Medial Cutaneous Nerve Research Articles

Sural-to-medial femoral cutaneous amplitude ratio in early diagnosis of uremic neuropathy.

Medial femoral cutaneous (MFC) sensory nerve action potentials (SNAPs) can be easily recorded using distal stimulation. This study aimed to identify a new parameter using MFC SNAPs for the early electrophysiological diagnosis of length-dependent axonal polyneuropathy (LDAP) associated with uremic neuropathy. Patients with chronic renal failure who were referred to the electrodiagnostic laboratory due to symptoms suggesting polyneuropathy were included. Assessments encompassed neurological examination, Michigan Neuropathy Screening Instrument (MNSI), and Semmes-Weinstein monofilament test. Antidromic radial, median, ulnar, MFC, sural, and superficial peroneal sensory; median, ulnar, tibial, and peroneal motor nerve conduction studies were performed. Sural-to-radial amplitude ratio (SRAR) and sural-to-medial femoral cutaneous amplitude ratio (SMFCAR) were calculated, and their diagnostic sensitivities were compared with the age and sex matched healthy controls. Thirty-two chronic renal failure patients (mean age 60.0 ± 9.6 years) and 37 controls (60.6 ± 9 years) were included. MNSI indicated clinical polyneuropathy in 59.4% of patients, while sural SNAP amplitude was diagnostic in 78%. Median SRAR and SMFCAR values were significantly lower in patients than controls (p < .001 for both). The cut-off values for SMFCAR and SRAR were <1.82 and <0.30, respectively, both with a sensitivity of 59% and a specificity of 94%. Sural SNAP is the most sensitive parameter in the diagnosis of LDAP. SMFCAR is not superior to SRAR. If the sural SNAP amplitude is normal, SMFCAR can serve as an alternative to SRAR in dialysis patients with bilateral arteriovenous fistulae or in those unable to undergo radial NCS.

Fiber anatomy and histological characteristics of the innervation of the triangular fibrocartilage complex.

To evaluate the precise origin of sensory nerves through gross anatomical study of the TFCC, synthesized alongside imaging and histological techniques. Six cadaveric forearm specimens were obtained to map the course and branches of the ulnar nerve through macrodissection. Immunohistochemical staining targeting PGP 9.5 and type IV collagen was performed on frozen TFCC sections to visualize nerve fibers microscopically. Computed tomography, magnetic resonance imaging, and arthrography findings were also reviewed. At the macroscopic level, the articular branches supplying the TFCC originated predominantly from the dorsal branch of the ulnar nerve. Microscopic analysis revealed positive PGP 9.5 expression and discernible neural marker expression, signifying fine nerve fiber ingrowth within the TFCC. Imaging modalities aided the diagnosis of TFCC lesions. The dorsal cutaneous branch of the ulnar nerve, medial cutaneous nerve of the forearm, and volar sensory branch of the ulnar nerve emerged as the principal nerves innervating the TFCC. This study provides anatomical evidence that the TFCC receives innervation from branches of the ulnar nerve and contains sensory nerve fibers. These findings enhance understanding of potential neuropathic pain mechanisms in TFCC injuries and offer insights to guide surgical interventions. Further investigations are warranted to elucidate the clinical implications.

Modified medial approach for the treatment of fractures of the lower third of the humeral shaft: An anatomical study

BackgroundThe anatomical study of the modified medial approach for addressing fractures of the distal third of the humeral shaft aimed to elucidate the benefits of this method in providing optimal exposure for surgical intervention. MethodsSixteen upper limb specimens from eight cadavers, obtained from the Anatomy Teaching Department of Fujian Medical University, were dissected. Three-dimensional anatomical structures were mapped onto a two-dimensional coordinate system. Key anatomical structures relevant to the modified medial approach, including the medial cutaneous nerve, musculocutaneous nerve, ulnar nerve, basilic vein, brachial artery, superior ulnar collateral artery, and inferior ulnar collateral artery, were documented in detail. ResultsThe average humeral shaft length measured (29.22 ± 2.78) cm, with its medial surface being flat and well-suited for plate fixation. The basilic vein, located superficially in the upper arm's first quadrant, measured (1.35 ± 0.35) cm from the most prominent point of the medial epicondyle of the humerus, with the deep fascia being penetrated at (12.41 ± 1.71) cm. The basilic vein serves as a key landmark for the modified medial approach. The nervi cutanei antebrachii medialis, running along the medial biceps humerus, closely accompanies the basilic vein, perforating the deep fascia above the medial epicondyle and extending anterior external and posterior medial branches. These branches are positioned (0.80 ± 0.17) cm and (0.45 ± 0.29) cm, respectively, from the basilic vein. Additionally, all nervi cutanei antebrachii medialis pass anteriorly to the basilic vein before continuing distally to the forearm. The ulnar nerve initially accompanies the basilic vein in the upper arm but diverges posteriorly without branching at (14.75 ± 1.74) cm, with the maximum separation from the basilic vein measuring (2.28 ± 0.59) cm. The brachial artery bifurcates into the superior and inferior ulnar collateral arteries along the humeral shaft. The superior collateral ulnar artery primarily supplies the ulnar nerve, positioned (14.14 ± 1.27) cm from the medial epicondyle, which ensures a sufficient blood supply for operative procedures. The musculocutaneous nerve and radial nerve branch are located in the lateral region of the brachial muscle, with minimal postoperative impact on muscle strength when splitting the brachial muscle by one-third. ConclusionsThe modified medial approach, as revealed by anatomical studies, focuses on the fracture site with a straight skin incision aligned between the most prominent point of the medial epicondyle and the midpoint of the axilla, positioned one transverse finger from the radial side. Using the basilic vein as a reference, major vessels and nerves remain undisturbed, ensuring a safe operative zone. This technique allows for significant exposure of both the anterior and external humeral shaft fracture site and the ulnar side butterfly fragment while minimizing tissue damage and facilitating rapid recovery. The approach offers notable clinical value due to its reduced invasiveness and accelerated postoperative rehabilitation.

Morphological Variability of the Sural Nerve and Its Clinical Significance.

The sural nerve provides sensory innervation to the skin on the distal posterolateral third of the lower extremity. The morphological variants are characterized by high variability. However, it most commonly arises from a union of the medial sural cutaneous nerve and the peroneal communicating branch of the common fibular nerve. This article overviews the anatomical and clinical significance of the sural nerve. Despite the remarkable development of genetic diagnostics, sural nerve biopsy is still a very important tool to diagnose peripheral neuropathies such as diabetic, vascular and inflammatory neuropathies. Furthermore, the sural nerve is also commonly transplanted due to its characteristics. Such a procedure is applicable in cases of segmental nerve loss, but it is also used to restore potency in patients after radical prostatectomy. The knowledge of anatomical variants of the sural nerve is also crucial as it allows to minimize its damage during surgical procedures. Furthermore, during an ankle surgery, a nerve block can be used to complement anesthesia. The major aim of this work is to review contributions of the sural nerve to physiological and pathophysiological processes.

ANATOMICAL VARIATIONS IN A FINITE ELEMENT NERVE MODEL OF THE HUMAN FOOT

The nerves in the foot offer a significant role in controlling the movement and correct loading of the foot by providing continuous feedback to the central nervous system. The health importance in the anatomical variations of nerves, such as the locations, the lengths, the communicating branches, and the distance between the adjacent nerve terminals between individuals have given prominence to anatomists as well as physiologists. A previously developed one-dimensional (1D) model of the nerve was extended to determine different anatomical variations in the nerves of the foot, as a realistic anatomical-based variant nerve model of the human foot is not available. The model was verified against experimental data from the literature for communicating branches and distances of various area of the human foot. For instance, the simulated distances of the communicating branches of the plantar nerves and medial dorsal cutaneous nerve (MDCN) division proximal to the first digital space were found to be 43.3 mm and 112.3 mm, respectively, which was in general agreement with the experimental distances of 8-56 mm and 96-116.74 mm, respectively. The developed nerve variant model provides a platform for future studies of the various geometrical and efficient concerns of neurovascular diseases such as diabetic neuropathies by determining the parameters of nerve conduction studies.

The Anterior Branch of the Medial Femoral Cutaneous Nerve Innervates Cutaneous and Deep Surgical Incisions in Total Knee Arthroplasty.

Background/Objectives: The intermediate femoral cutaneous nerve (IFCN), the saphenous nerve, and the medial femoral cutaneous nerve (MFCN) innervate the skin of the anteromedial knee region. However, it is unknown whether the MFCN has a deeper innervation. This would be relevant for total knee arthroplasty (TKA) that intersects deeper anteromedial genicular tissue layers. Primary aim: to investigate deeper innervation of the anterior and posterior MFCN branches (MFCN-A and MFCN-P). Secondary aim: to investigate MFCN innervation of the skin covering the anteromedial knee area and medial parapatellar arthrotomy used for TKA. Methods: This study consists of (1) a dissection study and (2) unpublished data and post hoc analysis from a randomized controlled double-blinded volunteer trial (EudraCT number: 2020-004942-12). All volunteers received bilateral active IFCN blocks (nerve block round 1) and saphenous nerve blocks (nerve block round 2). In nerve block round 3, all volunteers were allocated to a selective MFCN-A block. Results: (1) The MFCN-A consistently innervated deeper structures in the anteromedial knee region in all dissected specimens. No deep innervation from the MFCN-P was observed. (2) Sixteen out of nineteen volunteers had an unanesthetized skin gap in the anteromedial knee area and eleven out of the nineteen volunteers had an unanesthetized gap on the skin covering the medial parapatellar arthrotomy before the active MFCN-A block. The anteromedial knee area and medial parapatellar arthrotomy was completely anesthetized after the MFCN-A block in 75% and 82% of cases, respectively. Conclusions: The MFCN-A shows consistent deep innervation in the anteromedial knee region and the area of MFCN-A innervation overlaps the skin area covering the medial parapatellar arthrotomy. Further trials are mandated to investigate whether an MFCN-A block translates into a clinical effect on postoperative pain after total knee arthroplasty or can be used for diagnosis and interventional pain management for chronic neuropathic pain due to damage to the MFCN-A during surgery.

Modified Oblique Lobenhoffer (MOL) approach for posterolateral and posteromedial column access in tibial plateau fractures: a detailed cadaveric anatomical study

BackgroundTibial plateau fractures involving posteromedial (PM) and posterolateral (PL) columns are complex injuries that require an appropriate approach. The management of the PL column in these cases can be controversial, and limitations using deep posteromedial interval approaches have been referenced. In this paper, a modification of the Lobenhoffer approach, designed to optimize the access to the PL column, is described in detail. The aim of this study was to assess the feasibility of this approach in a cadaveric anatomical study.Materials and methodsIn total, five fresh-frozen cadaveric specimens were used for detailed anatomical study surrounding the approach. Relationships with cutaneous and deep neurovascular structures were evaluated. The exposure area of the PL and PM columns using this approach was assessed.ResultsThe cadaveric study showed safe and adequate exposure. Oblique skin and fascia incision just medial to the posterior midline was safe to protect the medial sural cutaneous nerve and the small saphenous vein. Elevation of the popliteus and tibialis posterior muscles offered safe protection of the anterior tibial artery and popliteal neurovascular bundle during retractor placement. Adequate full proximal exposure of the PM and PL columns, including the posterolateral lateral (PLL) and posterolateral central (PLC) segments, was obtained in all specimens.ConclusionsThe Modified Oblique Lobenhoffer (MOL) approach can be a feasible option to access PL and PM columns in tibial plateau fractures.Level of evidenceIV.

Medial dorsal cutaneous nerve entrapment following inversion ankle sprain

The medial dorsal cutaneous nerve is one of the terminal branches of the superficial peroneal nerve that provides sensory innervation to the dorsum of the foot. It may be prone to injury by direct blow, iatrogenic surgical lesion or in rare situations secondary to ankle sprains. The authors report a case of persistent ankle pain in a female patient caused by a post- traumatic compressive neuropathy of the medial dorsal cutaneous nerve secondary to an ankle sprain which was successfully surgically treated with complete resolution of the symptoms.

Minimally invasive subtalar joint and talonavicular joint preparation for hindfoot arthrodesis: A Cadaveric study evaluating structures at risk

Minimally invasive surgery (MIS) is growing in popularity due to smaller incisions, faster recovery times with less post-operative pain, and measurable decreases in morbidity. Our center performed an MIS hindfoot joint preparation about the talonavicular and subtalar joints and defined structures at risk in order to make this procedure more reproducible. Using ten fresh frozen cadaver limbs, we created a medial and lateral portal for talonavicular joint (TN) access, and an additional portal for subtalar joint (STJ) access to prepare the subtalar joint. After denuding the aforementioned joints of cartilage, the specimens were dissected to identify nearby anatomical structures. We documented the position of the peroneal sheath and sural nerve relative to the STJ portal, and the position of the dorsalis pedis artery (DP), medial dorsal cutaneous nerve (MDCN), extensor hallucis longus (EHL), extensor digitorum longus (EDL), tibialis anterior (TA), and tibialis posterior (TP) tendons relative to the TN portals. The average distance of the sural nerve and the peroneal sheath from the STJ portal was 34.21 mm and 14.12 mm respectively. The average distance of the DP, MDCN, and deep peroneal nerve from the medial and lateral TN portals were 13.31 mm, 11.54 mm, and 17.14 respectively. No neurovascular structures were transected throughout joint preparation. To our knowledge this is the first study looking into structures at risk for this specific procedure.

Ultrasound assessment of medial crural cutaneous nerve and infrapatellar branch and of the saphenous nerve: establishing a safety zone for preventing nerve injury in knee surgery and injections.

Our study aimed to illustrate the positional relationship of the two branches of the saphenous nerve: the infrapatellar branch of the saphenous nerve (IPBSN) and medial crural cutaneous nerve (MCCN), as well as the anatomical landmarks using high-resolution ultrasound (HRUS) to help prevent iatrogenic nerve injury. We used HRUS to explore the positional relationships among the anatomical landmarks, IPBSN, and MCCN in 40 knees of 20 participants. The distances from these branches to key reference points were recorded. Using the ultrasound caliper mode, we measured the depth from the skin surface to the nerves at four distinct points. The average distances between IPBSN and medial border of patella (MBP) and IPBSN and medial border of patellar ligament (MBPL) were 47 ± 7mm and 42 ± 9mm, respectively. MCCN showed mean distances of 94 ± 9mm and 96 ± 9mm to MBP and MBPL, respectively. The mean distance from the upper edge of pes anserine to IPBSN at the patellar apex (PA) level was 24 ± 10mm and to MCCN was 34 ± 9mm. We used high-resolution ultrasound to evaluate IPBSN and MCCN and their positions relative to anatomical landmarks. The study results offer valuable insights into the course of these nerves, which can help establish a safety zone to prevent accidental nerve injuries during knee surgeries and injections.

Medial Femoral Cutaneous Nerve Conduction Study with Distal Stimulation and Recording Technique

Medial Femoral Cutaneous Nerve Conduction Study with Distal Stimulation and Recording Technique

Anatomical landmarks for ankle block

We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle.

A Cadaveric Study of Two Uncommon Cases of Sural Nerve Complex Variation

Abstract Introduction The sural nerve is a sensitive nerve whose function is to provide sensory supply for the posterolateral aspect of the distal third of the leg and the lateral side of the dorsum of the foot. This nerve is formed in the upper third of the calf from the terminal branches of the tibial and common peroneal nerves and the communicating branch of the sural nerve. Objectives The aim of our study is to showcase two anatomical variants of the sural nerve. Materials and methods Two formalin-preserved cadavers, one male and one female, embalmed using formalin 4% were dissected with the intent of being used as teaching materials for the students attending anatomy classes at the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania. Results In both cases, less common anatomical variations of the formation of sural nerve were discovered. On the male cadaver, we identified the sural nerve as a continuation of the medial sural cutaneous nerve. The lateral sural cutaneous nerve and the communicating branch of the sural nerve were both absent. On the female cadaver, we identified both the medial sural cutaneous nerve and the lateral sural cutaneous nerve. The sural nerve was, however, a continuation of only the lateral sural cutaneous nerve, with the medial sural cutaneous nerve as an independent branch. Conclusions We described two anatomical variants of the sural nerve, which are less common than those documented in the literature.

Connection between medial dorsal cutaneous nerve and saphenous nerve: case report.

There are no data on the connection of the saphenous nerve (SN), located on the medial side of the foot, with the terminal branches of the superficial fibular nerve. The aim of this study is to reveal the variation that surgeons should pay attention to for anesthesia applied in foot surgeries. In this study, the left foot of a 70-year-old female cadaver fixed with formalin was dissected. The distance to the medial malleolus and the incision line was recorded using digital caliper to determine the reference points in the resulting variation. It was observed that a branch from the SN, which arose from the SN and proceeded anteriorly to the upper part of the medial malleolus and continued towards the dorsum of the foot, hooked with a branch from the medial dorsal cutaneous nerve (MDCN). The branches arising from this hook were distributed on the medial edge of the foot up to the proximal metatarsophalangeal joint I. The distance of this nerve connection to the medial malleolus is 91.14mm, and the distance to the incision line is 15.76mm. It is suggested that the case presented as an unusual SN variation, which may affect the success of local anesthesia in invasive procedures to the medial part of the foot and could be considered in the evaluation of sensory loss after anteromedial surgical approach to the ankle, should be included in the classification of the cutaneous innervation pattern of the foot.

A Case Report of a Rare Variation of the Medial Cutaneous Nerve of Forearm

Introduction: The brachial plexus is the largest and most complex nerve network in the body, which is formed in the neck and enters the axillary cavity after passing under the clavicle. So far, many variations have been reported in the brachial network, which are clinically important. The plexus has three cords, one of which is the medial cord. The medial cutaneous nerve of the arm and the medial cutaneous nerve of the forearm are the branches of the medial cord that innervate the skin of the medial surface of the arm and forearm, respectively. In this study, a rare variation was observed in the branches of the medial cord of the brachial plexus during the dissection of the upper limb of an approximately 80-year-old man in the Dissection Hall of Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Thus, in normal condition, there is no connection between the medial cutaneous nerve of the arm and the medial cutaneous nerve of the forearm, and each of them innervates the skin of the medial arm and forearm separately, but in this case, these two nerves are connected. And since knowing this type of variation is very important for surgeons, more studies are needed to determine its prevalence in the population.

PROJECTION FETAL ANATOMY VASCULAR AND NERVOUS FORMATIONS OF THE ANTERIOR REGION OF THE ARM

Abstract. In the case of gunshot wounds, the upper extremities prevail poly-structural injuries, primarily characterized by damage to nerve trunks, vessels, soft tissues, and bones. Compartment syndrome is one of the most di ffi cult pathological conditions underlying the majority of fi rearm complications is injuries of the limbs and, above all, those accompanied by bone fractures and limbs, and can lead to permanent disability.Until now, fetal patterns have not been defi nitively clarifi ed in the topography of fascial- muscular formations, fi ber spaces, and projection anatomy of the vascular and nervous structures of the anterior region of the arm at diff erent stages of human ontogenesis.The study aimed to establish the vascular- nervous projection structures of the anterior arm region in human fetuses.The study was conducted on preparations of the upper limbs of 48 human fetuses aged from 4 to 10 months using macromicroscopic dissection, injection of vessels, and morphometry.It was established that in human fetuses the projection of the main vascular of the nerve bundle of the shoulder on the skin corresponds to the line that connects the point between the middle and front thirds of the width of the axillary fossa to the middle ulnar fossa. The median nerve in the upper third of the shoulder is determined near the medial edge of the biceps muscle of the shoulder, as a rule, laterally of the brachial artery, within the middle of the anterior region of the arm, median the nerve crosses the brachial artery in front and goes straight in the lower third of the shoulder approximately from the brachial artery. Projection of the ulnar nerve within the upper third of the anterior region of the arm corresponds to the projection of the main vascular- nerve bundle, within the middle and lower thirds – the line that connects the middle of the medial bicipital groove of the shoulder with the medial epicondyle of the humerus. An anatomical landmark for the determination of topography of the main vein, the median cutaneous nerve of the forearm and of the median nerve is the medial edge of the biceps muscle of the shoulder, and the lateral edge of this muscle is a landmark for identifying the main vein.Obtained data on fetal and projection anatomy of structures of the anterior region of the arm in human fetuses of diff erent ages have an important role and applied value and will reduce the risk of iatrogenic injuries and exclude the possibility of developing vascular and nervous complications in the postoperative period, choose the correct tactics of operative interventions in the anterior region of the arm.

Anatomical patterns of the sural nerve: a meta-analysis with clinical and surgical considerations.

The sural nerve (SN) supplies the posterolateral aspect of the leg and the lateral aspects of the ankle and foot and descends through the gastrocnemius muscle along the lower third of leg. Because in-depth knowledge about SN anatomy is essential for clinical and surgical approaches, our study aims to review SN anatomical patterns. We searched the PubMed, Lilacs, Web of Science, and SpringerLink databases to find relevant articles for meta-analysis. We assessed the quality of the studies using the Anatomical Quality Assessment tool. We used proportion meta-analysis to analyze the SN morphological variables and simple mean meta-analysis to analyze the SN morphometric variables (nerve length and distance to anatomical landmarks). Thirty-six studies comprised this meta-analysis. Overall, Type 2A (63.68% [95% CI 42.36-82.64]), Type 1A (51.17% [95% CI 33.16-69.04]) and Type 1B (32.19% [95% CI 17.83-48.38]) were the most common SN formation patterns. The lower third of leg (42.40% [95% CI 32.24-52.86]) and middle third of leg (40.00% [95% CI 25.21-53.48]) were the most common SN formation sites. The pooled SN length from nerve formation to the lateral malleolus was 144.54mm (95% CI 123.23-169.53) in adults, whereas the SN length was 25.10mm (95% CI 23.20-27.16) in fetuses in the second trimester of gestation and 34.88mm (95% CI 32.86-37.02) in fetuses in the third trimester of gestation. The most prevalent SN formation pattern was the union of the medial sural cutaneous nerve with the lateral sural cutaneous nerve. We found differences regarding geographical subgroup and subject age. The most common SN formation sites were the lower and middle thirds of the leg.

Ultrasound-guided fasciotomy for chronic exertional forearm compartment syndrome: a cadaveric feasibility study

ObjectivesChronic exertional forearm compartment syndrome is observed in patients who engage in physical activity requiring repetitive isometric muscular effort of the wrist during prolonged grasping. Open fasciotomy was considered as the gold-standard treatment, for its ability to release all compartments. However, its invasiveness means that high-level athletes have to abstain from competition for a long period of time. For this reason, minimally invasive techniques have been developed, to allow faster recovery.The objective of this cadaveric study was to evaluate the feasibility and reproducibility of ultrasound-guided palmar fasciotomy in the treatment of chronic exertional forearm compartment syndrome. MethodsSurgery consisted in ultrasound-guided palmar fasciotomy of the superficial anterior compartment, using a single minimally invasive approach. Twenty forearms were then dissected by an independent operator, (1) to check complete fasciotomy and (2) to screen for iatrogenic lesions on the tendons, veins and superficial sensory branches. ResultsSixteen fasciotomies were total and 4 partial: i.e., a release rate of 80%. The superficial sensory branches were intact, and notably the branches of the medial cutaneous nerve of the forearm. Mean surgery time was 9 min, progressively decreasing with the repetition of the ultrasound-guided procedure. ConclusionsUltrasound-guided fasciotomy in the management of chronic exertional forearm compartment syndrome appears to be a simple, effective, safe and reproducible technique.

Clinically Relevant Anatomical Variations in the Brachial Plexus.

Anatomical variation in the brachial plexus may result in a variety of clinically relevant patterns, including various neuralgias of the upper extremity and differing nerve territories. Some conditions can be debilitating in symptomatic patients, resulting in paresthesia, anesthesia, or weakness of the upper extremity. Others may simply result in cutaneous nerve territories that deviate from a traditional dermatome map. This study evaluated the frequency and anatomical presentations of a large number of clinically relevant brachial plexus nerve variations in a sample of human body donors. We identified a high frequency of various branching variants, of which clinicians, especially surgeons, should be aware. The medial pectoral nerves in 30% of the sample were found to originate from either the lateral cord, or both the medial and lateral cords of the brachial plexus rather than exclusively from the medial cord. The dual cord innervation pattern greatly increases the number of spinal cord levels traditionally believed to innervate the pectoralis minor muscle. The thoracodorsal nerve arose as a branch of the axillary nerve 17% of the time. The musculocutaneous nerve sent branches to the median nerve in 5% of specimens. The medial antebrachial cutaneous nerve shared a common trunk with the medial brachial cutaneous nerve in 5% of individuals and derived from the ulnar nerve in 3% of specimens.

The anterior branch of the medial femoral cutaneous nerve innervates the anterior knee: a randomized volunteer trial.

The midline skin incision for total knee arthroplasty may be an important generator of chronic neuropathic pain. The incision is innervated by the medial femoral cutaneous nerve (MFCN), the intermediate femoral cutaneous nerves (IFCN) and the infrapatellar branch from the saphenous nerve. The MFCN divides into an anterior (MFCN-A) and a posterior branch (MFCN-P). The primary aim was to compare the areas anesthesized by MFCN-A versus MFCN-P block for coverage of the incision. Nineteen healthy volunteers had IFCN and saphenous nerve blocks. The subgroup of volunteers with a non-anesthetized gap between the areas anesthetized by the saphenous and the IFCN blocks was defined as the study group for the primary outcome. Subsequently selective MFCN-A block and MFCN block (MFCN-A + MFCN-P) were performed to investigate the contributions from MFCN-A and MFCN-P to the innervation of the midline incision. All assessments were performed blinded. Ten out of 19 volunteers had a non-anesthetized gap. Nine out of these 10 volunteers had coverage of the non-anesthetized gap after selective anesthesia of the MFCN-A, whereas anesthesia of the MFCN-P did not contribute to coverage of the gap in any of the 10 volunteers. In half of the cases, a gap of non-anesthetized skin was present on the surgical midline incision after anesthesia of the saphenous nerve and the IFCN. This gap was covered by selective anesthesia of the MFCN-A without contribution from MFCN-P. The selective MFCN-A block may be relevant for diagnosis and interventional management of neuropathic pain due to injury of MFCN-A.