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The superficial anatomical landmarks are not reliable for predicting the recurrent branch of the median nerve



The variability of the recurrent branch (RB) of the median nerve lends itself to an increased risk of injury when performing the minimally invasive approach for carpal tunnel release without its direct visualization. This risk is less so when it is released via the more invasive open approach as the RB can be easily identified, but the drawback is that of longer postoperative patient recovery time. Therefore, performing these releases via the less invasive approach should be more favorable for patients providing it could be done safely. Hence with there being a positive link between the hypertrophy of the thenar musculature and the course of RB according to previous studies.


We dissected 28 hands of 14 donated bodies fixed using Thiel’s method to try to demonstrate these findings of the associations among the RB, palmar creases and other superficial anatomical landmarks. Fisher’s exact test was conducted to verify the relationship between those structures statistically.


Statistically significant links were found between the type of the RB and the type of the palmar creases (p value = 0.0094) and between the RB type and the palmaris longus muscle presence (p value = 0.028).


It was inferred that palmar creases and other superficial anatomical landmarks listed in the text could not be used to predict the variability of the RB and the choice of mini-invasive approach should not be based on their course.

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We are very thankful to all body donors for their kind donation and Katerina Kuncová for the illustrations used in this text. This research received institutional support from Charles University, Prague, Czech Republic (Grant No. PROGRESS Q37).

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Authors and Affiliations



VoK Project development; Dissection; Manuscript writing/editing. MS Photo documentation and its processing; Dissection; Manuscript writing/editing. GF Dissection supervision; Manuscript writing/editing. CN Manuscript writing/editing and data processing. VlK Statistical analysis of data, manuscript writing/editing. DK Manuscript writing/editing and supervision.

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Correspondence to David Kachlík.

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Kunc, V., Štulpa, M., Feigl, G. et al. The superficial anatomical landmarks are not reliable for predicting the recurrent branch of the median nerve. Surg Radiol Anat 42, 939–943 (2020).

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  • Recurrent branch
  • Median nerve
  • Palmar creases
  • Anatomical variation
  • Carpal tunnel syndrome
  • Hand surgery