Hand fasciae innervation: The palmar aponeurosis

Stecco, Carla; Macchi, Veronica; Barbieri, Alessandro; Tiengo, Cesare; Porzionato, Andrea; De, Raffaele

doi:10.1002/ca.23076

Cited by 22 publications

(32 citation statements)

References 30 publications

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“…The choice of anti-S100 as neuronal marker permitted to obtain good reactions even in the cadaver samples, being fully comparable with those from living patients. [22][23][24] In fact, nerve elements were observed in all samples analyzed, and the anti-S100 reaction for myelin-forming Schwann cells showed the same innervation trend in both living patients and cadavers (Figure 1): the t-test between them did not produce any significant differences for any tissue (data not shown).…”

Section: Resultsmentioning

confidence: 81%

“…The thin but huge network of nerve fibers in all directions confirms its probable role in proprioception, due to the capacity to perceive variations of tension in a complex tridimensionality, integrating signals from longitudinal, transversal and vertical axes. 23 Mense and coauthors 35,36 have repeatedly stated that the deep fascia has a dense sensory nervous network, including nociceptive fibers, and also affirmed that the lack of proprioceptive corpuscular receptors in the thoracolumbar fascia does not preclude its role as a proprioceptive structure, because some free nerve endings may function as proprioceptors. Hoheisel et al 35 Our results show that it is important to preserve fascial structures carefully during hip surgery.…”

Section: Discussionmentioning

confidence: 99%

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Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, deep fascia, muscles, capsule, capsule ligament, ligamentum teres, and tendon in the human hip from 11 patients and 2 cadavers were quantified by staining with anti‐S100 antibody for myelin‐forming Schwann cells, to obtain the percentage of antibody positivity, density and mean diameter of the nerve fibers. The skin was the most highly innervated (0.73% ± 0.37% of positive area in patients; 0.80% ± 0.28% in cadavers); the tendon was the least innervated (0.07% ± 0.01% in patients, 0.07% ± 0.007% in cadavers). The muscles (vasto‐lateral and gluteus medius) were the second most innervated structure according the percentage (0.31% ± 0.13% in living humans, 0.30% ± 0.07% in cadavers), but with only a few nerves, with large diameters (mean diameter 36.4 ± 13.4 µm). Instead, the superficial fasciae showed 0.22% ± 0.06% and 0.26% ± 0.05% of positive areas in living humans and cadavers, respectively. Fasciae were invaded by networks of small nerve fibers, revealing a possible role in pain. The superficial fascia was the second most highly innervated tissue after the skin, with a density of 33.0 ± 2.5/cm2, and a mean nerve sizes of 19.1 ± 7.2 µm. Lastly, the capsule turned out to be poorly innervated (0.09%), showing that its removal does not necessarily lead to painful consequences. Statement of clinical significance: Deeper knowledge about the innervation of the soft tissue in the human hip joint will enhance study and understanding of the best surgical procedures to follow during hip arthroplasty to reduce post‐operative pain.

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Section: Resultsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fede

Porzionato

Petrelli

et al. 2020

Journal Orthopaedic Research

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“…This study also confirms the absence of mechanoreceptors, like Pacini and Ruffini corpuscles, in the thoracolumbar fascia and gluteal fascia, as already demonstrated by Tesarz et al 7 . It is probable that these receptors are usually localized in the superficial adipose tissue and superficial fascia, with the function of perceiving mechanical stimuli 6 , and where the superficial fascia joints the deep fascia, as in the retinacula surrounding joints, in the palmar and plantar fascia [18][19][20][21] , to increase the proprioception of these areas.…”

Section: Discussionmentioning

confidence: 99%

Evidence of a new hidden neural network into deep fasciae

Fede

Petrelli

Guidolin

et al. 2021

Sci Rep

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It is recognized that different fasciae have different type of innervation, but actually nothing is known about the specific innervation of the two types of deep fascia, aponeurotic and epymisial fascia. In this work the aponeurotic thoracolumbar fascia and the epymisial gluteal fascia of seven adult C57-BL mice were analysed by Transmission Electron Microscopy and floating immunohistochemistry with the aim to study the organization of nerve fibers, the presence of nerve corpuscles and the amount of autonomic innervation. The antibodies used were Anti-S100, Anti-Tyrosine Hydroxylase and Anti-PGP, specific for the Schwann cells forming myelin, the sympathetic nerve fibers, and the peripheral nerve fibers, respectively. The results showed that the fascial tissue is pervaded by a rhomboid and dense network of nerves. The innervation was statistically significantly lower in the gluteal fascia (2.78 ± 0.6% of positive area, 140.3 ± 31.6/mm2 branching points, nerves with 3.2 ± 0.6 mm length and 4.9 ± 0.2 µm thickness) with respect to the thoracolumbar fascia (9.01 ± 0.98% of innervated area, 500.9 ± 43.1 branching points/mm2, length of 87.1 ± 1.0 mm, thickness of 5.8 ± 0.2 µm). Both fasciae revealed the same density of autonomic nerve fibers (0.08%). Lastly, corpuscles were not found in thoracolumbar fascia. Based on these results, it is suggested that the two fasciae have different roles in proprioception and pain perception: the free nerve endings inside thoracolumbar fascia may function as proprioceptors, regulating the tensions coming from associated muscles and having a role in nonspecific low back pain, whereas the epymisial fasciae works to coordinate the actions of the various motor units of the underlying muscle.

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“…Loss of the 4th web space CDN without median sensory recovery would further impair hand function. This results in comparably greater deficits, as the palmar sensation of the fingers and palmar proprioception contribute to the function of the digits and overall function of the hand (Stecco et al, ). Neurotization priority is therefore given to the CDN to the 1st palmar web space to help re‐establish functional pinch and grip.…”

Section: Discussionmentioning

confidence: 99%

Transfer of the Dorsal Cutaneous Branch of the Ulnar Nerve for Restoration of Median Nerve Sensation: A Cadaveric Study

et al. 2018

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The use of dorsal cutaneous branch of the ulnar nerve (DCBUN) transfer for median nerve (MN) sensory restoration has not been evaluated anatomically and histologically in humans. The purpose of this study was to evaluate the feasibility of DCBUN to MN transfer for sensory restoration with respect to nerve branch pattern, length, and fascicle count match.Using seven fresh frozen cadaveric upper limb specimens, the DCBUN and its branch patterns, lengths, and sizes were recorded. The MN was exposed within the carpal tunnel and dissected distally to identify the common digital nerves (CDN). Simulated nerve transfer was performed with palmar coaptation of the DCBUN branches with the CDNs. Histological analysis of each nerve branch was performed. The seven specimens had a mean of 3.57 branches (range 2-4) off the DCBUN. The longest branch innervated the dorsal 4th web space, on average reaching 7.6 cm distal to the wrist crease. Transferring the DCBUN branches palmarly did not substantially change their maximum distance distal to the wrist crease. The MN CDNs and DCBUN branches had mean cross-sectional areas of 6.37 and 1.99 mm , respectively, and mean fascicle counts of 10.4 and 4.05, respectively. The DCBUN provides 2-4 branches suitable for tension-free end-to-end transfer to the MN CDNs. The individual size of the DCBUN branch is smaller than CDN; however, combining two or more branches of the DCBUN would overcome the fascicle and size mismatch to reconstruct the 1st web space CDN for critical sensory restoration. Clin. Anat. 31:1006-1012, 2018. © 2018 Wiley Periodicals, Inc.

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Hand fasciae innervation: The palmar aponeurosis

Cited by 22 publications

References 30 publications

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

Evidence of a new hidden neural network into deep fasciae

Transfer of the Dorsal Cutaneous Branch of the Ulnar Nerve for Restoration of Median Nerve Sensation: A Cadaveric Study

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