Ramo cutâneo palmar do nervo mediano: variação anatômica

Edie Benedito Caetano; José Eduardo de Bona; Thais Mayor Simonatto; Luis Andres Montero Gonzales

doi:10.23925/1984-4840.2018v20i4a10

Authors

Edie Benedito Caetano Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde (FCMS) – Sorocaba (SP), Brasil. http://orcid.org/0000-0003-4572-3854
José Eduardo de Bona Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde (FCMS) – Sorocaba (SP), Brasil. http://orcid.org/0000-0002-2416-7281
Thais Mayor Simonatto Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde (FCMS) – Sorocaba (SP), Brasil. http://orcid.org/0000-0002-0654-5373
Luis Andres Montero Gonzales Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde (FCMS) – Sorocaba (SP), Brasil. http://orcid.org/0000-0002-1966-7353

DOI:

https://doi.org/10.23925/1984-4840.2018v20i4a10

Keywords:

median nerve, palmar plate, anatomic variation, wrist, cadaver

Abstract

The anatomy of the palmar cutaneous branch of the median nerve (PCBMN) and its clinical implications have been described by various authors. Most of them report the palmar cutaneous branch of the median nerve in the carpal tunnel release surgery. However, few reports in the literature discuss the anatomical variations of this nerve which may represent a risk during palmar access to the approach of distal radius fractures, access to scaphoid and surgical tendon graft involving the carpal radial and long palmar flexor tendons. We reported a rare anatomical variation, in which we identified the duplication of the PCBMN, since we recorded only one case in the literature associating doubling the palmar cutaneous branch of the median nerve with a proximal branch originating from more than 17 cm above the palmar crease of the wrist. These variations endanger the PCBMN during surgical access to the distal forearm, and the proximal region of the palm. We did not identify any position of the two branches from the ulnar side of the tendon of the flexor carpi radialis muscle.

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Author Biography

Edie Benedito Caetano, Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde (FCMS) – Sorocaba (SP), Brasil.

Departamento de Cirurgia da Faculdade de Ciências Médicas e da Saúde PUC-SP

References

Naff N, Dellon AL, Mackinnon SE. The anatomical course of the palmar cutaneous branch of the median nerve, including a description of its own unique tunnel. J Hand Surg Br. 1993;18(3):316-7. https://doi.org/10.1016/0266-7681(93)90050-P

Das SK, Brown HG. In search of complications in carpal tunnel decompression. Hand. 1976;8(3):243-9. https://doi.org/10.1016/0072-968X_76_90009-7

Matloub HS, Yan JG, Mink Van Der Molen AB, Zhang LL, Sanger JR. The detailed anatomy of the palmar cutaneous nerves and its clinical implications. J Hand Surg Br. 1998;23(3):373-9. https://doi.org/10.1016/S0266-7681(98)80061-2

McCann PA, Clarke D, Amirfeyz R, Bhatia R. The cadaveric anatomy of the distal radius: implications for the use of volar plates. Ann Royal Coll Surg Engl. 2012;94(2):116-20. https://doi.org/10.1308/003588412X13171221501186

Martin CH, Seiler JG, Lesesne JS. The cutaneous innervation of the palm: an anatomic study of the ulnar and median nerves. J Hand Surg. 1996;21(4):634-8. https://doi.org/10.1016/S0363-5023(96)80017-7

Bezerra AJ, Carvalho VC, Nucci A. An anatomical study of the palmar cutaneous branch of the median nerve. Surg Radiol Anat. 1986;8(3):183-8.

Hobbs RA, Magnussen PA, Tonkin MA. Palmar cutaneous branch of the median nerve. J Hand Surg Am. 1990;15(1):38-43. https://doi.org/10.1016/S0363-5023(09)91103-0

MacDonald R, Lichtman DM, Hanlon JJ, Wilson JN. Complications of surgical release for carpal tunnel syndrome. J Hand Surg Am. 1978;3(1):70-7. https://doi.org/10.1016/S0363-5023(78)80118-X

Dowdy PA, Richards RS, McFarlane RM. The palmar cutaneous branch of the median nerve and the palmaris longus tendon: a cadaveric study. J Hand Surg Am. 1994;19(2):199-202. https://doi.org/10.1016/0363-5023(94)90005-1

Roche SJ, Ng CY. Absent palmar cutaneous branch of median nerve. J Hand Microsurg. 2014;6(1):47-8. https://doi.org/10.1007/s12593-014-0130-x

Lindley SG, Kleinert, JM. Prevalence of anatomic variations encountered in elective carpal tunnel release. J Hand Surg Am. 2003;28(5):849-55. https://doi.org/10.1016/S0363-5023(03)00365-4

Jones C, Beredjiklian P, Matzon JL, Kim N, Lutsky K. Incidence of an anomalous course of the palmar cutaneous branch of the median nerve during volar plate fixation of distal radius fractures. J Hand Surg Am. 2016;41(8):841-4. https://doi.org/10.1016/j.jhsa.2016.05.011

Da Silva MF, Moore DC, Weiss APC, Akelman E, Sikirica M. Anatomy of the palmar cutaneous branch of the median nerve: clinical significance. J Hand Surg Am. 1996;21(4):639-43. https://doi.org/10.1016/S0363-5023(96)80018-9

Bertelli JA. Distal sensory nerve transfers in lowertype injuries of the brachial plexus. J Hand Surg Am. 2012;37(6):1194-9. https://doi.org/10.1016/j.jhsa.2012.02.047

Stellbrink G. [Compression of the palmar branch of the median nerve by atypical palmaris longus muscle]. Handchirurgie. 1972;4(4):155-7.

Gessini L, Jandolo B, Pietrangeli A, Senese A. Compression of the palmar cutaneous nerve by ganglions of the wrist. J Neurosurg Sci. 1983;27(4):241-3.