Classification of the variations of the palmar recurrent branch of the median nerve with special emphasis on angulation

OBJECTIVEIatrogenic nerve injuries are devastating to both the patient and the surgeon. This study focuses on the anatomical relationship of the palmar recurrent branch with the parent median nerve in an attempt to identify higher risk types.METHODSThe palmar recurrent branch was dissected in 75 embalmed cadavers. The median nerve was divided into 4 sections from lateral to medial, defined as zones 1–4. The angle to the axial plane of the median nerve was also measured and classified as 0°, 45°, 60°, and 90°.RESULTSAccessory recurrent branches were found in 36.2% of cases. The recurrent branch originated from zone 1 in 32.42%, zone 2 in 61.54%, zone 3 in 6.04%, and zone 4 in 0%. These are respectively classified as types I, II, III, and IV. The motor branch made an angle with the median nerve of 0° in 17% of cases, 45° in 37.4%, 60° in 26.4%, and 90° in 19.2%. These are respectively classified as types A, B, C, and D.CONCLUSIONSClose attention should be paid to the potential anatomical variabilities when performing nerve surgeries. For the palmar recurrent branch, the more medial the origin and the greater the angle it makes with the median nerve, the more dangerous it is. This classification is helpful in unifying the language and comparing results.

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Transfer of the Motor Branch of the Abductor Digiti Quinti for Thenar Muscle Reinnervation in High Median Nerve Injuries

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2017.08.009 ◽

2018 ◽

Vol 43 (1) ◽

pp. 8-15 ◽

Cited By ~ 9

Author(s):

Jayme Augusto Bertelli ◽

Francisco Soldado ◽

Alfonso Rodrígues-Baeza ◽

Marcos Flávio Ghizoni

Keyword(s):

Median Nerve ◽

Nerve Injuries ◽

Thenar Muscle ◽

Motor Branch ◽

Muscle Reinnervation ◽

High Median

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Macrovascular decompression of the median nerve for posttraumatic neuralgic limb pain

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.6.peds12471 ◽

2013 ◽

Vol 12 (3) ◽

pp. 270-273 ◽

Cited By ~ 1

Author(s):

Aqueel Pabaney ◽

Shawn L. Hervey-Jumper ◽

Joseph Domino ◽

Cormac O. Maher ◽

Lynda J. S. Yang

Keyword(s):

Neuropathic Pain ◽

Median Nerve ◽

Brachial Artery ◽

Motor Neuropathy ◽

Tissue Mass ◽

Anatomical Relationship ◽

Lancinating Pain ◽

Outcomes For Children ◽

Pain Recognition ◽

Relationship Of

Neuropathic pain is rare in children, and few reports provide adequate guidelines for treatment. The authors describe the successful treatment of tardy neuropathic pain via macrovascular decompression in a 15-year-old boy who presented with progressive pain 11 years following trauma to the upper extremity that had required surgical repair of the brachial artery. Examination revealed mild chronic median and ulnar motor neuropathy as well as recent progressive lancinating pain and a Tinel sign at the prior scar. A soft tissue mass in the neurovascular bundle at the site of previous injury was noted on MRI. Surgical exploration demonstrated an altered anatomical relationship of the previously repaired brachial artery and the median nerve, resulting in pulsatile compression of the median nerve by the brachial artery. Neurolysis and decompression of the median nerve with physical separation from the brachial artery resulted in immediate pain relief. This is the first report of macrovascular decompression of a major peripheral nerve with complete symptom resolution. Noninvasive imaging together with a thorough history and physical examination can support identification of this potential etiology of peripheral neuralgic pain. Recognition and treatment of this uncommon problem may yield improved outcomes for children with neuropathic pain.

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Riche-Cannieu connection in median nerve injuries

Canadian Journal of Plastic Surgery ◽

10.1177/229255039600400209 ◽

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.

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The anatomical relationship of the common peroneal nerve to the proximal fibula and its clinical significance when performing fibular-based posterolateral reconstructions

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03708-9 ◽

2021 ◽

Author(s):

Erik Hohmann ◽

Reinette Van Zyl ◽

Vaida Glatt ◽

Kevin Tetsworth ◽

Natalie Keough

Keyword(s):

Clinical Significance ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Proximal Fibula ◽

Anatomical Relationship ◽

The Common ◽

Relationship Of

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Variations in the Course of the Thenar Motor Branch of the Median Nerve and Their Relationship to the Hypertrophic Muscle Overlying the Transverse Carpal Ligament

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2010.08.011 ◽

2010 ◽

Vol 35 (11) ◽

pp. 1820-1824 ◽

Cited By ~ 26

Author(s):

Mohammad M. Al-Qattan

Keyword(s):

Median Nerve ◽

Transverse Carpal Ligament ◽

Motor Branch

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Neurilemoma of the Median Nerve - Surgical Strategies Based on a Case Report

Polish Journal of Surgery ◽

10.2478/pjs-2014-0076 ◽

2014 ◽

Vol 86 (9) ◽

Author(s):

Łukasz Ulatowski ◽

Anna Kaniewska

Keyword(s):

Case Report ◽

Median Nerve ◽

Nerve Trunk ◽

Reconstruction Technique ◽

Nerve Reconstruction ◽

Surgical Strategies ◽

Second Procedure ◽

Relationship Of ◽

The Relationship ◽

Neural Sheath

AbstractThe study presented a case of a patient with a neurilemoma of the median nerve. It presented as a six centemeters tumor, at the level of the proximal one third of the arm with only mild paraesthesias within frst to third ray of the hand. MRI showed the relationship of the tumor and the median nerve, and allowed for the preliminary diagnose of a benign peripheral neural sheath tumor (neurilemoma or neurofibroma). During the first operation the tumor has not been excised, because nerve reconstruction technique was not available. During the second procedure excision of the tumor has been performed without resection of the median nerve trunk with no postoperative deficiencies. The paper provides a detailed description of a surgical procedure. The presented case, like current publications shows that peripheral neural sheath tumor may be usually excised without resection of the nerve trunk, although the possibility of nerve fascicles injury or the need to excise them in the case of neurofibroma clearly suggest that these type of operations should be carried out in centers with microsurgical facilities.

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Relationship of Hull Mesocarp Color to Seed Germination and Vigor in Large-Seeded Virginia-Type Peanuts

Peanut Science ◽

10.3146/pnut.22.1.0005 ◽

1995 ◽

Vol 22 (1) ◽

pp. 22-26 ◽

Cited By ~ 3

Author(s):

J. F. Spears ◽

G. A. Sullivan

Keyword(s):

Accelerated Aging ◽

Dry Weight ◽

Seed Moisture Content ◽

Physiological Maturity ◽

Seed Maturity ◽

Seed Moisture ◽

Arachis Hypogaea L ◽

Maturity Class ◽

Relationship Of

Abstract Classification of peanuts (Arachis hypogaea L.) based on pod mesocarp color has become a popular means of estimating maturity of runner peanuts. This study was initiated to determine if the hull mesocarp color is related to seed maturity of virginia-type peanuts and to evaluate changes in quality as seed mature. Cultivars NC 7 and NC 9 peanuts were harvested by hand in 1990, 1991, and 1992. Pods were separated according to mesocarp color. Seed moisture content and dry weight within a maturity class varied with cultivar and production year. Germination of NC 7 seed grown in 1990 and 1992 increased as seed approached maturity. Immature NC 9 seed grown in 1991 and 1992 had substantially lower germination than seed from mature pods. There was no increase in germination during maturation of NC 7 seed harvested in 1991 or NC 9 from 1990. Seed leakage during imbibition, measured by electrical conductivity, decreased as seed matured. The lowest leakage levels occurred when seed had reached physiological maturity. Germination following accelerated aging (AA) increased as seed matured. Maximum AA germination of NC 7 occurred when seed had reached 77, 84, and 100% of their final dry weight in 1990, 1991, and 1992, respectively. NC 9 seed achieved maximum germination following AA after the seed amassed at least 90% of their final dry weight.

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