Patterns of Ulnar Nerve Arborization in the Palm: Clinical Implications for Nerve Decompression in the Hand and Wrist Svenna H.W.L. Verhiel, MD, Daphne.

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Presentation transcript:

Patterns of Ulnar Nerve Arborization in the Palm: Clinical Implications for Nerve Decompression in the Hand and Wrist Svenna H.W.L. Verhiel, MD, Daphne van Hooven, BSc, Rohit Garg, MD, Rachel E.W. Gottlieb, BSc, Marco J.P.F. Ritt, MD, PhD, Neal C. Chen, MD, Kyle R. Eberlin, MD Journal of Hand Surgery Global Online Volume 1, Issue 1, Pages 21-27 (January 2019) DOI: 10.1016/j.jhsg.2018.10.004 Copyright © 2018 The Authors Terms and Conditions

Figure 1 Classification of arborization pattern according to Murata et al.6 n, nerve. Adapted from Murata K, Tamai M, Gupta A. Anatomic study of variations of hypothenar muscles and arborization patterns of the ulnar nerve in the hand. J Hand Surg Am. 2004;29(3):506. Copyright 2004 by the American Society for Surgery of the Hand. Journal of Hand Surgery Global Online 2019 1, 21-27DOI: (10.1016/j.jhsg.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Figure 2 Measurements performed in this study: (1) distance between the wrist flexion crease and branching of the deep motor branch from the ulnar nerve, (2) distance between the wrist flexion crease and division of the superficial sensory branch of the ulnar nerve into the fourth common digital nerve and the ulnar proper digital nerve of the little finger, (3) distance between the wrist flexion crease and the origin of the communicating branch, (4) angle of the communicating branch with the originating nerve, (5) and distance from the distal edge of the transverse carpal ligament to the origin of communicating branch. Journal of Hand Surgery Global Online 2019 1, 21-27DOI: (10.1016/j.jhsg.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Figure 3 Classification of communicating branches according to Meals and Shaner11 and modified by Bas and Kleinert.20 Journal of Hand Surgery Global Online 2019 1, 21-27DOI: (10.1016/j.jhsg.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Figure 4 Variation in arborization pattern (right lower forceps holding on to additional branch originating from ulnar nerve proximal to Guyon canal, right upper forceps holding on to fourth common digital nerve, and left forceps holding on to third common digital nerve). Journal of Hand Surgery Global Online 2019 1, 21-27DOI: (10.1016/j.jhsg.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Figure 5 Communicating branch from the ulnar to the median nerve (type 1) with multiple distal attachments to the median nerve. Journal of Hand Surgery Global Online 2019 1, 21-27DOI: (10.1016/j.jhsg.2018.10.004) Copyright © 2018 The Authors Terms and Conditions

Figure 6 Communicating branches from the ulnar to the median nerve and its relation to the transverse carpal ligament. Journal of Hand Surgery Global Online 2019 1, 21-27DOI: (10.1016/j.jhsg.2018.10.004) Copyright © 2018 The Authors Terms and Conditions