Abstract
Objective
To identify palmar cutaneous branches of median nerve and ulnar nerve (PCBMN and PCBUN) and try to find a safe path at wrist and forearm in the decompression procedure of carpal tunnel syndrome.
Materials and methods
Ten formalin-fixed and five fresh-frozen cadaveric forearms were included in the study. The cross point of longitude of middle finger and distal wrist crease was defined as 0 point. Distal wrist crease (DWC) and 0 point were chosen as references for measurements. Several points on the pathway of PCBMN and PCBUN were measured.
Results
The average distance between the origin of the PCBMN and PCBUN to the DWC was 4.95 ± 0.88 cm, 10.12 ± 1.50 cm, separately. The average distance between DWC and the point where PCBMN and PCBUN separated from their trunk was found to be 2.09 ± 0.31 cm, 2.90 ± 0.50 cm, separately. The distances between PCBMN, PCBUN and 0 point at DWC level was found to be 0.61 ± 0.12 cm, 0.47 ± 0.31 cm, separately. The diameters of two cutaneous branches were 0.10 ± 0.02 cm, 0.11 ± 0.04 cm, separately.
Conclusion
The general longitudinal palmar incision could avoid injuries to recurrent branch of median nerve and distal branches of palmar cutaneous nerve can be avoided macroscopically. The area about 5 mm ulnar and 6 mm radial to 0 point at wrist level was a relatively safe area.
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References
Alizadeh K, Lahiji F, Phalsaphy M (2006) Safety of carpal tunnel release with a short incision. A cadaver study. Acta Orthop Belg 72:415–419
Cheung JW, Shyu JF, Teng CC, Chen TH, Su CH, Shyr YM, Wang JJ, Wu CW, Lui WY, Liu JC (2004) The anatomical variations of the palmar cutaneous branch of the median nerve in Chinese adults. J Chin Med Assoc 67:27–31
Gitkind AI, Zhao P, Oh-Park MY, Fast A (2009) Median palmar cutaneous nerve injury in a volleyball player. Am J Phys Med Rehabil 88:272–274
Morte PD, Magee LM (2011) Hyperalgesia after volar wrist tattoo: a case of complex regional pain syndrome? J Clin Neuromuscul Dis 12:118–121
Ozcanli H, Coskun NK, Cengiz M, Oguz N, Sindel M (2010) Definition of a safe-zone in open carpal tunnel surgery: a cadaver study. Surg Radiol Anat 32:203–206
Pardal-Fernandez JM, Gracia-Rodriguez I, Iniesta-Lopez I, Rodriguez-Vazquez M (2011) Posttraumatic neuropathy of the palmar cutaneous branch of the median nerve: four cases. Laceration or entrapment? Acta Neurochir (Wien) 153:617–620
Teh KK, Ng ES, Choon DS (2009) Mini open carpal tunnel release using Knifelight: evaluation of the safety and effectiveness of using a single wrist incision (cadaveric study). J Hand Surg Eur Vol 34:506–510
Tubbs RS, Rogers JM, Loukas M, Comert A, Shoja MM, Cohen-Gadol AA (2011) Anatomy of the palmar branch of the ulnar nerve: application to ulnar and median nerve decompressive surgery. J Neurosurg 114:263–267
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Xu, X., Lao, J. & Zhao, X. 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 Neurochir 155, 1751–1755 (2013). https://doi.org/10.1007/s00701-013-1764-3
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DOI: https://doi.org/10.1007/s00701-013-1764-3