Abstract
Purpose
Spasticity of the first web space is common in upper limb spasticity. Selective neurectomy is one of the treatments that can reduce spasticity. The purpose of this study was to describe the variations of the deep motor branch of the ulnar nerve for the adductor pollicis (AP) and the first dorsal interosseous muscle (DIO) to assess the feasibility of selective neurectomy and suggest an ideal surgical approach.
Methods
The deep branch of the ulnar nerve (DBUN) was dissected in 21 hands. Measurements included the distance between the point of passage of the DBUN between the two heads of the adductor and three anatomical landmarks: the bi-styloid line, the flexor carpi radialis and the pisiform bone, and the number and mode of divisions of each branch.
Results
The point of passage of the DBUN between the two heads of the adductor is very constant respective to the landmarks. The DBUN gives off 1–3 branches each for the oblique head of the AP, the transverse head, and the first DIO. Muscles receive more than one branch in 95% cases for the oblique head and 62% of cases for the transverse head, and 100% for the DIO.
Conclusions
This anatomical study suggests that selective neurectomy is feasible for the AP and first DIO muscles in most cases. An ideal approach for selective neurectomy of these muscles should start from the point of passage of the DBUN between the two heads of the AP. This point is easily identified with the help of the described landmarks.
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References
Atkins SE, Logan B et al (2009) The deep motor branch of the ulnar nerve: a detailed examination of its course and the clinical significance of its damage. J Hand Surg 34E(1):47–57
Bonnel F, Vila RM (1985) Anatomical study of the ulnar nerve in the hand. J Hand Surg 10:165–168
Botte MJ, Keenan MA, Gellman H, Garland DE, Waters RL (1989) Surgical management of spastic thumb-in-palm deformity in adults with brain injury. J Hand Surg 14A:174–182
Brunelli GA, Brunelli GR (2000) L’iponeurotizzazione (denervazione parziale selettiva) nelle paralisi spastiche. Riv Chir Riab Mano Arto Sup 38(1):93–97
Cambon-Binder A, Leclercq C (2015) Anatomical study of the musculocutaneous nerve branching pattern: application for selective neurectomy in the treatment of elbow flexors spasticity. Surg Radiol Anat 37:341–348
Gil Y, Shin K et al. Anatomy of the deep branch of the ulnar nerve (2015) J Hand Surg 41(8): 843 – 7
Homma T, Sakai T (1991) Ramification pattern of intermetacarpal branches of the deep branch ramus profundus) of the ulnar nerve in the human hand. Acta Anat 141:139–144
Lauritzen RS, Szabo RM, Lauritzen DB (1996) Innervation of the lumbrical muscles. J Hand Surg 21B:57–58
Leclercq C, Gras M (2016) Hyperselective neurectomy in the treatment of the spastic upper limb. Phys Med Rehabil Int 3:1075
McFarlane RM, Mayer JR, Hugill JV (1976) Further observations on the anatomy of the ulnar nerve at the wrist. Hand 8:115–117
Parot C, Leclercq C (2016) Anatomical study of the motor branches of the median nerve to the forearm and guidelines for selective neurectomy. Surg Radiol Anat 38:597. https://doi.org/10.1007/s00276-015-1593-6
Paulos R, Leclercq C (2015) Motor branches of the ulnar nerve to the forearm: an anatomical study and guidelines for selective neurectomy. Surg Radiol Anat 37:1043–1048
SPASM (A European Thematic Network to Develop Standardised Measures of Spasticity) (2006), Disabil Rehabil, 28 (Suppl 1) S1–S75
Stoffel A (1913) Treatment of spastic contractures. Am J Orthop Surg. 10:611
Sulaiman S, Soames R, Lamb C (2015) Ulnar nerve cutaneous distribution in the palm: application to surgery of the hand. Clin Anat 28:1022–1028
Tonkin M, Freitas A, Koman A, Leclercq C, Van Heest A (2008) The surgical management of thumb deformity in cerebral palsy J. Hand Surg 33E:77–80
Tonkin MA, Hatrick NC, Eckersley JR, Couzens G (2001) Surgery for cerebral palsy-Part 3: classification and operative procedures for thumb deformity. J Hand Surg 26B:465–470
Wynter S, Dissabandara L (2018) A comprehensive review of motor innervation of the hand: variations and clinical significance. Surg Radiol Anat 40:259–269. https://doi.org/10.1007/s00276-017-1898-8
Acknowledgements
We thank the staff of the anatomy laboratory of the Ecole de Chirurgie du Fer à Moulin for its help. (AP-HP, Ecole de Chirurgie, 75005 Paris, France).
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Bini, N., Leclercq, C. Anatomical study of the deep branch of the ulnar nerve and application to selective neurectomy in the treatment of spasticity of the first web space. Surg Radiol Anat 42, 253–258 (2020). https://doi.org/10.1007/s00276-019-02380-y
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DOI: https://doi.org/10.1007/s00276-019-02380-y