scholarly journals Topographical, anatomical and neurosurgical aspects of "end-to-side" nerve repair

2021 ◽  
Vol 23 (1) ◽  
pp. 121-128
Author(s):  
A. Y. Nisht ◽  
Nikolay F. Fomin ◽  
Vladimir P. Orlov
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Lateral Surface ◽  
Peripheral Nerves ◽  
Radial Nerve ◽  
Surgical Techniques ◽  
Nerve Fibers ◽  
Individual Variability ◽  
Motor Branch ◽  
Deep Branch

The article presents the results of a comprehensive anatomical and experimental study of individual variability in the structure and topography of motor branches of peripheral nerves in relation to the justification of methods for selective reinnervation of tissues by the "end-to-side" neurorrhaphy. It was found that relatively longer branches of peripheral nerves with a small number of connecting inter-arm collaterals characteristic of narrow and long limbs create conditions for less traumatic mobilization of motor branches. In cases with relatively wide and short extremities mobilization of peripheral nerves is complicated by the presence of a large number of collateral branches and intra-trunk connections, which are often damaged when separate bundles that make up the mobilized branches of the donor or recipient nerve are isolated from the main nerve trunk. It has been shown that potential recipient nerves should be motor branches of peripheral nerves, the preservation of which is of fundamental importance for the function of the corresponding segment of the limb. To create conditions conducive to selective reinnervation of functionally significant muscle groups of the upper limb, we have developed, justified from anatomical positions, and tested in an experiment on anatomical material methods for connecting the distal motor branches of peripheral nerves by the "end-to-side" neurorrhaphy. The main idea of accelerated recovery of the thumb opposition in injuries of the median nerve is to reinnervate the muscles of the elevation of the I finger due to nerve fibers that are part of the deep branch of the ulnar nerve. For this purpose, surgical techniques have been developed for connecting the recurrent motor branch of the damaged median nerve mobilized at the level of the wrist with the edges of a surgically formed perineurium defect on the lateral surface of the bundles that make up the deep branch of the ulnar nerve. In another clinical situation, in patients with radial nerve injuries, for the muscle reinnervation, а method is proposed for neurotisation of the deep motor branch of the radial nerve by the end-to-side suture to the lateral surface of the median nerve. We assume that performing the "end-to-side" nerve suture at the level of the base of the hand in the cases of proximal damage to the median nerve will reduce the time of reinnervation of the muscles of the thumb elevation by 400450 days. Transposition of the deep branch of the damaged at the proximal level radial nerve with "end-to-side" neurorrhaphy to the median nerve by 250300 days (based on the total length of the shoulder and forearm, which is about 50 cm and the rate of regeneration of nerve fibers 1 mm per day). Accordingly, with higher injuries (brachial plexus), the gain in the time of reinnervation of the distal segments will be even greater. In our opinion, the results can be used as a basis for further clinical research on the development of methods for selective tissue reinnervation in cases with isolated injuries of the peripheral nerves.

Transfer of Sensory Nerves in Hand Surgery

1984 ◽  
Vol 9 (1) ◽  
pp. 46-49 ◽  
Author(s):  
P. BEDESCHI ◽  
L. CELLI ◽  
A. BALLI
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
Sensory Nerves ◽  
Dorsal Rami

The transfer of sensitive dorsal rami of the ulnar nerve (two cases) and of two sensitive dorsal rami of the radial nerve (five cases) was accomplished in order to restore the sensitivity of the first three finger tips in patients suffering from serious and longstanding inveterate lesions of the median nerve. The Authors describe the two surgical techniques in detail and, according to the satisfactory results obtained, specify the indications and advantages of this operation.

Riche-Cannieu connection in median nerve injuries

1996 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Mm Carr ◽  
Jb Boyd ◽  
Cva Bowen
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Motor Response ◽  
Clinical Presentation ◽  
Nerve Injuries ◽  
Careful Evaluation ◽  
Motor Branch ◽  
Normal Volunteers ◽  
Deep Branch

The Riche-Cannieu connection between the deep branch of the ulnar nerve and the recurrent motor branch of the median nerve was first noted in hand dissections almost 100 years ago. It was then considered rare and unimportant. Electrophysiologists have recently shown that this connection occurs in a large proportion of normal volunteers and accounts for a variable proportion of motor response in the thenar musculature. This report describes two cases of median nerve injuries with intact thenar function and postulates that this anomalous clinical presentation is due to the Riche-Cannieu connection. The unusual clinical situations emphasize the need for careful evaluation of nerve injuries.

Carpal Tunnel Syndrome Caused by a Simple Ganglion

HAND ◽  
1981 ◽  
Vol os-13 (2) ◽  
pp. 164-166 ◽  
Author(s):  
F. J. Harvey ◽  
J. S. Bosanquet
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Peripheral Nerves ◽  
Nerve Compression ◽  
Median Nerve Compression ◽  
Deep Branch ◽  
Tunnel Syndrome

The compression of peripheral nerves by simple ganglia is a well recognized and documented clinical entity. It has been reported where ganglia have been associated with the ankle, knee and elbow joints (D. M. Brooks, 1952). It is probably best known in compression of the deep branch of the ulnar nerve in the wrist, first described by Seddon (Seddon H. J. 1952). Median nerve compression at the wrist, however, that causes a carpal tunnel syndrome would appear to be well recognized but poorly documented. Brooks (1952) described a case and until now, no others have been recorded in the literature. This case report describes such median nerve involvement with some interesting features.

scholarly journals Flexor Pollicis Brevis Muscle. Anatomical Study and Clinical Implications

2017 ◽  
Vol 11 (1) ◽  
pp. 1321-1329
Author(s):  
Edie Benedito Caetano ◽  
Yuri da Cunha Nakamichi ◽  
Renato Alves de Andrade ◽  
Maico Minoru Sawada ◽  
Mauricio Tadeu Nakasone ◽  
...  
Keyword(s):  
Medical School ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Anatomical Study ◽  
Sao Paulo ◽  
Clinical Implications ◽  
Normal Pattern ◽  
Anatomical Dissection ◽  
Deep Branch ◽  
Catholic University

Introduction: This paper reports anatomical study of nature, incidence, innervation and clinical implications of Flexor Pollicis Brevis muscle (FPB). Material and Methods: The anatomical dissection of 60 limbs from 30 cadavers were performed in the Department of Anatomy of Medical School of Catholic University of São Paulo. Results: The superficial head of FPB has been innervated by the median nerve in 70% and in 30% it had double innervation. The deep head of FPB were absent in 14%, in 65%, occurred a double innervation. In 17.5% by deep branch of ulnar nerve and in 3.6% by recurrent branch of median nerve. Conclusion: The pattern of innervation more frequent in relationship to the flexor pollicis brevis muscle and should be considered as a normal pattern is that superficial head receives innervation of branches of median nerve and the deep head receives innervation of ulnar and median nerve.

Peripheral Nervous SystemUpper Extremity

2013 ◽  
Author(s):  
Adam Fisch
Keyword(s):  
Nervous System ◽  
Brachial Plexus ◽  
Median Nerve ◽  
Peripheral Nervous System ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Upper Extremities ◽  
Cervical Plexus

Chapter 3 discusses how to draw the peripheral nervous system (upper extremities), including the brachial plexus, median nerve, ulnar nerve, radial nerve, and the cervical plexus.

Emergence of Radial Nerve Dominance in Median Nerve Cortex After Median Nerve Transection in an Adult Squirrel Monkey

1997 ◽  
Vol 77 (1) ◽  
pp. 522-526 ◽  
Author(s):  
C. E. Schroeder ◽  
S. Seto ◽  
P. E. Garraghty
Keyword(s):  
Median Nerve ◽  
Squirrel Monkey ◽  
Ulnar Nerve ◽  
Action Potentials ◽  
Radial Nerve ◽  
Current Source ◽  
Short Latency ◽  
Nerve Transection ◽  
A Site ◽  
Stimulation Of

Schroeder, C. E., S. Seto, and P. E. Garraghty. Emergence of radial nerve dominance in median nerve cortex after median nerve transection in an adult squirrel monkey. J. Neurophysiol. 77: 522–526, 1997. Throughout the glabrous representation in Area 3b, electrical stimulation of the dominant (median or ulnar) input produces robust, short-latency excitation, evident as a net extracellular “sink” in the Lamina 4 current source density (CSD) accompanied by action potentials. Stimulation of the collocated nondominant (radial nerve) input produces a subtle short-latency response in the Lamina 4 CSD unaccompanied by action potentials and followed by a clear excitatory response 12–15 ms later. Laminar response profiles for both inputs have a “feedforward” pattern, with initial activation in Lamina 4, followed by extragranular laminae. Such corepresentation of nondominant radial nerve inputs with the dominant (median or ulnar nerve) inputs in the glabrous hand surface representation provides a likely mechanism for reorganization after median nerve section in adult primates. To investigate this, we conducted repeated recordings using an implanted linear multi-electrode array straddling the cortical laminae at a site in “median nerve cortex” (i.e., at a site with a cutaneous receptive field on the volar surface of D2 and thus with its dominant afferent input conveyed by the median nerve) in an adult squirrel monkey. We characterized the baseline responses to median, radial, and ulnar nerve stimulation. We then cut the median nerve and semi-chronically monitored radial nerve, ulnar nerve and median nerve (proximal stump) evoked responses. The radial nerve response in median nerve cortex changed progressively during the weeks after median nerve transection, ultimately assuming the characteristics of the dominant nerve profile. During this time, median, and ulnar nerve profiles displayed little or no change.

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.

Restoration of Elbow Flexion in Traumatic Upper Brachial Plexus Palsy in Adults: Outcome with Intraplexus Distal Nerve Transfers in 78 Patients

2018 ◽  
Vol 37 (04) ◽  
pp. 285-290
Author(s):  
Mario Siqueira ◽  
Roberto Martins ◽  
Wilson Faglioni Junior ◽  
Luciano Foroni ◽  
Carlos Heise
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Traumatic Injury ◽  
Surgical Techniques ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Nerve Transfers ◽  
Significant Difference ◽  
Distal Nerve

Objective To present the functional outcomes of distal nerve transfer techniques for restoration of elbow flexion after upper brachial plexus injury. Method The files of 78 adult patients with C5, C6, ± C7 lesions were reviewed. The attempt to restore elbow flexion was made by intraplexus distal nerve transfers using a fascicle of the ulnar nerve (group A, n = 43), or a fascicle of the median nerve (group B, n = 16) or a combination of both (group C, n = 19). The result of the treatment was defined based on the British Medical Research Council grading system: muscle strength < M3 was considered a poor result. Results The global incidence of good/excellent results with these nerve transfers was 80.7%, and for different surgical techniques (groups A, B, C), it was 86%, 56.2% and 100% respectively. Patients submitted to ulnar nerve transfer or double transfer (ulnar + median fascicles transfer) had a better outcome than those submitted to median nerve transfer alone (p < 0.05). There was no significant difference between the outcome of ulnar transfer and double transfer. Conclusion In cases of traumatic injury of the upper brachial plexus, good and excelent results in the restoration of elbow flexion can be obtained using distal nerve transfers.

Transferring the Motor Branch of the Opponens Pollicis to the Terminal Division of the Deep Branch of the Ulnar Nerve for Pinch Reconstruction

2019 ◽  
Vol 44 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Francisco Soldado ◽  
Alfonso Rodrígues-Baeza ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Ulnar Nerve ◽  
Motor Branch ◽  
Deep Branch
Sign in / Sign up

Export Citation Format

Share Document