Median-to-Ulnar Nerve Communication in Carpal Tunnel Syndrome: An Electrophysiological Study

The median-to-ulnar communicating branch (MUC) is an asymptomatic variant of the upper limb innervation that can lead to interpretation errors in routine nerve conduction studies. The diagnosis of carpal tunnel syndrome (CTS) or ulnar nerve lesions can be complicated by the presence of MUC. In this study, we describe electrophysiological features of MUC in CTS patients presenting to our clinic. We enrolled MUB cases from consecutive CTS patients referred to our laboratory between the years 2014 and 2019. MUC was present in 53 limbs (36 patients) from the studied population. MUC was bilateral in 53% of patients. MUC type II was the most common subtype (74%), followed by types III and I; more coexisting MUC types were found in the majority of tested limbs. A positive correlation was demonstrated between the severity of CTS and the presence of positive onset, faster CV, or a double component of the compound muscle action potentials. We emphasize the importance of suspecting the presence of MUC in CTS in the presence of a positive onset or a double component in routine motor conduction studies.

A Study on Incidence of Communicating branch between Musculocutaneous Nerve and Median Nerve

Introduction: In present day Surgical practice it is mandatory to have a detailed idea of basic Anatomy and possible variations from normal pattern of all the major nerves and vessels in the body. One such important nerve in the body is Musculo Cutaneous nerve which is the chief nerve supplying the muscles of the front of the arm and also supplies the skin of lateral aspect of forearm. In the present study undertaken 58 upperlimbs were dissected and the incidence of communicating branch between Musculocutaneous Nerve and Median Nerve was studied. Aims and Objectives: The study is undertaken to know the incidence of communicating branch between Musculocutaneous Nerve and Median Nerve and its importance in surgical approaches of the upper limb. Materials and Methods: Under aseptic precautions, Standard dissection procedures were followed to dissect out the Musculocutaneous nerves and Median nerves in the 58 upper limbs of both right and left sides in the human cadavers of both sexes and the incidence of communicating branch between Musculocutaneous Nerve and Median Nerve were studied in detail and images were taken with digital camera for proper presentation of the study. Results and Conclusion: In the present study undertaken 7 upper limbs (12 percent) out of 58 upper limbs dissected showed the presence of communicating branch between Musculocutaneous nerve and Median nerve which comes under the category of type II of choi et al classification. on an average percentage of incidence of communicating branch between Musculocutaneous nerve and Median nerve varies between 10 percent to 53 percent. KEY WORDS: Musculocutaneous nerve, Median nerve and communication between Musculocutaneous nerve and median nerve.

High-resolution sonographic study of the communicating branch of Berrettini: an anatomical feasibility study

Sensory changes are common manifestations of nerve complications of carpal tunnel surgery. Division or contusion of a superficial communicating branch between the median nerve and the ulnar nerve, the communicating branch of Berrettini, can explain these symptoms. The aim of this study was to describe the potential value of high-resolution sonography to examine this branch. We conducted a study on eight fresh cadaver hands. An ultrasound assessment of the communicating branch of Berrettini, accompanied by an injection of methylene blue, was performed by a senior radiologist. Subsequent dissections confirmed that the eight guided ultrasound injections allowed the methylene blue to be placed around the origin and termination of the communicating branch of Berrettini. This study extends the limits of ultrasound both in the postoperative diagnosis of potential nerve complications and its possible use in ultrasound-guided carpal tunnel release.

Multiple variations of superficial and deep veins in the neck region of a cadaver: a case report

Multiple variations on the right side of the neck of a 65-year-old male cadaver were observed during a routine dissection. The cadaver had no sign of facial trauma or previous surgery. The facial vein had a communicating branch with the internal jugular vein and distally drained into the jugulo-subclavian confluence via a common trunk with external jugular vein. Other superficial veins of the neck drained into the brachiocephalic vein separately. On the contrary, no anatomical variation was observed on the left side. Even if the variations of the head and neck are common, more than one variation in a single cadaver unilaterally is remarkable. We suggest that it is important for surgeons to examine the patients with ultrasound before any clinical interventions on the neck to determine the possible variations beforehand.

The Rare Five Finger Pectoralis Nerves: A Case Report

The brachial plexus is a complex network of nerve tissue in the human body that has been reported to vary from person to person. We describe a very rare variation of the brachial plexus found on a routine cadaveric dissection. On the left side of the chest, we identified two lateral pectoral nerves arising from the lateral cord and innervating the pectoralis major muscle; two medial pectoral nerves (MPNs) arising from the medial cord that innervates both pectoral muscles and a communicating branch that connects the lateral and MPN. In addition, this communicating branch had a nerve that innervated the pectoralis minor muscle. Knowing the variations of branching of the pectoral nerves is critical when performing any medical procedure in the pectoral region, such as plastic breast reconstruction surgery after modified radical mastectomy in breast cancer, removal of the pectoral muscles, anesthetizing the brachial plexus, or axillary dissection.

Anatomical Variation of a Communicating Branch between the Musculocutaneous and the Median Nerve: A Case Report

<p><strong>Objective</strong>. The aim of our paper is to depict an anatomical variation of the brachial plexus, concerning a communicating branch between the median and the musculocutaneous nerve and its clinical significance. Anatomical variations of the brachial plexus and especially those of the musculocutaneous nerve are quite common. Awareness of these variations is of paramount importance in clinical practice, mainly in achieving best results in minimal invasive or surgical procedures.</p><p><strong>Case Report</strong>. After dissection in upper extremities in a 89-year-old male cadaver, a communicating branch between the median and the musculocutaneous nerve was found. This communicating branch was formed before the musculocutaneous nerve perforated the coracobrachialis muscle. It also derived from the level of the ansa medianis and its course was of an approximately 2cm length.</p><p><strong>Conclusion</strong>. The clinical significance of our study is the entrapment of the musculocutaneous nerve that may cause clinical findings similar to those of the carpal tunnel syndrome.</p>

Endoscopic band ligation for transverse colonic variceal bleeding: case report and review of the literature

ABSTRACT Colonic varices are lesser-known in comparison with gastroesophageal varices in a complication associated with liver cirrhosis. The ideal therapeutic intervention for a colonic varix is still unclear. We report a 42 year-old man with 20 years of alcohol use who presented with hematochezia and abdominal distension. The patient was diagnosed with alcoholic liver cirrhosis. The colonoscopy revealed a dilated and tortuous varix in the transverse colon close to the hepatic flexure with oozing blood, a communicating branch and with “red sign”, evidence of acute bleeding. Endoscopic band ligation (EBL), the most useful intervention for esophageal varices, was further successfully performed to arrest the bleeding colonic varices. One month after initial treatment, the colonic varices nearly vanished and were replaced by an ulcer. It is extremely rare for colonic varices to be treated with EBL. There is only one similar case in reported literature, but it seems to be safe and effective as an intervention for EBL for acute colonic variceal bleeding. SIMILAR CASES: Second case treated by endoscopic band ligation.