genetic Condition ◽

Ulnar Styloid ◽

Wrist Motion ◽

First Case ◽

Distal Interphalangeal ◽

Carpal Coalition ◽

Ulnar Styloid Process

AbstractSymphalangism is a rare genetic condition characterized by ankylosis of the proximal interphalangeal (PIP) or/and distal interphalangeal (DIP) joints. The patient presented with fused bilateral PIP joints and poor flexion, and an unsatisfactory range of motion (ROM) in the metacarpophalangeal (MP) and DIP joints. Concomitantly, multi-carpal coalition, proximal carpal malalignment, and ulnar styloid process abnormality were also observed in radiographs obtained at diagnosis. Rehabilitation training of the MP and DIP joints and a wrist supporter were recommended to achieve MP and DIP functional motion and restrict dramatic wrist motion. This is the first case report of symphalangism with multi-carpal coalition and abnormality of the ulnar styloid process to the best of our knowledge.

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