Common Digital Nerve Research Articles

Superficial Communication Between Ulnar and Media Nerves in the Hand. An Anatomical Study

The objective of this study was to characterize the communication between ulnar and the median nerve in the superficial palmar region from a sample of mestizo-raced population predominant in Latin America. The superficial palmar regions of 53 fresh cadaveric specimens were evaluated, whom of which underwent necropsy procedure at the Institute of Legal Medicine. Dissection was performed by planes until visualizing the presence of the Communicating Branch (CB) between the digital branches of the ulnar nerve (UN) and the median nerve (MN). Qualitative and morphometric evaluation of the CB was carried out. A CB were observed in 82/ 106 (77.4 %) of the cadaveric specimens studied, of which, 38/53 (71.7 %) were bilateral, 15/53 (28.3 %) unilateral; this being a statistically significant difference (p <0.002). Oblique trajectory of the CB between the fourth and third common digital nerve was observed in 70 (85.4 %) specimens, while the CB with transverse trajectory was found in 7 (8.5 %) regions and in a plexiform form in 5 (6.1 %) cases. The length of the CB was 20.2 ± 5.1 mm and the distances from the upper edge of the flexor retinaculum to the proximal and distal points of the CB were 25 ± 6 mm and 37.4 ± 8.3 mm respectively. The anatomical characteristics of the CB patterns, as well as the morphometric CB findings and their points of reference from the carpal flexor retinaculum, make it possible to delimit a safe area of surgical access in the first-fifth proximal of the palmar region, during the surgical approach of carpal tunnel syndrome.

Fascial Manipulation Technique in the Conservative Management of Morton's Syndrome: A Pilot Study.

Background and Objective: Morton’s syndrome (MS) is a common cause of neuropathic chronic forefoot pain, characterised by the development of a swelling of the common digital plantar nerve, whose aetiology is not fully known. There is currently no gold standard of treatment; nonoperative management commonly involves manual therapies, orthoses therapy and infiltrative techniques, while surgery is indicated after failure of conservative measures. The present preliminary study prospectively evaluates patients affected by MS treated by Fascial Manipulation technique (FM), a noninvasive manual therapy, focused on the release of the deep fascia, reducing its stiffness. Materials and Methods: Patients with clinical and sonographic diagnosis of MS with at least a 4-month history of neuropathic symptoms underwent a cycle of three weekly FM sessions. Clinical follow-up, including VAS and AOFAS scores, was performed 21 days (T1) and 3 months (T2) after treatment. Results: Nine patients, among 28 recruited initially, completed the manual therapy sessions and relative follow-up points. This noninvasive pain treatment led to significant improvement of VAS (p = 0.0034) and AOFAS scores (p = 0.0240) at the first follow-up (T1). At 3-month follow-up (T2), both scores decreased slightly, remaining however superior to the pre-treatment values. Only VAS was still significant (p = 0.0184). Conclusions: Despite the small size of the case series, this pilot study is unique in supporting Fascial Manipulation in the nonoperative treatment of MS. Further studies are needed with a large cohort of gender balanced patients to confirm the encouraging results obtained.

Anastomosis Patterns between the Median and Ulnar Nerves in the Upper Limbs

AbstractThere are four types of anastomoses between the median and ulnar nerves in the upper limbs. It consists of crossings of axons that produce changes in the innervation of the upper limbs, mainly in the intrinsic muscles of the hand. The forearm has two anatomical changes – Martin-Gruber: branch originating close to the median nerve joining distally to the ulnar nerve; and Marinacci: branch originating close to the ulnar nerve and distally joining the median nerve. The hand also has two types of anastomoses, which are more common, and sometimes considered a normal anatomical pattern – Berrettini: Connection between the common digital nerves of the ulnar and median nerves; and Riche-Cannieu: anastomosis between the recurrent branch of the median nerve and the deep branch of the ulnar nerve. Due to these connection patterns, musculoskeletal disorders and neuropathies can be misinterpreted, and nerve injuries during surgery may occur, without the knowledge of these anastomoses. Therefore, knowledge of them is essential for the clinical practice. The purpose of the present review is to provide important information about each type of anastomosis of the median and ulnar nerves in the forearm and hand.

Medial Sural Perforator “Nerve through Flap”: Anatomical Study and Clinical Application

Background: Nerve recovery after a complex trauma is affected by many factors and a poorly vascularized bed is often the cause of failure and perineural scar. Many techniques have been devised to avoid this problem and the possibility to transfer a nerve with a surrounding viable sliding tissue could help in this purpose; Methods: We performed an anatomic study on 8 injected specimens to investigate the possibility to raise a medial sural artery perforator (MSAP) flap including the sural nerve within its vascularized sheath; Results: In anatomic specimens, a visible direct nerve vascularization was present in 57% of legs (8 out of 14). In 43% a vascular network was visible in the fascia layer. There were no vascular anomalies. In one patient the MSAP flap was raised including the sural nerve with its proximal tibial and peroneal components within the deep sheath. The tibial and peroneal component of the sural nerve were anastomized independently with the common digital nerve of 4th and 5th fingers and with the collateral nerve for the ulnar aspect of the 5th. After 9 months, the patient showed an improving nerve function both clinically and electromyographically without any problem due to nerve adherence; Conclusions: Given the still debated advantage of a vascularized nerve graft versus a non-vascularized one, this flap could be useful in those cases of composite wounds with nerve lesions acting as a “nerve through flap”, in order to reduce nerve adherence with a viable surrounding gliding tissue.

Sporadic Malignant Perineurioma: A Rare Diagnosis Among Malignant Peripheral Nerve Sheath Tumors

Malignant perineurioma is a rare subset of malignant peripheral nerve sheath tumors (MPNSTs) with ultrastructural and immunohistochemical features of perineurial differentiation, distinguishing it from other MPNSTs, which typically demonstrate Schwannian features. The clinical course and prognosis of this rare tumor is not well defined. The electronic medical records were searched for patients with a diagnosis of MPNST. Patients with a pathologic diagnosis of malignant perineurioma or MPNST with perineurial features were identified and further evaluated. Five patients with malignant perineurioma, or MPNST with perineurial features, were identified. Four patients (2 male and 2 female) were included with tumors associated with a common digital nerve, small muscular branch to the deltoid, sciatic nerve, and accessory nerve. One patient with the pathology diagnosis meeting inclusion criteria was excluded, as no clinical information was available for this patient. Patients in our series presented at varied stages of disease. Clinical courses after diagnosis of malignant perineurioma, where follow-up was available, were largely uncomplicated with regard to recurrence and metastatic disease. Careful follow-up is indicated, and further work is needed to characterize the clinical course of these rare tumors.

Anatomic Dissection of the Superficial Planes of the Hand on a Cadaver – Review of the Bifurcation Point of the Common Digital Arteries and Nerves

Hand trauma is one of the leading causes of plastic emergency surgery on rural areas. The knowledge of the precise course of vessels and nerves is of major clinical importance in order to evaluate the integrity of neurovascular structures in face of common injuries.

Anatomic basis for a new ultrasound-guided, mini-invasive technique for release of the deep transverse metatarsal ligament.

IntroductionMorton's neuroma is an entrapment neuropathy of the third common plantar digital nerve, caused by the deep transverse metatarsal ligament (DTML). Minimally invasive or percutaneous surgery is a very common procedure, but surgical effectivity of this technique remains controversial. The goal of our study was to prove the effectiveness and safety of a new ultrasound‐guided technique for DTML‐release in a cadaver model.Materials, Methods, and ResultsThe DTML was visualized in 10 fresh frozen donated body to science‐feet (eight male and two females, five left and five right) using an US device (GE Logic R7; 13 MHz linear probe, Madrid, Spain). Consecutively, minimally invasive ultrasound‐guided surgery was performed. Exclusion criteria of the donated bodies to science were previous history of forefoot surgery and space occupying mass lesions. The complete release of the ligament was achieved in all specimens without damage of any important anatomical structures as proven by anatomical dissection.ConclusionsThe results of this study indicate that our novel approach of an ultrasound‐guided release of the DTML is safer and more effective compared to blind techniques. The DTML could reliably be visualized and securely cut through a dorsal, minimally invasive surgical incision of only 2 mm.

Sex Correlation to the Prevalence of Pedal Neuromas in Various Interspaces: A Retrospective Study.

Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and in females. The principal investigator observed Morton's neuromas commonly in the second and third interspaces in both sexes. To our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each sex independently. The present study evaluates Morton's neuroma interspace location and whether there is a variation by sex. In this retrospective study, 582 deidentified magnetic resonance imaging reports with a diagnosis code for Morton's neuroma were evaluated for patients scanned from January 2, 2015, through April 19, 2016. Incomplete records and those with radiologist findings inconsistent with Morton's neuroma were eliminated. For the remaining 379 patients, data were collected on sex, laterality, history of trauma, plantar plate tear, age, and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data were evaluated using the Pearson χ2 and independent-samples Mann-Whitney U tests, with P < .05 indicating statistical significance. No statistically significant distribution between sex and second and third interspace Morton's neuromas was noted. Right vs left foot, age, and history of trauma did not vary statistically significantly between sexes. There was a statistically significant difference between the presence of plantar plate tears between sexes. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (P = .01). This study found that there were no statistically significant differences between sexes and Morton's neuromas location, laterality, or age.

Gender Correlation to the Prevalence of Pedal Neuromas in Various Interspaces - A Retrospective Study.

Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and predominantly identified in females. The principal investigator observed Morton's neuromas commonly in both the 2nd and 3rd interspaces in both genders. To the best of our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each gender independently. The present study evaluates Morton's neuroma interspace location and if there is a variation between males and females. In this retrospective study, 582 de-identified ProScan magnetic resonance imaging reports, with a diagnosis code for Morton's neuroma (ICD Code 355.6), were obtained from their centralized database. These reports were evaluated for patients scanned from January 2015-April 2016. Incomplete records and those where the radiologist findings were not consistent with Morton's neuroma were eliminated. For the remaining 379 patients, data was collected on several factors such as gender, laterality, history of trauma, plantar plate tear, age and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data was then evaluated statistically utilizing the Pearson Chi-Square and Independent Samples Mann-Whitney U Test with statistical significance deemed p&lt;0.05. No statistically significant distribution between gender and second and third interspace Morton's neuromas were noted. Additionally, right vs left foot, age and history of trauma did not vary between genders in a significant way. Lastly, there was a statistically significant difference between the presence of plantar plate tears between genders. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (34/92, p=0.01). Our study found that there was not a statistically significant difference between female and male and Morton's neuromas location, laterality or age.

High Division of the Median Nerve with Unusually High Origin of the 3rd Space Common Digital Nerve

BackgroundMedian nerve (MN) variation in the carpal tunnel has been well documented by Lanz. Encountering rarely documented variants, that do not fit into existing classifications, increases the risk of iatrogenic injury. MethodsThe random occurrence of two unclassifiable anatomical variants of the MN in the carpal tunnel gives motivation to search the literature for similar and identical cases. Case reportsThis article presents two cases of very rare anatomical variants of high division of the MN. First case is a pure high branching of the 3rd space common digital nerve (CDN). The second case is a high division of the MN to a thicker lateral component and a thinner medial component. The lateral component of the MN gives off the palmar cutaneous branch (PCB), the thenar motor branch (TMB), the 1st and 2nd space CDN's and contributes medially with a branch to the 3rd space CDN. The medial component of the MN bifurcates distally into a medial and lateral branch. The lateral branch from the medial component of the MN distally unites with the medial branch of the lateral component of the MN to form the 3rd space CDN. The medial branch from the medial component of the MN has a major contribution to the 4th space CDN from the ulnar nerve. In both cases, the medial component of the MN has a transmuscular course through the flexor digitorum superficialis (FDS) muscle. DiscussionFinding similar case reports from worldwide suggests the need to improve current classification of the MN variants in the carpal tunnel. ConclusionsOne cannot rely entirely on the existing anatomical classifications of the MN in the carpal tunnel. There is an underappreciated risk of iatrogenic injury, especially in endoscopic carpal tunnel release, and a chance of missing out on repair of important anatomical structures in trauma cases. There is a possibility of augmenting group 3 of Lanz's classification by adding subgroup “3D High division of the MN with the medial component having a transmuscular course through the FDS muscle”, stating the different distal branching patterns.

Median and Digital Nerve In Situ Tension in the Hand.

Background: Digital nerves will experience tension under normal daily activities, and understanding the amount of tension experienced in these nerves relates directly to the necessary strength in nerve repairs. To begin quantification of tension, the tension borne by the median and digital nerves in cadaveric hands was quantified under conditions of finger hyperextension, nerve distraction, and finger flexion. Methods: Five cadaveric hands were mounted in a special fixture that allowed finger hyperextension and flexion and could apply known distractions while the tension borne by each digital nerve was measured. Sequential dissection exposed the digital nerves so that measurements of tension in the median, common, and proper digital nerves were conducted with finger hyperextension, nerve distraction, and finger flexion. Results: Metacarpophalangeal (MCP) hyperextension of 30° created mean nerve tensions up to 0.64 N, 5 mm of nerve distraction created mean nerve tensions up to 1.23 N, and 90° of MCP flexion relieved up to a mean of 1.18 N of nerve tension. Conclusions: In situ tension is present in the median and digital nerves with digital motion. Finger hyperextension and nerve distraction produce tension, whereas finger flexion reduces tension. Existing nerve repairs are strong enough to withstand in situ nerve tensions produced by reasonable digital motion if the original nerve length is present.

Normal Vascular and Nerve Distribution of the Pes Region in Dogs: An Anatomical and Diagnostic Imaging

To investigate the normal anatomical distribution of the arterial blood supply, venous drainage and innervation on both the dorsal and plantar aspects of pes region including the level of tarsal joint due to its clinical importance with a little data available. Methods: Ten hind paws of five adult apparently healthy domestic dogs of both sexes; six paws injected, through blood vessels with colored latex neoprene for anatomical dissection and the other four paws injected a contrast mixture of red lead oxide and turpentine oil for the radiographic investigation of blood vessels. In addition to five live dogs used to apply the distal limb local anesthesia with the aid of Needle-Guided Ultrasonography. Results: This investigation revealed that the dorsal and plantar aspects of dog pes region supplied by superficial and deep sets of arteries, veins and nerves. The three dorsal metatarsal arteries originated from the arcuate artery. The medial tarsal vein forming characteristic venous arcades. The 3rd plantar metatarsal artery divided into two axial arteries while the 2nd and 4th continued axially without division. The plantar common digital and metatarsal nerves II, III, IV communicated to give origins of the axial and abaxial plantar proper digital nerves except the abaxials of the 2nd and 5th digits which supplied by a branch from medial plantar nerve and lateral plantar nerve respectively. Conclusion: There were little differences between dogs and other carnivores in vascularization of hind paw with the recommendation of using Needle-Guided Ultrasonography in the distal limb local anesthesia to avoid vascular puncture or damage.

A New Surface Landmark for Thumb Digital Nerve Bifurcation: A Cadaveric Study

The radial and ulnar thumb digital nerves are critical for tactile sensation and dexterity in the hand. This cadaveric study sought to validate a surface landmark for the bifurcation of the thumb radial digital nerve (RDN) and ulnar digital nerve (UDN). We used 24 fresh-frozen cadaveric specimens for dissections. With the thumb placed in the plane of the palm and fully radially abducted, the index finger metacarpophalangeal joint was flexed to 90°. Then, while keeping the distal interphalangeal joint straight, the proximal interphalangeal joint was flexed until the fingertip contacted the thenar eminence to identify the point of bifurcation. We made a U-shaped incision and identified the bifurcation of the thumb RDN and UDN. The point of bifurcation was measured from the ulnar- and proximal-most aspects of the incision. The bifurcation of the thumb RDN and UDN was consistently identified within the U in 22 of 24 specimens (92%). In 16 specimens, the index RDN was also identified either trifurcating with the thumb RDN and UDN or branching from a common digital nerve of index RDN and thumb UDN. Most bifurcation points were found directly along the ulnar and proximal edge of the incision. Two specimens contained a bifurcation point 2 mm ulnar to the ulnar limb of the U. The bifurcation U is a consistent landmark for the thumb RDN and UDN point of bifurcation. The variable branching patterns in this region confirms the importance of thorough clinical examination with penetrating injuries to the thenar eminence. This surface anatomic landmark for the thumb RDN and UDN bifurcation may aid in preventing iatrogenic injuries during elective procedures and identifying at-risk structures during penetrating injuries to the palm.

Palmar Digital Neuropathy With Anatomical Variation of Median Nerve: Usefulness of Orthodromic Technique: A Case Report

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.

Mechanical diagnosis and therapy and Morton’s neuroma: a case-series

ABSTRACTObjectives: Morton’s neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for MN are sparse, and utility of physical therapy (PT) is unknown. Mechanical Diagnosis and Therapy (MDT) is a classification system utilizing direction-specific treatment for orthopedic conditions based on mechanical and symptomatic response to repeated end range movements. The purpose of this case series is to describe the management of three patients with a medical diagnosis of MN using the MDT classification system.Methods: Three female patients aged 54–75 years with unilateral plantar forefoot pain for 6 weeks to 8 years were referred by a podiatrist following positive clinically accepted diagnostic criteria for MN including radiological imaging and provocation testing. Patients were evaluated and treated utilizing MDT assessment and treatment principles. The intervention consisted of repeated movements matched to the patient’s directional preference at either the lumbar spine (1 patient) or distal extremity (2 patients).Results: Immediate and one-year outcomes were excellent, demonstrating rapid and lasting improvement. Following discharge, the patients have been asymptomatic or able to self-manage without seeking additional medical intervention for this condition. Total visit frequency per patient averaged 2–3 visits total across 8–16 days.Discussion: Responses to repeated end range movements testing allowed for classification and prescription of exercise to rapidly improve symptoms and function in three patients referred to PT services with medically diagnosed MN. This series provides preliminary evidence that MDT may be effective in classifying and treating patients with MN.

Mechanical Diagnosis and Therapy and Morton's Neuroma: A Case Report.

Purpose: Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for this condition are sparse, and physiotherapy's usefulness is limited. Client Description: A woman aged 44 years was referred to physiotherapy for left forefoot pain lasting 3 months. The podiatrist diagnosed MN using ultrasonography. Examination found positive squeeze test, painful interphalangeals and metatarsal heads, and painful metatarsophalangeal joint (MPJ) extension. Intervention: Repeated flexion of MPJ digit II relieved the patient's pain. She was treated six times over 3 months to progress treatment, achieve longer lasting pain relief, and recover function to full pain-free status, including running. Measures and Outcome: The patient's pain reduced after treatment from a variable 2-7 out of 10 on the Numeric Pain Rating Scale to 0 out of 10. After two sessions, the patient's Lower Extremity Functional Scale score improved, from 56 out of 80 to 70 out of 80, and by discharge, it was 73 out of 80. At 6-month follow-up, the patient was still running pain-free. Implications: This article describes the rapid and lasting improvement in chronic forefoot pain associated with MN after mechanical diagnosis and therapy assessment and treatment. Finding new, effective, conservative interventions is important for this condition because so few evidence-supported treatments exist. The findings from this case report demonstrate the benefit derived from exercise-based treatment and may indicate a role for physiotherapy in managing MN.

Nerve Diameter in the Hand: A Cadaveric Study.

Nerve injuries in the hand are common and often pose a challenge for the upper extremity surgeon. A range of reconstructive options exist for nerve repair, but proper matching of nerve diameter is important for many of these techniques. The purposes of this study were to (1) describe the nerve diameters of the hand and their relative differences and (2) investigate whether there is a relationship between nerve diameter and external hand dimensions or body mass index. We utilized 18 freshly frozen cadaveric hands from adult donors aged 20-86 of both sexes for this study. Two independent observers measured each nerve diameter to the nearest 0.1 mm using a digital caliper. Using the flexor zones as boundaries, a total of 33 nerve measurements were performed for each cadaveric hand. Nerve diameter increased from the distal to the proximal flexor zones. The internal common digital nerves in flexor zone 3 were larger than the external digital nerves. The median nerve was found to be nearly 2 times larger than the ulnar nerve at 2 locations within the wrist. There was a positive correlation between body mass index, hand span, hand width, and nerve diameter at several measured locations. This study provides reference values for nerve diameters of the hand and wrist and describes their relative differences. It is important for surgeons to be aware of these differences and to consider this information as we advance our efforts to reconstruct the hand and develop technologies for nerve repair.

Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report

AbstractLipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but they may compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, and the abductor muscle of the V finger. Regarding the symptoms, the patient felt moderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomas may present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exam may aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.

A Study of Anatomy and Landmarks for Third Common Palmar Digital Nerve and Its Variations

A Study of Anatomy and Landmarks for Third Common Palmar Digital Nerve and Its Variations