Surgical and Radiologic Anatomy

, Volume 26, Issue 4, pp 275–280 | Cite as

Relationships of the palmar cutaneous branch of the median nerve: a morphometric study

  • P. ChaynesEmail author
  • J. Bécue
  • P. Vaysse
  • M. Laude
Original Article


Treatment of carpal tunnel syndrome consists in decompression of the median nerve by section of the flexor retinaculum. Usually, this surgery improves the disease with disappearance of the symptoms. However, some painful sequelae may remain such as painful discharges, paresthesiae or permanent anesthesia of the base of the thumb or of the scar related to an injury of the palmar cutaneous branch of the median nerve (PCBm). This study was performed to define the accurate emergence and the anatomic characteristics of this nerve in relation to stable landmarks. Moreover, it assessed the importance of the visual identification of the branch during section of the flexor retinaculum. Thirty-five hands were dissected under macroscopic examination and under magnification of the thinnest branches. Measurements were performed with a caliper and the forearm in supination. Determination of the bistyloid line showed variability in the location of the distal wrist crease. Thus, it could not be used as a landmark to locate the PCBm. The palmar cutaneous branch is the distal collateral branch of the median nerve in the forearm. It emerges on its radial side, on average 44.3 mm before the bistyloid line. It courses in line with the third finger and perforates the antebrachial aponeurosis about 5.7 mm from the bistyloid line. This emergence can be located in the palm, where it can be injured if the incision is performed in line with the third finger. The PCBm usually ends in the palm by division into two or three branches. The lateral branch supplies the skin of the thenar eminence while the medial, usually shorter branch supplies the midline part of the palm. This study has shown the importance of performing the cutaneous incision in line with the fourth finger to avoid injury to the PCBm.


Anatomy Carpal tunnel syndrome Median nerve Morphometric analysis Palmar cutaneous branch 



The authors wish to thank M. Hubert Deroque for his help in the preparation of the materials and photographs.


  1. 1.
    Bezerra AJ, Carvalho VC, Nucci A (1986) An anatomical study of the palmar cutaneous branch of the median nerve. Surg Radiol Anat 8:183–188PubMedGoogle Scholar
  2. 2.
    Bonnel F, Mailhe P, Allieu Y, Rabischong P (1980) Bases anatomiques de la chirurgie fasciculaire du nerf médian au poignet. Ann Chir 34:707–710PubMedGoogle Scholar
  3. 3.
    Born T, Mahoney J (1995) Cutaneous distribution of the ulnar nerve in the palm: does it cross the incision used in carpal tunnel release? Ann Plast Surg 35:23–25PubMedGoogle Scholar
  4. 4.
    Bureau H, Magalon G, Roffe JL (1982) Le syndrome du canal carpien. J Chir 119:739–747Google Scholar
  5. 5.
    Carroll RE, Green DP (1972) The significance of the palmar cutaneous nerve at the wrist. Clin Orthop 83:24–28PubMedGoogle Scholar
  6. 6.
    Chabaud B, Flocard F, Dasse Y, Ribot C, Bady B, Sindou M (1993) Applications chirurgicales des variations anatomiques du nerf médian au poignet. Neurochirurgie 39:92–100PubMedGoogle Scholar
  7. 7.
    DaSilva MF, Moore DC, Weiss APC, Akelman E, Sikirica M (1996) Anatomy of the palmar cutaneous branch of the median nerve: clinical significance. J Hand Surg [Am] 21:639–643Google Scholar
  8. 8.
    Dowdy PA, Richards RS, McFarlane RM (1994) The palmar cutaneous branch of the median nerve and the palmaris longus tendon: a cadaveric study. J Hand Surg [Am] 19:199–202Google Scholar
  9. 9.
    Engber WD, Gmeiner JG (1980) Palmar cutaneous branch of the ulnar nerve. J Hand Surg [Am] 5:26–29Google Scholar
  10. 10.
    Gerritsen AAM, Uitdehaag BMJ, van Geldere D, Scholten RJPM, de Vet HCW, Bouter LM (2001) Systematic review of randomized clinical trials of surgical treatment for carpal tunnel syndrome. Br J Surg 88:1285–1295CrossRefPubMedGoogle Scholar
  11. 11.
    Hobbs RA, Magnussen PA, Tonkin MA (1990) Palmar cutaneous branch of the median nerve. J Hand Surg [Am] 15:38–43Google Scholar
  12. 12.
    Jimenez DF, Gibbs SR, Clapper BS (1998) Endoscopic treatment of carpal tunnel syndrome: a critical review. J Neurosurg 88:817–826PubMedGoogle Scholar
  13. 13.
    Kuhlmann N, Tubiana R, Lisfranc R (1978) Apport de l’anatomie dans la compréhension des syndromes de compression du canal carpien et des séquelles des interventions décompressives. Rev Chir Orthop 64:59–70PubMedGoogle Scholar
  14. 14.
    MacDonald R, Lichtman DM, Hanlon JJ, Wilson JN (1978) Complications of surgical release for carpal tunnel syndrome. J Hand Surg 3:70–76Google Scholar
  15. 15.
    Marie P, Foix C (1913) Atrophie isolée de l’éminence thénar d’origine névritique. Rôle du ligament annulaire antérieur du carpe dans la pathogénie de la lésion. Rev Neurol 26:647–648Google Scholar
  16. 16.
    Martin CM, Seiler JG, Lesesnes JS (1996) The cutaneous innervation of the palm: an anatomic study of the ulnar and median nerves. J Hand Surg [Am] 21:634–638Google Scholar
  17. 17.
    Matloub HS, Yan JG, Mink van der Molen AB, Zhang LL, Sanger JR (1998) The detailed anatomy of the palmar cutaneous nerves and its clinical implications. J Hand Surg [Br] 23:373–379Google Scholar
  18. 18.
    Naff N, Dellon AL, McKinnon SE (1993) The anatomical course of the palmar cutaneous branch of the median nerve, including a description of its own unique tunnel. J Hand Surg [Br] 18:316–317Google Scholar
  19. 19.
    Olave E, Del Sol M, Gabrielli C, Mandiola E, Rodrigues CFS (2001) Biometric study of the relationships between palmar neurovascular structures, the flexor retinaculum and the distal wrist crease. J Anat 198:737–741CrossRefPubMedGoogle Scholar
  20. 20.
    Razemon JP (1983) Syndrome du canal carpien. In: Souquet R (ed) Syndromes canalaires du membre supérieur. Expansion Scientifique, Paris, pp 64–73Google Scholar
  21. 21.
    Spinner M (1978) Injuries to the major branches of peripheral nerves of the forearm, 2nd edn. WB Saunders, PhiladelphiaGoogle Scholar
  22. 22.
    Taleisnik J (1973) The palmar cutaneous branch of the median nerve and the approach to the carpal tunnel. J Bone Joint Surg [Am] 55:1212–1217Google Scholar
  23. 23.
    Testut L, Jacob O (1922) Traité d’anatomie topographique avec applications médico-chirurgicales, 4th edn, vol 2. Doin, ParisGoogle Scholar
  24. 24.
    Watchmaker GP, Weber D, McKinnon SE (1996) Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release. J Hand Surg [Am] 21:644–650Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Laboratoire d’AnatomieFaculté de Médecine de Toulouse-RangueilToulouseFrance
  2. 2.Laboratoire d’AnatomieFaculté de Médecine d’AmiensAmiensFrance

Personalised recommendations