Abstract
Introduction: Variations in the anatomy of nerves at wrist have been recognised to be of importance to surgeon. Attention has been called for injury to palmar cutaneous branch of median nerve as a cause of the painful dysesthesia that follows carpal tunnel surgery.A comprehensive evaluation in wrist region is essential to avoid complications. Objective: In present study the objective was to study the anatomic variationsin number and side of origin of palmar cutaneous branch from median nerve. Materials and Methods: The study included 51 hands from human cadavers at Department of Anatomy, Mysore Medical College & Research Institute, Mysore during the time period of 2011-13. The specimens were fixed in 10% formalin, finely dissected and the numbers and side of origin were noted. Results: The palmar cutaneous branch was present in all 51 specimens and it was located under the tendons of palmaris longus & flexor carpi radialis. The palmar cutaneous branch of median nerve was single in 46 specimens (90.18%) and in 5 specimens it was observed to be multiple (9.8%). In 50 specimens the palmar cutaneous branches originated from radial side of the median nerve (98.04%) and in only one specimen (1.96%) it originated on ulnar side of the median nerve. Conclusion: A key to carry out therapeutic and diagnostic procedures successfully on carpal tunnel depends on the knowledge of the possible variations of nerves which may be encountered. Such variations are not only more prone to iatrogenic injuries but they interfere in the correct interpretation of clinical conditions as well.
Highlights
Variations in the anatomy of nerves at wrist have been recognised to be of importance to surgeon
Carroll and Green called attention to the possibility of palmar cutaneous branch damage as a source of painful dysesthesia fo llowing surgery for carpal tunnel syndrome.2Taleisnk recommended a curved longitudinal incision located on the ulnar side of the long axis of the ring finger.3Hobbs concluded that the transverse carpal ligament should be located on the ulnar side of the long axis of the middle finger to prevent dama ge to the palmar cutaneous branch of median nerve in dissected 25 cadaver hands.[4]
All the above data states that palmar cutaneous branch will be affected during carpal tunnel surgery invariably; the present study aims at making the following observations in the specimens, to study the presence of multiple palmar cutaneous branches arising from median nerve and to study the side of origin of palmar cutaneous branch of median nerve to avoid further complications during carpal tunnel release
Summary
Variations in the anatomy of nerves at wrist have been recognised to be of importance to surgeon. The palmar cutaneous branch is the last branch of median nerve given in the forearm before passing beneath flexor retinaculum of wrist It supplies the skin over the lateral parts of the palm. Carroll and Green called attention to the possibility of palmar cutaneous branch damage as a source of painful dysesthesia fo llowing surgery for carpal tunnel syndrome.2Taleisnk recommended a curved longitudinal incision located on the ulnar side of the long axis of the ring finger.3Hobbs concluded that the transverse carpal ligament should be located on the ulnar side of the long axis of the middle finger to prevent dama ge to the palmar cutaneous branch of median nerve in dissected 25 cadaver hands.[4] Neuroma of the palmar cutaneous branch of median nerve is a common complication of anterior wrist surgery after carpal tunnel decompression.[5]
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