Isolated compression neuropathy of the palmar cutaneous branch of the median nerve

A case of isolated thenar numbness, with an associated painful palmar wrist mass is presented. At operation, a palmar wrist ganglion compressing the palmar cutaneous branch of the median nerve was encountered. After ganglion excision the numbness in the palm was relieved, and there was no recurrence at 6 years follow-up.     

Entrapment neuropathy of the palmar cutaneous branch of the median nerve concomitant with carpal tunnel syndrome: a case report

A case of the entrapment neuropathy of the palmar cutaneous branch of the median nerve, concomitant with carpal tunnel syndrome is presented. This report demonstrates that the Semmes-Weinstein monofilament test and nerve conduction studies can identify entrapment of the palmar cutaneous branch of the median nerve concomitant with carpal tunnel syndrome.     

正中神经指浅屈肌肌支移位修复尺神经运动支的应用解剖

目的 通过对正中神经指浅屈肌肌支和尺神经运动支的解剖学研究,为正中神经指浅屈肌肌支移位修复尺神经运动支,恢复手内在肌功能的临床应用提供解剖学基础.方法 选用20例40侧近期经福尔马林浸泡固定的成人上肢标本,暴露正中神经、尺神经,测量正中神经指浅屈肌肌支各项解剖学数据;应用图像分析系统对组织切片做定量分析,测算该肌支有髓神经纤维数目.临床模拟操作正中神经指浅屈肌肌支移位修复尺神经运动支.结果 正中神经第4肌支发出部位距离桡骨茎突和尺骨茎突连线(48.4±2.4)mm,入肌部位距离桡骨茎突和尺骨茎突连线(21.4±1.8)mm,可分离长度(27.1±1.2)mm,横径(1.2±0.2)mm,前后径(0.7±0.1)mm;尺神经的运动支和感觉支之间自然分束无损伤分离.长度为(7.1±0.70)cm;组织切片及图片系统测得正中神经指浅屈肌第4肌支有髓神经纤维数目为(1378.9±107.9)条.结论 正中神经指浅屈肌第4肌支可修复尺神经运动支,以期恢复手内在肌的功能.     

正中神经掌皮支的应用解剖

目的　为腕掌部手术避免损伤掌皮支提供解剖学基础。方法　对 5 0侧成人上肢标本的掌皮支来源、走行、分支、分布及其营养动脉等进行解剖学观测。结果　掌皮支在腕远横纹的“0”点近端(4 4 .9± 2 1.6)mm处发自正中神经桡侧 ,在该点近端 (18.6± 11.5 )mm处穿出前臂深筋膜后 ,紧贴深筋膜和屈肌支持韧带浅面 ,越豆、舟顶间线的中、外 1/3交点至手掌。在“0”点远端 (8.2± 3 .4)mm处穿出掌腱膜。掌皮支干长 (4 9.7± 2 5 .2 )mm ,起点处宽 (1.2± 0 .9)mm。掌皮支主要分支有 3支者占 5 2 %(2 6侧 ) ,2支者 3 4% (17侧 ) ,1支者 14 % (7侧 ) ,它主要分布于手掌的大鱼际区和掌中区。桡、尺动脉发出营养支 (84.69% )与掌皮支干伴行后进入神经 ,掌浅弓发出营养支 (89.62 % )直接进入掌皮支的手掌部分支。结论　腕掌部手术应靠近尺侧作纵切口以免损伤掌皮支     

Compression neuropathy of the motor branch of the median nerve caused by palmar ganglion

We describe a palmar ganglion producing paralysis of the motor branch of the median nerve; such a case has not been reported previously. Ultrasonography was useful for preoperative diagnosis.     

Lipoma of the flexor digitorum superficialis causing triggering at the carpal canal and median nerve compression

A lipoma in the carpal canal was associated with both triggering of the fingers at the level of the transverse carpal ligament and median nerve compression. We were unable to find a similar case reported in the English-language literature.     

Granular cell tumor of the palmar cutaneous branch of the median nerve

Granular cell tumor rarely occurs in the hand. A patient with this tumor involving the palmar cutaneous branch of the median nerve, and twelve-month follow-up is discussed. This lesion, similar to neurofibromas, can infiltrate peripheral nerves and cannot be dissected from them. The lesion is probably of Schwann cell origin.     

A case of neurofibroma of the palmar cutaneous branch of the median nerve

This case report describes a previously unreported entity, a neurofibroma of the palmar cutaneous branch of the median nerve. The lesion presented as a palmar mass with an overlying abnormality of the skin. Treatment consisted of excision of the lesion. Infiltration of the terminal branches of the nerve by the tumour prevented nerve reconstruction but provided a previously unknown diagnostic clue: fibrosis of an area of skin innervated by the involved nerve, which had the appearance of a callosity.     

正中神经掌皮支的局部解剖与临床意义

目的 为避免腕、掌部手术切口损伤正中神经掌皮支提供解剖学资料.方法 对52例成人上肢标本正中神经掌皮支的来源、走行、分支、分布、血管显微解剖等进行解剖测量.结果 52例标本均有掌皮支,50例自正中神经桡侧发出,2例自尺侧发出,走行在掌长肌腱和桡侧腕屈肌腱之间的深层.发出点距离0点(远侧腕横纹中点)为(45.2±21.2)mm,穿出前臂深筋膜处距离0点(19.8±12.3)mm,穿出掌腱膜处距离0点(8.2±4.3)mm,掌皮支主干长(49.2±24.2)mm,起点处宽(1.2±0.7)mm,掌皮支与舟骨结节中点的垂直距离为(8.3±2.8) mm.掌皮支分3支者31例(占59.6％),分2支者15例(占28.9％),1支者6例(占11.5％).掌皮支主要分布于鱼际区和掌中区,以直入式、伴入式和肌支式进入神经.结论 掌皮支的来源、行程均较恒定.为避免伤及正中神经掌皮支及其营养血管,在腕部手术切口应选在尺侧半(环指纵轴的尺侧),在掌部应靠近第四掌骨作纵切口.     

Anomalous flexor digitorum superficialis muscle transposition for vascular coverage of the median nerve in recurrent carpal tunnel syndrome

Recurrent carpal tunnel syndrome is uncommon yet troublesome. Significant adhesions and scarring around the median nerve can render it relatively ischemic. A number of vascular flaps have been described to provide vascular coverage in attempts to decrease further cicatricial adhesions and to improve local blood supply around the median nerve. A rare case of an anomalous muscle in the distal forearm used as tissue to provide good vascularized coverage of the median nerve that was severely scarred in its bed is reported. The anomalous muscle was distal to the flexor digitorum superficialis tendon and inserted in the palmar fascia on the ulnar aspect of the hand. Referring branches from the ulnar artery provided vascular supply to the anomalous muscle. The muscle on these vascular pedicles was transposed over the median nerve, providing good, stable, unscarred coverage. The patient had an excellent result with resolution of the carpal tunnel symptoms. The redundant anomalous muscle provided a unique vascularized source for coverage of the median nerve in recurrent carpal tunnel syndrome.     

Anomalies of the flexor digitorum superficialis muscle

Three anomalies of the human flexor digitorum superficialis are presented. The normal development of this muscle from the amphibian to the human is discussed and the described anomalies of the muscle in humans classified.     

Restoration of flexor pollicis longus function by flexor digitorum superficialis transfer

Fourteen patients were treated by flexor digitorum superficialis transfer for irreparable flexor pollicis longus lesions. Results measured by return of interphalangeal joint motion were good in 12 patients, with one patient achieving a fair result and one failure. This is a reliable procedure in thumbs with a grade I or II (Boyes) tendon bed and should be considered as an alternative to free tendon grafting for reconstruction in patients in whom return of interphalangeal motion is desirable.     

Anomalous palmar cutaneous branch of the median nerve in the distal forearm: case report

Variations exist in the anatomy of the palmar cutaneous branch of the median nerve about the wrist. We report an anatomic variation in the course of the palmar cutaneous branch of the median nerve identified in a 17-year-old girl undergoing surgery for a scaphoid nonunion. Instead of coursing ulnar to the flexor carpi radialis tendon, deep to the antebrachial fascia between the tendons of the flexor carpi radialis and palmaris longus, the palmar cutaneous branch of the median nerve was noted to cross volar to the distal aspect of the flexor carpi radialis to lie on its radial aspect. Knowledge of the anatomic variant described in this report should encourage surgeons to dissect carefully as they expose the flexor carpi radialis during the exposure of the distal radius or scaphoid.     

Palmar cutaneous branch of the median nerve

The palmar cutaneous branch of the median nerve was dissected in 25 fresh cadavers. The origin from the median nerve, the course, termination, and variability of the palmar cutaneous nerve are described in relation to two reference lines. In no case did a branch of the palmar cutaneous nerve extend ulnar to the axial line of the ring finger. The planning of incisions around the palmar aspect of the palm and wrist should be based on this anatomical knowledge.     

Nerve stripping: new treatment for neuromas of the palmar cutaneous branch of the median nerve

We present a new method for the treatment of painful neuromas of the palmar cutaneous branch of the median nerve. A preliminary cadaver study was done to investigate the extraneural and intraneural course of the palmar cutaneous branch of the median nerve with respect to the main trunk of the median nerve. Seven patients presented with a painful neuroma following previous surgery on the palmar aspect of the wrist. The neuroma was dissected and excised by stripping the whole of the palmar cutaneous branch from the main trunk of the median nerve. In all cases complete relief from pain and discomfort was achieved. The resulting area of numbness in the palm did not represent a significant problem.     

Nerve fibre composition of the palmar cutaneous branch of the median nerve and clinical implications.

Fifteen fresh human cadaver hands were dissected, using x2.8 loupe magnification, to study the subcutaneous innervation at the site of the incision (in the line with the radial border of the ring finger) for standard open carpal tunnel decompression. Subcutaneous nerve branches were detected and traced proximally to determine their origin. Morphometric analysis of nerve cross sections from the site of the incision and from the main nerve trunk proximal to cutaneous arborisation was performed using light and transmission electron microscopy and a computer-based image analysis system. At the site of the incision, the ulnar sub-branch (US) of the palmar cutaneous branch of the median nerve (PCBMN), which innervates the skin over the hypothenar eminence, was found in 10 of 15 cases. Branches from the ulnar side were not detected. The main trunk of PCBMN consisted on average of 1000 (SD 229) myelinated axons arranged in 1-4 fascicles. In the US of the PCBMN there were on average 620 (SD 220) myelinated axons, 80% of them smaller than 40 microm(2) i.e. thin myelinated axons, and on average 2037 (SD 1106) unmyelinated axons, arranged in 1-3 fascicles. The ratio of the number of myelinated axons in the US and the main trunk of the PCBMN was on average 63% (SD 19%). Frequency distribution of cross-sectional areas of myelinated axons shows no significant difference between the US and the main nerve trunk of the PCBMN. The importance of incision trauma to subcutaneous innervation of palmar triangle is emphasised and possible mechanisms of scar discomfort are discussed.     

Entrapment of the lateral antebrachial cutaneous nerve exiting through the forearm fascia

Isolated lateral antebrachial cutaneous nerve entrapment syndromes are uncommon. This report describes the compression of the lateral antebrachial cutaneous nerve of the forearm at the level of its passage through the superficial antebrachial fascia, distal to the elbow crease. Numbness and a painful dysesthesia over the radial aspect of the volar forearm were documented. Failure of conservative treatment necessitated surgical decompression.     

Compression of the motor branch of the median nerve by the superficial palmar branch of the radial artery

A case of isolated thenar wasting caused by a large superficial palmar branch of the radial artery is reported.