Cutaneous Branch Of Ulnar Nerve Research Articles

Lipomatosis of dorsal cutaneous branch of ulnar nerve – a rare cause of sensory neuropathy of dorsum of the hand

Wrist pain along the ulnar aspect is a diagnostic dilemma for a long time, this is because of the complex anatomy and numerous pathologies related to these structures. The most common cause is the tear of the triangular fibrocartilage complex. The remaining etiologies are lunotriquetral ligament tears, extensor carpi ulnaris tendon disorders, distal radioulnar joint disorders, impingement and impaction syndromes, pisotriquetral joint disorders, and ulnar wrist masses. Imaging is an important cornerstone in the evaluation of ulnar-sided wrist pain which aids the clinical history and physical examination. X-rays, USG, CT, magnetic resonance imaging (MRI), and MR arthrography are the currently available modalities that are often used to guide diagnosis and treatment. However, while requesting MRI, the need for inclusion of distal forearm is not well understood. In this case report, we describe a rare cause for ulnar-sided wrist pain which was diagnosed accurately with MRI. The inherent properties of MRI and the inclusion of the distal forearm helped us in reaching the final diagnosis. With this case report, we describe the ability of MRI to detect the nature of the lesion which helped to preclude the need for biopsy, hence entitling it as a “do-not touch lesion.”

Is It Possible to Perform Fifth Carpometacarpal Joint Arthroscopy? Cadaveric Study on Its Feasibility, Safety, and Potential Hazards in Portal Creation.

Background Fifth carpometacarpal joint (CMCJ) fracture dislocation is a relatively rare injury and most will require operative treatment because of its unstable nature. Improper reduction and fixation lead to joint surface destruction, pain, and reduced grasping power. Intra-articular fragment reduction is often obscured by dorsally displaced ulnar fragment. Therefore, fifth CMCJ arthroscopy can be advantageous in assisting intra-articular fragment reduction. However, there is no detailed description of the portal landmarks or portals' relationship with adjacent important structures in the literature. Purposes To explore the feasibility and safety of fifth CMCJ arthroscopy, locations of the portals are examined in cadaveric hand specimens. Their proximity to important anatomical structures such as dorsal cutaneous branch of ulnar nerve (DCBUN), ring finger and little finger extensor digitorum communis (EDC), and extensor digiti minimi (EDM) is measured. Methods Fifth CMCJ arthroscopy is performed on 11 cadaveric hand specimens by specialist-level surgeon. The portals are marked and portal positions are further confirmed under the fluoroscopy. Then the cadaveric specimens were undergone anatomical dissection by specialist-level surgeon. During dissection, the spatial relationship between the portal positions and DCBUN, EDC to ring finger and little finger, and EDM is identified. The distance between the portals and the above important structures was measured in millimeters. Results DCBUN was consistently found between fourth metacarpohamate (4-MH) and fifth metacarpohamate (5-MH) portals, with it being closer to the latter (mean distance, 2.03 mm; range, 0-4.43 mm; standard deviation [SD], 1.09 mm). The closest tendon for 4-MH portal is ring finger EDC (mean distance, 2.65 mm; range, 0-5.89 mm; SD, 1.78 mm), while 5-MH portal and accessory portal were closest to EDC (mean distance, 1.88 mm; range, 0-3.69 mm; SD, 1.25 mm) and EDM (mean distance, 7.79 mm; range, 6.63-10.72 mm; SD, 1.49 mm), respectively. During the process of specimen dissection, we found no damage to the above structures after portal introduction. Conclusion The above findings support the use of fifth CMCJ arthroscopy, which can be used for assisted reduction in fifth metacarpal base fracture dislocation and hamate body fracture. Gentle soft tissue spreading technique during portal creation prevents injury to the important structure surrounding the portals. Level of evidence This is a Level V study.

Schwannoma of the digital nerve

Schwannomas are the most common benign tumours affecting the peripheral nervous system. They represent a benign proliferation of Schwann cells. Schwannomas and other peripheral nerve sheath tumours are common in the head and neck, spine, thorax, abdominal wall, and retroperitoneum. However, localization in hand is exceptional. We present a 22-years-old female patient diagnosed and operated on for schwannoma of the digital nerve (dorsal cutaneous branch originating from the palmar cutaneous branch of ulnar nerve). In the case of a palpable hand mass, one of the possible diagnoses is schwannoma, and since the operative technique is somewhat specific with tumour enucleation and internal neurolysis, it is necessary to preoperatively keep in mind schwannoma in the differential diagnosis.

Shingles in palmar cutaneous branch of ulnar nerve.

Shingles in palmar cutaneous branch of ulnar nerve.

Novel technique of diagnosing and reducing pain in cervical radiculopathy

Background: Neck pain with upper limb pain is a common complaint of patients seen in Out Patient Department (OPD). Such pain may be because of a pinched nerve. There is inflammation in the nerve which causes radicular symptoms. The available clinical tests for cervical radiculopathy are provocative tests, difficult to perform and techniques vary from author to author. The reliability of these tests is only when done in clusters. We devised a novel non-provocative clinical sign to diagnose cervical radiculopathy and a method to reduce upper limb radicular pain and thereby improving the function of the upper limb. Method: Patient’s bilateral pronated wrists were palpated dorsomedially on the ulnar styloid. This elicited tenderness over the Dorsal Cutaneous branch of Ulnar Nerve (DCU). The painless active degree of movement at shoulder and elbow joints was noted. Nerve block at the palpated tender point was given using 2% lignocaine in 95 patients. We used Visual Analogue Scale score to measure radicular pain intensity before and 5 minutes after injection Results: All patients had tenderness at the DCU on the symptomatic upper limb. All patients had reduction in VAS of radicular pain from 7.36±0.89 before injection to 1.89±0.98 after injection with improvement of shoulder and elbow active movement.Conclusion: We recommend palpation of DCU in both upper limbs in all cases of suspected cervical radiculopathy. Palpation to elicit tenderness over DCU in cervical radiculopathy, was documented as Pote’s sign positive. Injection of local anesthetic agent over DCU reduces pain and improves upper limb function and it was documented as Pote’s test positive. This test is of diagnostic and therapeutic significance. This test is minimally invasive and can be done in an OPD set-up.

Alternatives to sural nerve grafts in the upper extremity.

The sural nerve is the most common nerve graft donor despite requiring a second operative limb and causing numbness of the lateral foot. The purposes of this study were to review our experience using nerve autografts in upper extremity nerve reconstruction and develop recommendations for donor selection. A retrospective case series study was performed of all consecutive patients undergoing nerve grafting procedures for upper extremity nerve injuries over an 11-year period (2001-2012). Eighty-six patients received 109 nerve grafts over the study period. Mean patient age was 42.9 ± 18.3years; 57% were male. There were 51 median (59%), 26 ulnar (30%), 14 digital (13%), 13 radial (16%), and 3 musculocutaneous (4%) nerve injuries repaired with 99 nerve autografts (71 from upper extremity, 28 from lower extremity). Multiple upper extremity nerve autograft donors were utilized, including the medial antebrachial cutaneous nerve (MABC), third webspace branch of median, lateral antebrachial cutaneous nerve (LABC), palmar cutaneous, and dorsal cutaneous branch of ulnar nerve. By using an upper-extremity donor, a second operative limb was avoided in 58 patients (67%), and a second incision was avoided in 26 patients (30%). The frequency of sural graft use declined from 40% (n = 17/43) to 11% (n = 7/64). Our algorithm for selecting nerve graft material has evolved with our growing understanding of nerve internal topography and the drive to minimize additional incisions, maximize ease of harvest, and limit donor morbidity. This has led us away from using the sural nerve when possible and allowed us to avoid a second operative limb in two thirds of the cases.

Can palmar creases serve as landmarks for the deeper neuro-vascular structures?

Purpose The aim of this study was the examination of the superficial anatomy of palmar creases and their relation to deeper neuro-vascular structures.MethodsFour creases: distal wrist flexion crease, thenar crease, proximal palmar crease and distal palmar crease were evaluated with reference to the following structures: palmar cutaneous branch of median nerve, palmar cutaneous branch of ulnar nerve, the nerve of Henle, transverse palmar branches from ulnar nerve, recurrent motor branch of median nerve, radial proper palmar digital nerve to the index and the ulnar proper palmar digital nerve to the thumb, Berrettini’s communicating branch, ulnar nerve and artery, superficial palmar arch. We performed dissections of 20 cadaveric upper limbs derived from a homogenous Caucasian group. In our study we measured the location of surgically important structures with reference to palmar skin creases.Results Among the other observations we noticed that the palmar cutaneous branches of the median and ulnar nerves were located at least 0.5 cm away from the thenar crease. The superficial palmar arch was found between the thenar and proximal palmar crease and never crossed the proximal or distal palmar creases.ConclusionsThese anatomical dissections will provide reference material for further ultrasound studies on the arrangements of neuro-vascular structures in reference to superficial palmar creases.

Dorsal cutaneous branch of ulnar nerve: an appraisal on the anatomy, injuries and application of conduction velocity studies in diagnosis

Classical textbooks and recent publications about the anatomy of the dorsal cutaneous branch of the ulnar nerve are revisited and correlated with methods of measurement of its conduction velocity, in order to evaluate the indications and limitations of the procedure. Etiology and pathogenesis of isolated lesions of this nerve branch are discussed.

Conduction study of dorsal cutaneous branch of ulnar nerve in normal human subjects and in leprosy : M. Gourie-Devi and H. Taliath (Bangalore, India)

Conduction study of dorsal cutaneous branch of ulnar nerve in normal human subjects and in leprosy : M. Gourie-Devi and H. Taliath (Bangalore, India)