Shingles in palmar cutaneous branch of ulnar nerve

Object The palmar cutaneous branch of the ulnar nerve (PCUN) has received little attention in the literature, and to the authors' knowledge, has received no attention in the neurosurgical literature. The present study was performed to help the surgeon minimize postoperative complications of nerve decompression at the wrist. Methods Forty cadaveric upper limbs underwent dissection of the ulnar nerve in the forearm, at the wrist, and in the palm. The PCUN was investigated and when identified, measurements were made and relationships documented between this cutaneous branch and the ulnar artery. The length and width of the PCUN were measured, as was the distance from the medial epicondyle of the humerus to the origin of the PCUN from the ulnar nerve. Results A PCUN was found on 90% of sides. The origin of the PCUN from the ulnar nerve was found to lay a mean of 14.3 cm distal to the medial epicondyle. The mean length and width of this branch were 13 and 0.08 cm, respectively. In the forearm, the PCUN traveled lateral to the ulnar artery on 75% of sides and on the medial side of this vessel on the remaining sides. The PCUN perforated the fascia of the anterior forearm just proximal to the distal wrist crease. In the palm, the PCUN traveled superficial to the superficial palmar arch on all but 5 sides, where it traveled deep to this vascular structure's distal extent. On 2 sides each, the PCUN communicated with the superficial and deep ulnar nerves. On 2 sides, the PCUN communicated with the palmar cutaneous branch of the median nerve. The majority of the terminal fibers of the PCUN were found on the ulnar side of a hypothetical line drawn longitudinally through the fourth digit and supplied an area roughly 3 × 3 cm over the proximal medial palm. Conclusions The authors hope that the present data may be useful to the surgeon during decompressive procedures at the wrist, such as carpal tunnel and the Guyon canal. Based on this study, skin incisions of the palm made longitudinally along a line through the middle of the fourth digit would minimize injury to the PCUN.

Download Full-text

The Detailed Anatomy of the Palmar Cutaneous Nerves and its Clinical Implications

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80061-2 ◽

1998 ◽

Vol 23 (3) ◽

pp. 373-379 ◽

Cited By ~ 40

Author(s):

H. S. MATLOUB ◽

J-G. YAN ◽

A. B. MINK VAN DER MOLEN ◽

L-L. ZHANG ◽

J. R. SANGER

Keyword(s):

Ulnar Nerve ◽

Carpal Tunnel Release ◽

Significant Risk ◽

Sensory Nerves ◽

Clinical Implications ◽

Palmar Cutaneous Branch ◽

Cutaneous Branch ◽

Fresh Frozen ◽

Palmaris Longus Tendon ◽

Open Carpal Tunnel Release

The forearms and hands of 40 fresh-frozen cadavers were dissected under the microscope to study the palmar cutaneous branch of the median nerve (PCBm) and the palmar cutaneous branch of the ulnar nerve (PCBu). Branches of the PCBm innervating the scaphoid were typically found, but in no specimen did we find a ‘typical’ cutaneous branch of the ulnar nerve. According to our findings, standard incisions for open carpal tunnel release carry a significant risk of damaging branches of the PCBm or PCBu. The chance of injury to these sensory nerves can be minimized by using a short incision in the proximal palm or a twin incision approach, which we describe. Because the PCBm is closely associated with the ulnar side of the flexor carpi radialis (FCR) sheath, this sheath should be opened on the radial side during harvest of the FCR tendon for transfer. When transferring the palmaris longus tendon, it should be cut proximal to the distal wrist crease to avoid possible damage to the PCBm.

Download Full-text

Susceptibility of the Superficial Sensory Branch of the Radial Nerve to Form Painful Neuromas

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(84)90012-3 ◽

1984 ◽

Vol 9 (1) ◽

pp. 42-45 ◽

Cited By ~ 73

Author(s):

A. LEE DELLON ◽

SUSAN E. MACKINNON

Keyword(s):

Median Nerve ◽

Ulnar Nerve ◽

Radial Nerve ◽

Palmar Cutaneous Branch ◽

Cutaneous Branch ◽

Distal Fixation ◽

Extensor Carpi Radialis

The superficial sensory branch of the radial nerve appears prone to develop painful neuromas out of proportion to its likelihood for injury. Based on cadaver dissections and intraoperative observations, an anatomical mechanism for this “predisposition” is suggested. Exit of this nerve beneath dense fascia and the tendons of brachioradialis and extensor carpi radialis longus provide a proximal tethering against which tension develops as the distal fixation point (neuroma) is pulled through the long excursion of wrist are of motion. This long excursion and proximal tethering are not present anatomically for the dorsal cutaneous branch of the ulnar nerve nor the palmar cutaneous branch of the median nerve.

Download Full-text

Ultrasonographic Imaging of Entrapment of the Palmar Cutaneous Branch of the Ulnar Nerve Due to Accessory Abductor Digiti Minimi Muscle

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000001403 ◽

2020 ◽

Vol 99 (12) ◽

pp. e136-e137

Author(s):

Yi-Chiang Yang ◽

Wei-Ting Wu ◽

Ke-Vin Chang ◽

Levent Özçakar

Keyword(s):

Ulnar Nerve ◽

Palmar Cutaneous Branch ◽

Cutaneous Branch ◽

Abductor Digiti Minimi ◽

Abductor Digiti Minimi Muscle

Download Full-text

How to prevent injury to the palmar cutaneous branch of median nerve and ulnar nerve in a palmar incision in carpal tunnel release, a cadaveric study

Acta Neurochirurgica ◽

10.1007/s00701-013-1764-3 ◽

2013 ◽

Vol 155 (9) ◽

pp. 1751-1755 ◽

Cited By ~ 4

Author(s):

Xiuyue Xu ◽

Jie Lao ◽

Xin Zhao

Keyword(s):

Median Nerve ◽

Ulnar Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Cadaveric Study ◽

Palmar Cutaneous Branch ◽

Cutaneous Branch

Download Full-text

Anatomical variations of the innervated radial artery superficial palmar branch flap: A series of 28 clinical cases

Archives of Plastic Surgery ◽

10.5999/aps.2020.00423 ◽

2020 ◽

Vol 47 (5) ◽

pp. 435-443

Author(s):

Jae-Won Yang

Keyword(s):

Radial Artery ◽

Skin Flap ◽

Large Diameter ◽

Anatomical Variations ◽

Palmar Cutaneous Branch ◽

Cutaneous Branch ◽

Secondary Procedures ◽

Potential Damage ◽

Neural Anatomy ◽

Clinical Cases

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes.Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated.Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness.Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

Download Full-text