29 results on '"Palmar cutaneous branch"'
Search Results
2. Is Palmar Cutaneous Branch of the Median Nerve More Swollen in Carpal Tunnel Syndrome?
- Author
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Ha Mok Jeong, Young Ha Jeong, and Joon Shik Yoon
- Subjects
palmar cutaneous branch ,median nerve ,carpal tunnel syndrome ,ultrasonography ,Medicine - Abstract
Objective To investigate the characteristics of the palmar cutaneous branch of the median nerve (PCBMN) in patient with carpal tunnel syndrome (CTS) using high-resolution ultrasound. Methods Fourteen healthy volunteers (17 wrists) and 31 patients with CTS (41 wrists) were evaluated by high-resolution ultrasound. All patients were classified into three groups based on the electrophysiologic CTS impairment severity: mild, moderate, and severe. Using high-resolution ultrasound, the cross-sectional areas (CSAs) of the PCBMN were measured at the proximal wrist crease, bistyloid line, and distal wrist crease, and the largest CSA was defined as the maximal CSA. Results The maximal CSA of the PCBMN of the control, mild, moderate, and severe CTS groups were 0.27±0.08, 0.30±0.07, 0.35±0.10, and 0.47±0.13 mm2, respectively. The maximal CSA of the PCBMN was significantly larger in the severe CTS group than in the other groups. Conclusion The PCBMN could be concomitantly affected in patients with severe CTS.
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- 2021
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3. Anatomical variations of the innervated radial artery superficial palmar branch flap: A series of 28 clinical cases
- Author
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Jae-Won Yang
- Subjects
radial artery superficial palmar branch ,palmar cutaneous branch ,median nerve ,finger injury ,perforator flap ,Surgery ,RD1-811 - Abstract
Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes. Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated. Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness. Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.
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- 2020
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4. Risk Assessment of Injury to Palmar Cutaneous Branch of the Median Nerve Using High-Resolution Ultrasound
- Author
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Young Ha Jeong, Jun Ho Choi, Hyuk Sung Choi, Seok Kang, Seung Nam Yang, and Joon Shik Yoon
- Subjects
Palmar cutaneous branch ,Median nerve ,Ultrasound ,Carpal tunnel syndrome ,Medicine - Abstract
Objective To evaluate the relationship between the palmar cutaneous branch of median nerve (PCBMN) and surrounding anatomical structures by using high-resolution ultrasound (HRUS) to assess the risk of PCBMN injury. Methods The PCBMN course and the characteristics of bilateral distal forearms and wrists of 30 healthy volunteers were identified. The distance between PCBMN and other anatomical structures at three different levels along its course were measured using HRUS. Moreover, the depth of PCBMN from skin and its cross-sectional area (CSA) were measured. Results HRUS showed the PCBMN in all subjects. PCBMN branched off from the radial aspect of the median nerve (MN) at 4.69±0.89 cm proximal to the bistyloid line (BSL) and extended radially toward the flexor carpi radialis (FCR) tendon. PCBMN was within the ulnar edge of FCR tendon sheath, and became more superficial and perforated the antebrachial fascia between the FCR tendon laterally and the palmaris longus (PL) tendon medially. PCBMN was located at 4.08±0.72 mm on the ulnar aspect of the FCR tendon and 4.78±0.36 mm radially on the PL tendon at BSL. At the distal wrist crease level, the PCBMN was located at 5.68±0.58 mm on the ulnar side of the FCR tendon. The PCBMN depth from skin at BSL and its branching point was 1.92±0.41 and 7.95±0.79 mm, respectively. The PCBMN CSA was 0.26±0.15 mm2 at BSL. Conclusion HRUS can be used to identify PCBMN and its relationship with other anatomical structures. Our data can be used to predict PCBMN location, and prevent complications associated with invasive procedures involving the wrist.
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- 2019
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5. Anatomy of the Median Nerve: Anatomic Variations and Anomalies
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Trehan, Samir K., Daluiski, Aaron, Duncan, Scott F. M., editor, and Kakinoki, Ryosuke, editor
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- 2017
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6. Peripheral Nerve Blocks in the Wrist Region
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Jankovic, Danilo, Peng, Philip, Jankovic, Danilo, and Peng, Philip
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- 2015
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7. Chronic Right Hand Pain
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Yaghoubian, Arezou Tory, Rolfe, Kevin W., de Virgilio, Christian, editor, Frank, Paul N., editor, and Grigorian, Areg, editor
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- 2015
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8. Anatomy of the palmar cutaneous branch of the median nerve: A review.
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Smith, Jennifer L. and Ebraheim, Nabil A.
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HAND ,MEDIAN nerve ,ORTHOPEDIC surgery ,PHYSICIANS ,TENDONS ,WRIST ,SKELETAL muscle ,INNERVATION - Abstract
The palmar cutaneous branch of the median nerve (PCBm) supplies afferent innervation to the volar aspect of the hand. It consistently originates from the radial side of the median nerve, travels in relation to the tendons of the palmaris longus and flexor carpi radialis muscles, and courses superficially through fascial planes to reach the surface of the palm. Because it is at risk of injury in numerous operations, this review serves to provide a summary of anatomical findings regarding the PCBm across various studies to aid orthopedists and other clinicians in anticipating the location of the nerve during surgical procedures. [ABSTRACT FROM AUTHOR]
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- 2019
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9. Forearm – Thenar : Surface Recording Technique, Antidromic Study
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Gentili, Giuliano, Di Napoli, Mario, Gentili, Giuliano, and Di Napoli, Mario
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- 2015
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10. Compression of the palmar cutaneous branch of the median nerve secondary to previous rupture of the palmaris longus tendon: Case report.
- Author
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Wan, Yanlin, Jiang, Wenxue, Wang, Bingqi, and Sun, Yufu
- Abstract
• Palmar cutaneous branch of median nerve, potent factor for patients feeling abnormal post-operation. • Unusual case compression of palmar cutaneous branch of median nerve (PCBNN) • Anatomy of nerve and explanation of how easily its damaged. • Nerve affected by many factors. • Spotaneous formation of nodules after rupture of the palmaris tendon. We report an unusual case compression of the palmar cutaneous branch of the median nerve(PCBNN). A 52-year-old woman presenting with previous rupture of the palmaris longus tendon. During surgery, we found that the end of the tendon had formed nodules. After removing the nodules, the PCBMN was released, and half a year later, the abnormal feelings had disappeared. We aim to remind surgeons of this type of compression and to highlight the importance of maintaining vigilance in order to avoid nerve injury. PCBMN needs to be paid more attention and damaged tendons should be repaired. [ABSTRACT FROM AUTHOR]
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- 2020
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11. Lipofibromatous Hamartoma of the Palmar Cutaneous Branch of the Median Nerve.
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Hoellwarth, Jason S. and Goitz, Robert J.
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Background Lipofibromatous hamartoma (LFH) is a benign tumor of peripheral nerves, most commonly reported in the median nerve, and often associated with carpal tunnel symptoms. There have been nearly 200 reported cases of LFH in the median nerve, but to the authors' knowledge, this 10-year-old girl represents the first case report involving the palmar cutaneous branch. Methods An excisional biopsy of the mass was performed via a standard midline palmar incision. The tumor was found encapsulating the palmar cutaneous branch, and thus it was sacrificed. Results The incision healed without issue, but the patient reported numbness in the palm of her hand as was expected. Conclusion LFH is a benign tumor, although it can cause symptoms due to mass effect. If the diagnosis is uncertain or a patient is symptomatic, excisional biopsy can be performed even if involving a cutaneous nerve. [ABSTRACT FROM AUTHOR]
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- 2018
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12. Is Palmar Cutaneous Branch of the Median Nerve More Swollen in Carpal Tunnel Syndrome?
- Author
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Jeong, Ha Mok, Jeong, Young Ha, and Yoon, Joon Shik
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medicine.medical_specialty ,business.industry ,Rehabilitation ,Ultrasound ,Median nerve ,Wrist ,medicine.disease ,nervous system diseases ,Surgery ,medicine.anatomical_structure ,Cutaneous branch ,Healthy volunteers ,medicine ,Medicine ,Original Article ,In patient ,Ultrasonography ,Palmar cutaneous branch ,business ,Carpal tunnel syndrome - Abstract
Objective To investigate the characteristics of the palmar cutaneous branch of the median nerve (PCBMN) in patient with carpal tunnel syndrome (CTS) using high-resolution ultrasound.Methods Fourteen healthy volunteers (17 wrists) and 31 patients with CTS (41 wrists) were evaluated by high-resolution ultrasound. All patients were classified into three groups based on the electrophysiologic CTS impairment severity: mild, moderate, and severe. Using high-resolution ultrasound, the cross-sectional areas (CSAs) of the PCBMN were measured at the proximal wrist crease, bistyloid line, and distal wrist crease, and the largest CSA was defined as the maximal CSA.Results The maximal CSA of the PCBMN of the control, mild, moderate, and severe CTS groups were 0.27±0.08, 0.30±0.07, 0.35±0.10, and 0.47±0.13 mm2, respectively. The maximal CSA of the PCBMN was significantly larger in the severe CTS group than in the other groups.Conclusion The PCBMN could be concomitantly affected in patients with severe CTS.
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- 2021
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13. Palmar Cutaneous Branches of the Proper Digital Nerves Encountered in Dupuytren’s Surgery: A Cadaveric Study
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Choa, Robert M., McKee, Andrew F. M., McNab, Ian S. H., Eaton, Charles, editor, Seegenschmiedt, M. Heinrich, editor, Bayat, Ardeshir, editor, Gabbiani, Giulio, editor, Werker, Paul, editor, and Wach, Wolfgang, editor
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- 2012
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14. Management of painful cutaneous neuromas around the wrist.
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Jordaan, Pieter, Wang, Chen Kang, and Ng, Chye Yew
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Three cutaneous nerves are particularly vulnerable to injury during orthopaedic procedures around the wrist, namely the superficial radial nerve, the palmar cutaneous branch of the median nerve and the dorsal cutaneous branch of the ulnar nerve. These nerves are prone to the development of painful neuromas when injured. In this article, the relevant anatomy and the principles of management of such neuromas are reviewed. [ABSTRACT FROM AUTHOR]
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- 2017
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15. Incidence of an Anomalous Course of the Palmar Cutaneous Branch of the Median Nerve During Volar Plate Fixation of Distal Radius Fractures.
- Author
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Jones, Christopher, Beredjiklian, Pedro, Matzon, Jonas L., Kim, Nayoung, and Lutsky, Kevin
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Purpose Volar plating of distal radius fractures using an approach through the flexor carpi radialis (FCR) sheath is commonplace. The palmar cutaneous branch of the median nerve (PCB) is considered to run in a position adjacent to, but outside, the ulnar FCR sheath. Anatomic studies have not identified anatomic abnormalities relevant to volar plating. The purpose of this study was to determine the frequency of anomalous PCB branches entering the FCR sheath during volar plating. Methods This observational study involved 10 attending hand surgeons during a 7-month period (July 2015–January 2016). Surgeons assessed, documented, and reported any PCB anomalies that were encountered during volar plating through a trans-FCR approach. Results There were 182 volar plates applied that made up the study group. There were 10 cases (5.5%) of anomalous PCBs entering the FCR sheath. In 4 cases, the PCB pierced the radial FCR sheath proximally, crossed beneath the tendon, and traveled distally on the ulnar side. In 4 other cases, the PCB entered the FCR sheath proximally on the ulnar or central aspect of the sheath and remained within the sheath, staying along the ulnar or dorsal side of the tendon. In 1 case, the PCB pierced the ulnar distal aspect of the sheath and split into 2 branches. In 1 case, the PCB ran within the sheath along the radial aspect of the FCR. Conclusions Anomalies in the course of the PCB are more common than often considered. These variants are at risk during volar surgical approaches to the wrist that proceed through the FCR sheath. Clinical relevance Although dissecting along the radial side of the FCR sheath may protect the PCB in most cases, care must be taken to identify anomalous branches (if present) and protect them during surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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16. Compression of the palmar cutaneous branch of the median nerve secondary to previous rupture of the palmaris longus tendon: Case report
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Bingqi Wang, Wenxue Jiang, Yanlin Wan, and Yufu Sun
- Subjects
medicine.medical_specialty ,Unusual case ,integumentary system ,business.industry ,Compression ,Median nerve ,Case Report ,Nerve injury ,musculoskeletal system ,Tendon ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cutaneous branch ,medicine ,030211 gastroenterology & hepatology ,medicine.symptom ,Palmaris longus tendon ,business ,Palmar cutaneous branch - Abstract
Highlights • Palmar cutaneous branch of median nerve, potent factor for patients feeling abnormal post-operation. • Unusual case compression of palmar cutaneous branch of median nerve (PCBNN) • Anatomy of nerve and explanation of how easily its damaged. • Nerve affected by many factors. • Spotaneous formation of nodules after rupture of the palmaris tendon., Introduction We report an unusual case compression of the palmar cutaneous branch of the median nerve(PCBNN). Presentation of case A 52-year-old woman presenting with previous rupture of the palmaris longus tendon. During surgery, we found that the end of the tendon had formed nodules. After removing the nodules, the PCBMN was released, and half a year later, the abnormal feelings had disappeared. Discussion We aim to remind surgeons of this type of compression and to highlight the importance of maintaining vigilance in order to avoid nerve injury. Conclusion PCBMN needs to be paid more attention and damaged tendons should be repaired.
- Published
- 2020
17. Anatomic variations in the palmar cutaneous branch of the median nerve among adults in Lagos, Nigeria
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Bolaji O Mofikoya and Andrew O Ugburo
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Carpal tunnel surgery ,median nerve ,palmar cutaneous branch ,Surgery ,RD1-811 - Abstract
Dysesthesias due to palmar cutaneous branch of median nerve injuries infrequently follow carpal tunnel release surgeries. Objective: To determine the course of palmar cutaneous branch of the median nerve in wrist of adult Nigerians, identify the common variations, determine its relations to the palmaris longus (PL) in the region of the distal wrist crease. And on these basis, suggest a safe incision for carpal tunnel surgery in Nigerians. Materials and Methods: Detailed anatomic dissection of the palmar cutaneous branch of the median nerve was carried out with the aid of a loupe magnification on 40 Nigerian cadaver wrists. The origin, course in the distal forearm, wrist and proximal palm was traced. Measurements of the distances between the radial and ulnar branches of the nerve and the PL were made. The distance between origin of the nerve and the distal wrist crease was measured as well. The common branching pattern of the nerve was noted. Results: The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of the radial branch to PL was 0.81 cm (SD ± 0.3 cm), while the ulnar branch was 0.3 cm (SD ± 0.1 cm). from same structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD ± 2.1 cm). We noted the terminal distal branching pattern of the nerve to be highly variable. Conclusion: The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the PL in carpal tunnel surgeries in Nigerians.
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- 2012
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18. Anatomical landmarks for safer carpal tunnel decompression: an experimental cadaveric study.
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Samarakoon, Lasitha B., Guruge, Malith H., Jayasekara, Madusha, Malalasekera, Ajith P., Anthony, Dimonge J., and Jayasekara, Rohan W.
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CARPAL tunnel syndrome , *TRANSVERSE myelitis , *LIGAMENT injuries , *PALMARIA decipiens , *IDIOPATHIC femoral necrosis - Abstract
Background Carpal tunnel syndrome is a common presentation to surgical outpatient clinics. Treatment of carpal tunnel syndrome involves surgical division of the flexor retinaculum. Palmar and recurrent branches of the median nerve as well as the superficial palmar arch are at risk of damage. Methodology Thirteen cadavers of Sri Lankan nationality were selected. Cadavers with deformed or damaged hands were excluded. All selected cadavers were preserved with the conventional arterial method using formalin as the main preservative. Both hands of the cadavers were placed in the anatomical position and dissected carefully. We took pre- determined measurements using a vernier caliper. We hypothesized that the structures at risk during carpal tunnel decompression such as recurrent branch of the median nerve and superficial palmar arch can be protected if simple anatomical landmarks are identified. We also hypothesized that an avascular area exists in the flexor retinaculum, identification of which facilitates safe dissection with minimal intra operative bleeding. Therefore we attempted to characterize the anatomical extent of such an avascular area as well as anatomical landmarks for a safer carpal tunnel decompression. Ethical clearance was obtained for the study. Results In a majority of specimens the recurrent branch was a single trunk (n =20, 76.9%). Similarly 84.6% (n = 22) were extra ligamentous in location. Mean distance from the distal border of the TCL to the recurrent branch was 7.75 mm. Mean distance from the distal border of TCL to the superficial palmar arch was 11.48 mm. Mean length of the flexor retinaculum, as measured along the incision, was 27.00 mm. Mean proximal and distal width of the avascular area on TCL was 11.10 mm and 7.09 mm respectively. Conclusion We recommend incision along the radial border of the extended ring finger for carpal tunnel decompression. Extending the incision more than 8.16 mm proximally and 7.75 mm distally from the corresponding borders of the TCL should be avoided. Incision should be kept to a mean length of 27.0 mm, which corresponds to the length of TCL along the above axis. We also propose an avascular area along the TCL, identification of which minimizes blood loss. [ABSTRACT FROM AUTHOR]
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- 2014
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19. 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.
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Xu, Xiuyue, Lao, Jie, and Zhao, Xin
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MEDIAN nerve , *ULNAR nerve , *WRIST , *FOREARM , *JOINTS (Anatomy) - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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20. Posttraumatic neuropathy of the palmar cutaneous branch of the median nerve: four cases. Laceration or entrapment?
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Pardal-Fernández, Jose Manuel, Gracia-Rodríguez, Indalecio, Iniesta-López, Ivan, and Rodríguez-Vázquez, María
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CASE studies , *NEUROPATHY , *MEDIAN nerve , *ELECTROMYOGRAPHY , *ENTRAPMENT neuropathies , *PATIENTS - Abstract
The palmar cutaneous branch of the median nerve is highly exposed to trauma at the wrist; nevertheless, very few cases have been reported. We report four cases of this neuropathy, three being superficial while the fourth was deeper or more severe. The neuropathy was confirmed using electro-neurophysiological assessments. Macroscopically, the nerve appeared compressed and enlarged, and in all cases, surgical repair produced a significant improvement. This neuropathy often follows minor traumas and, maybe, should be taken into account as part of the differential diagnosis of posttraumatic or postsurgical lateral and distal wrist pain. [ABSTRACT FROM AUTHOR]
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- 2011
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21. Definition of a safe-zone in open carpal tunnel surgery: a cadaver study.
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Ozcanli, Haluk, Coskun, Nigar Keles, Cengiz, Menekşe, Oguz, Nurettin, and Sindel, Muzaffer
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CARPAL tunnel syndrome , *SURGERY , *SKIN innervation , *ULNAR nerve , *MEDIAN nerve , *BRACHIAL plexus - Abstract
Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was designed to define the safe-zone for mini-open carpal tunnel release. Sixteen fresh-frozen (8 right, 8 left) and 14 formalin-fixed (8 right, 6 left) cadaveric hands were dissected. Anatomy of the palmar cutaneous branch of the median and the ulnar nerve, motor branch of the median nerve, superficial palmar arch were evaluated relative to the surgical incision. We also identified the motor branch of the median nerve. Detailed measurements of the whole palmar region are reported in this study. The motor branch of the median nerve was extraligamentous as 60%, subligamentous as 34%, transligamentous as 6%. The palmar cutaneous branches of the median and the ulnar nerves in the palmar region were classified as Type A (34%), Type B (13%), Type C (13%), Type D (none), Type E (40%) according to forms of palmar cutaneous innervation originating from the ulnar and median nerves. Injury to the palmar cutaneous branch of the median nerve (PCBMN) is the most common complication of the carpal tunnel surgery. Various techniques were described to decrease post-operative morbidity. Based on these anatomic findings mini incision between the superficial palmar arch and the most distal part of the PCBMN in the palmar region is the safe-zone for carpal tunnel surgery. [ABSTRACT FROM AUTHOR]
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- 2010
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22. Entrapment neuropathy of the palmar cutaneous branch of the median nerve in carpal tunnel syndrome
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Imai, Tomihiro, Wada, Takuro, and Matsumoto, Hiroyuki
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ELECTROPHYSIOLOGY , *NEUROLOGY , *CUTANEOUS glands , *MEDIAN nerve , *CARPAL tunnel syndrome , *MEDIAN nerve injuries - Abstract
Objective: The aim of this study is to elucidate the significance of electrophysiological data of the palmar cutaneous branch of the median nerve (PCBm) in the diagnosis entrapment of the PCBm concomitant with carpal tunnel syndrome (CTS).Materials and Methods: Clinical and electrophysiological studies were conducted for abnormal sensation of the thenar eminence in eight CTS patients. Sensory nerve action potentials (SNAPs) of the PCBm were recorded from bipolar surface electrodes over the forearm using an orthodromic method. The preoperative SNAP evaluation was compared with the operative findings.Results: The eight patients were divided into two groups based on the characteristics of SNAPs of the PCBm; five patients had normal SNAPs of the PCBm and three patients had delayed or absent SNAPs. Open surgery confirmed entrapment of the PCBm in one patient in the first group and all patients in the latter group.Conclusions: Although clinical symptoms were not always reliable to diagnose entrapment of the PCBm in CTS, electrophysiological study of the PCBm was highly sensitive (75%) and entirely specific (100%) to demonstrate the entrapment of the PCBm preoperatively. [Copyright &y& Elsevier]
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- 2004
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23. Relationships of the palmar cutaneous branch of the median nerve: a morphometric study.
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Chaynes, P., Bécue, J., Vaysse, P., and Laude, M.
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CARPAL tunnel syndrome , *MEDIAN nerve injuries , *BRACHIAL plexus , *DISEASE complications , *ANESTHESIA , *PAIN management - Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2004
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24. Risk Assessment of Injury to Palmar Cutaneous Branch of the Median Nerve Using High-Resolution Ultrasound
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Hyuk Sung Choi, Seok Ho Kang, Young Ha Jeong, Jun Ho Choi, Seung Nam Yang, and Joon Shik Yoon
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musculoskeletal diseases ,030506 rehabilitation ,lcsh:Medicine ,Median nerve ,Wrist ,Antebrachial fascia ,03 medical and health sciences ,0302 clinical medicine ,Ultrasound ,Medicine ,Carpal tunnel syndrome ,Palmar cutaneous branch ,business.industry ,Rehabilitation ,lcsh:R ,Anatomy ,medicine.disease ,musculoskeletal system ,Tendon ,body regions ,Tendon sheath ,medicine.anatomical_structure ,Cutaneous branch ,Original Article ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
Objective To evaluate the relationship between the palmar cutaneous branch of median nerve (PCBMN) and surrounding anatomical structures by using high-resolution ultrasound (HRUS) to assess the risk of PCBMN injury. Methods The PCBMN course and the characteristics of bilateral distal forearms and wrists of 30 healthy volunteers were identified. The distance between PCBMN and other anatomical structures at three different levels along its course were measured using HRUS. Moreover, the depth of PCBMN from skin and its cross-sectional area (CSA) were measured. Results HRUS showed the PCBMN in all subjects. PCBMN branched off from the radial aspect of the median nerve (MN) at 4.69±0.89 cm proximal to the bistyloid line (BSL) and extended radially toward the flexor carpi radialis (FCR) tendon. PCBMN was within the ulnar edge of FCR tendon sheath, and became more superficial and perforated the antebrachial fascia between the FCR tendon laterally and the palmaris longus (PL) tendon medially. PCBMN was located at 4.08±0.72 mm on the ulnar aspect of the FCR tendon and 4.78±0.36 mm radially on the PL tendon at BSL. At the distal wrist crease level, the PCBMN was located at 5.68±0.58 mm on the ulnar side of the FCR tendon. The PCBMN depth from skin at BSL and its branching point was 1.92±0.41 and 7.95±0.79 mm, respectively. The PCBMN CSA was 0.26±0.15 mm2 at BSL. Conclusion HRUS can be used to identify PCBMN and its relationship with other anatomical structures. Our data can be used to predict PCBMN location, and prevent complications associated with invasive procedures involving the wrist.
- Published
- 2019
25. Innervated Thenar Pedicle Flap with the Palmar Cutaneous Branch of the Median Nerve for Treating a Thumb Pulp Defect: A Case Report.
- Author
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Kohei Kanaya, Takuro Wada, Kosuke Iba, and Toshihiko Yamashita
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SURGICAL flaps , *MEDIAN nerve , *THUMB , *BLOOD vessels , *PATIENTS - Abstract
A 51-year-old male plumber with a thumb pulp defect was treated with a reversed innervated thenar pedicle flap. The flap was based on the radial digital artery originating from the princeps pollicis artery with the palmarcutaneous branch of the median nerve. The flap survived and achieved good innervation with a moving 2-point discrimination of 6 mm at 12 months after surgery. This flap is indicated for patients who hesitate to have tissue taken from the foot. We believe that this flap is a feasible option for reconstructing thumb pulp defects. [ABSTRACT FROM AUTHOR]
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- 2014
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26. Sonographic appearance of flexor carpi radialis tenosynovitis associated with a neuritis of the palmar cutaneous branch of the median nerve.
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Geannette, Christian, Lee, Susan, and Nwawka, Ogonna
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- 2019
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27. The Palmar Cutaneous Branch Mimicking the Recurrent Motor Branch of the Median Nerve.
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Feiran Wu and Chye Yew Ng
- Abstract
We report an unusual anatomical variant of the palmar cutaneous branch (PCB) of the median nerve in a 46-year-old man presenting with recurrent carpal tunnel syndrome. At surgery, after neurolysis, the PCB was visualized arising at the level of the proximal margin of the transverse carpal ligament, mimicking the appearance of the recurrent motor branch. To date, there has been no description of this branch arising at this level. We aim to remind surgeons of this variation and highlight the importance of maintaining vigilance to avoid iatrogenic nerve injury. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
28. Anatomic variations in the palmar cutaneous branch of the median nerve among adults in Lagos, Nigeria
- Author
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Bolaji O, Mofikoya and Andrew O, Ugburo
- Subjects
musculoskeletal diseases ,body regions ,Carpal tunnel surgery ,median nerve ,Original Article ,palmar cutaneous branch ,musculoskeletal system - Abstract
Dysesthesias due to palmar cutaneous branch of median nerve injuries infrequently follow carpal tunnel release surgeries. Objective: To determine the course of palmar cutaneous branch of the median nerve in wrist of adult Nigerians, identify the common variations, determine its relations to the palmaris longus (PL) in the region of the distal wrist crease. And on these basis, suggest a safe incision for carpal tunnel surgery in Nigerians. Materials and Methods: Detailed anatomic dissection of the palmar cutaneous branch of the median nerve was carried out with the aid of a loupe magnification on 40 Nigerian cadaver wrists. The origin, course in the distal forearm, wrist and proximal palm was traced. Measurements of the distances between the radial and ulnar branches of the nerve and the PL were made. The distance between origin of the nerve and the distal wrist crease was measured as well. The common branching pattern of the nerve was noted. Results: The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of the radial branch to PL was 0.81 cm (SD ± 0.3 cm), while the ulnar branch was 0.3 cm (SD ± 0.1 cm). from same structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD ± 2.1 cm). We noted the terminal distal branching pattern of the nerve to be highly variable. Conclusion: The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the PL in carpal tunnel surgeries in Nigerians.
- Published
- 2013
29. Anatomical landmarks for safer carpal tunnel decompression: an experimental cadaveric study
- Author
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Rohan W. Jayasekara, A.P. Malalasekera, Malith H Guruge, D. J. Anthony, Madusha Jayasekara, and Lasitha Samarakoon
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Avascular area ,Recurrent branch of the median nerve ,Standard anatomical position ,Retinaculum ,Superficial palmar arch ,medicine.artery ,medicine ,Outpatient clinic ,Orthopedics and Sports Medicine ,Carpal tunnel syndrome ,Palmar cutaneous branch ,Recurrent branch ,business.industry ,Research ,medicine.disease ,Median nerve ,Surgery ,body regions ,medicine.anatomical_structure ,Anesthesiology and Pain Medicine ,Carpal tunnel decompression ,Transverse carpal ligament ,Cadaveric spasm ,business - Abstract
Background Carpal tunnel syndrome is a common presentation to surgical outpatient clinics. Treatment of carpal tunnel syndrome involves surgical division of the flexor retinaculum. Palmar and recurrent branches of the median nerve as well as the superficial palmar arch are at risk of damage. Methodology Thirteen cadavers of Sri Lankan nationality were selected. Cadavers with deformed or damaged hands were excluded. All selected cadavers were preserved with the conventional arterial method using formalin as the main preservative. Both hands of the cadavers were placed in the anatomical position and dissected carefully. We took pre- determined measurements using a vernier caliper. We hypothesized that the structures at risk during carpal tunnel decompression such as recurrent branch of the median nerve and superficial palmar arch can be protected if simple anatomical landmarks are identified. We also hypothesized that an avascular area exists in the flexor retinaculum, identification of which facilitates safe dissection with minimal intra operative bleeding. Therefore we attempted to characterize the anatomical extent of such an avascular area as well as anatomical landmarks for a safer carpal tunnel decompression. Ethical clearance was obtained for the study. Results In a majority of specimens the recurrent branch was a single trunk (n =20, 76.9%). Similarly 84.6% (n = 22) were extra ligamentous in location. Mean distance from the distal border of the TCL to the recurrent branch was 7.75 mm. Mean distance from the distal border of TCL to the superficial palmar arch was 11.48 mm. Mean length of the flexor retinaculum, as measured along the incision, was 27.00 mm. Mean proximal and distal width of the avascular area on TCL was 11.10 mm and 7.09 mm respectively. Conclusion We recommend incision along the radial border of the extended ring finger for carpal tunnel decompression. Extending the incision more than 8.16 mm proximally and 7.75 mm distally from the corresponding borders of the TCL should be avoided. Incision should be kept to a mean length of 27.0 mm, which corresponds to the length of TCL along the above axis. We also propose an avascular area along the TCL, identification of which minimizes blood loss.
- Published
- 2014
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