The Palmar Cutaneous Branch of the Median Nerve: A Detailed Morphometric Study

Orane Richards¹, Scott Border¹, Claire Bolton², Alexandra L. Webb^1,3*

¹Centre for Learning Anatomical Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
²Orthopaedic Surgery Unit, The Canberra Hospital, Canberra, Australia.
³Medical School, Australian National University, Canberra, Australia.

DOI: 10.4236/fmar.2014.24017                

Abstract

Damage to the palmar cutaneous branch of the median nerve (PCBMN) is a potential complication of surgery at the volar aspect of the wrist. The aim of this study was to determine the relationships of the PCBMN to both surface and bony landmarks using reliable methods. Ten pairs of forearms from cadavers aged 73 to 98 years were dissected. The PCBMN was identified and its course and relationships documented. The situation of the PCBMN was quantified relative to the distal wrist crease, bistyloid line, scaphoid tubercle, radial styloid process and flexor carpi radialis tendon. A PCBMN was identified on 90% of sides. The PCBMN arose from the radial aspect of the median nerve 52.4 (SD 31.0) mm from the bistyloid line and entered the transverse carpal ligament 10.9 (SD 9.5) mm proximal to the bistyloid line. At the level of the distal wrist crease the PCBMN was located 0.6 to 7.5 mm (mean 4.5; SD 1.9 mm) from the ulnar aspect of the flexor carpi radialis tendon. The inter- and intra-observer reliability of the measurement methods ranged from ICC 0.96 to 1.00. Detailed morphometric data of the PCBMN relative to bony landmarks contribute to knowledge of the spatial relationships of the PCBMN to inform the precision of surgical incisions.

Keywords

Palmar Cutaneous Branch, Median Nerve, Morphometry, Gross Anatomy, Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Al-Qattan, M.M. (1997) Anatomical Classification of Sites of Compression of the Palmar Cutaneous Branch of the Median Nerve. The Journal of Hand Surgery: British & European Volume, 22, 48-49. http://dx.doi.org/10.1016/S0266-7681(97)80014-9
[2]	Bergland, L.M. and Messer, T.M. (2009) Complications of Volar Plate Fixation for Managing Distal Radius Fractures. Journal of the American Academy of Orthopaedic Surgeons, 17, 369-377.
[3]	Chaynes, P., Becue, J., Vaysse, P. and Laude M. (2004) Relationships of the Palmar Cutaneous Branch of the Median Nerve: A Morphometric Study. Surgical and Radiologic Anatomy, 26, 275-280. http://dx.doi.org/10.1007/s00276-004-0226-2
[4]	Cheung, J.W., Shyu, J.F., Teng, C.C., Chen, T.H., Su, C.H., Shyr, Y.M., Wang, J.J., Wu, C.W., Lui, W.Y. and Liu, J.C. (2004) The Anatomical Variations of the Palmar Cutaneous Branch of the Median Nerve in Chinese Adults. Journal of the Chinese Medical Association, 67, 27-31.
[5]	Das, S.K. and Brown H.G. (1976) In Search of Complications in Carpal Tunnel Decompression. Hand, 8, 243-249. http://dx.doi.org/10.1016/0072-968X(76)90009-7
[6]	DaSilva, M.F., Moore, D.C., Weiss, A.P.C., Akelman, E. and Sikirica, M. (1996) Anatomy of the Palmar Cutaneous Branch of the Median Nerve: Clinical Significance. The Journal of Hand Surgery: American Volume, 21, 639-643. http://dx.doi.org/10.1016/S0363-5023(96)80018-9
[7]	Hobbs, R.A., Magnussen, P.A. and Tonkin, M.A. (1990) Palmar Cutaneous Branch of the Median Nerve. The Journal of Hand Surgery: American Volume, 15, 38-43. http://dx.doi.org/10.1016/S0363-5023(09)91103-0
[8]	Louis, D.S., Greene, T.L. and Noellert, R.C. (1985) Complications of Carpal Tunnel Surgery. Journal of Neurosurgery, 62, 352-356. http://dx.doi.org/10.3171/jns.1985.62.3.0352
[9]	Matloub, H.S., Yan, J.G., Van Der Molen, A.B.M., Zhang, L.L. and Sanger, J.R. (1998) The Detailed Anatomy of the Palmar Cutaneous Nerves and Its Clinical Implications. The Journal of Hand Surgery: British & European Volume, 23, 373-379. http://dx.doi.org/10.1016/S0266-7681(98)80061-2
[10]	Naff, N., Dellon, A.L. and Mackinnon, S.E. (1993) The Anatomical Course of the Palmar Cutaneous Branch of the Median Nerve including a Description of Its Own Unique Tunnel. Journal of Hand Surgery, 18, 316-317. http://dx.doi.org/10.1016/0266-7681(93)90050-P
[11]	Taleisnik, J. (1973) The Palmar Cutaneous Branch of the Median Nerve and the Approach to the Carpal Tunnel: An Anatomical Study. Journal of Bone and Joint Surgery: American Volume, 55, 1212-1217.
[12]	Tagliafico, A., Pugliese, F., Bianchi, S., Bodner, G., Padua, L., Rubino, M. and Martinoli, C. (2008) High-Resolution Sonography of the Palmar Cutaneous Branch of the Median Nerve. American Journal of Roentgenology, 191, 107-114. http://dx.doi.org/10.2214/AJR.07.3383
[13]	McCann, P.A., Clarke, D., Amirfeyz, R. and Bhatia, R. (2012) The Cadaveric Anatomy of the Distal Radius: Implications for the Use of Volar Plates. Annals of the Royal College of Surgeons of England, 94, 116-120. http://dx.doi.org/10.1308/003588412X13171221501186
[14]	Olave, E., Del Sol, M., Gabriellp, C., Mandiola, E. and Rodrigues, C.F. (2001) Biometric Study of the Relationships between Palmar Neurovascular Structures, the Flexor Retinaculum and the Distal Wrist Crease. Journal of Anatomy, 198, 737-741. http://dx.doi.org/10.1046/j.1469-7580.2001.19860737.x
[15]	Kwiatkowska, M., Jakutowicz, T., Ciszek, B. and Czubak, J. (2014) Can Palmar Creases Serve as Landmarks for the Deeper Neuro-Vascular Structures? Surgical and Radiologic Anatomy, 36, 495-501. http://dx.doi.org/10.1007/s00276-013-1211-4
[16]	Bonnel, F., Mailhe, P., Allieu, Y. and Rabischong, P. (1980) Bases Anatomiques de la Chirurgie Fasciculaire du Nerf Median au Poignet. Annales de Chirurgie, 34, 707-710.
[17]	Bezerra, A.J., Carvalho, V.C. and Nucci, A. (1986) An Anatomical Study of the Palmar Cutaneous Branch of the Median Nerve. Surgical and Radiologic Anatomy, 8, 183-188. http://dx.doi.org/10.1007/BF02427847
[18]	Dowdy, P., Richards, R. and McFarlane, R. (1994) The Palmar Cutaneous Branch of the Median Nerve and the Palmaris Longus Tendon. A Cadaveric Study. Journal of Hand Surgery, 19A, 199-202. http://dx.doi.org/10.1016/0363-5023(94)90005-1
[19]	Alizadeh, K., Lahiji, F. and Phalsaphy, M. (2006) Safety of Carpal Tunnel Release with a Short Incision. A Cadaver Study. Acta Orthopaedica Belgica, 72, 415-419.
[20]	Ozcanli, H., Coskun, N.K., Cengiz, M., Oguz, N. and Sindel, M. (2010) Definition of a Safe-Zone in Open Carpal Tunnel Surgery: A Cadaver Study. Surgical and Radiologic Anatomy, 32, 203-206. http://dx.doi.org/10.1007/s00276-009-0498-7
[21]	McCann, P.A., Amirfeyz, R., Wakeley, C. and Bhatia, R. (2010) The Volar Anatomy of the Distal Radius—An MRI Study of the FCR Approach. Injury, 4, 1012-1014. http://dx.doi.org/10.1016/j.injury.2010.02.031
[22]	Born, T. and Mahoney, J. (1995) Cutaneous Distribution of the Ulnar Nerve in the Palm: Does It Cross the Incision Used in Carpal Tunnel Release? Annals of Plastic Surgery, 35, 23-25. http://dx.doi.org/10.1097/00000637-199507000-00005
[23]	Carare, et al. (2006) Personal Communication.