The anatomical landmarks effective in the localisation of the median nerve during orthopaedic procedures

Mizia, Ewa; Pękala, Przemysław A.; Skinningsrud, Bendik; Rutowicz, Bartosz; Piekos, Patryk; Baginski, A.; Tomaszewski, Krzysztof A.

doi:10.5603/fm.a2020.0049

Cited by 5 publications

(6 citation statements)

References 24 publications

(31 reference statements)

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“…In a study with 10 cadaveric specimens, McCann et al (2012) identified the main trunk of the median nerve to be on average 0.89 cm (SD = ± 0.56 cm) ulnar to the flexor carpi radialis (FCR) tendon measured from the center of the two structures at the level of the watershed line of the distal radius. Mizia et al (2021) confirmed a similar distance (0.79 cm CI = 0.74-0.84) from the main trunk of the median nerve to the FCR tendon measured at the level of the proximal flexor retinaculum.…”

Section: Median Nervesupporting

confidence: 78%

“…The palmar cutaneous branch of the median nerve (PCBMN) was located on average 0.34 cm (SD = 0.27 cm) from the FCR tendon measured from the center of the two structures at the level of the watershed line of the distal radius (McCann et al, 2012). Using ultrasound in 114 upper limbs of healthy volunteers, the median nerve was located at an average distance of 0.79 cm (95% CI: 0.74–0.84) ulnar to the FCR at the level of the proximal flexor retinaculum (Mizia et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Bridgwater,

Mertz,

Brassett

et al. 2023

Clinical Anatomy

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Three commonly used approaches to the forearm in orthopedic surgery are Henry's, Thompson's, and the ulnar approach, each of which has the potential to cause injury to nerves around the wrist. Preserving these nerves is important to prevent complications such as neuroma formation and motor and sensory changes to the hand. We conducted a review of the literature to assess the nerves at risk and whether ‘safe zones’ exist to avoid these nerves. An independent reviewer conducted searches in Embase and MEDLINE of the literature from 2010 to 2020. A total of 68 papers were identified, with 18 articles being included in the review. Multiple nerves were identified as being at risk for each of the approaches described. In the anterior approach, the palmar cutaneous branch of the median nerve (PCBMN) is most at risk of injury. An incision immediately radial to the flexor carpi radialis (FCR) or directly over the FCR is most likely to avoid injury to both superficial branch of the radial nerve (SBRN) and PCBMN. With Thompson's approach, the safest zone for an incision is directly over or slightly radial to Lister's tubercle to avoid injury to SBRN and lateral cutaneous nerve of the forearm. For the ulnar approach, a safe zone was shown to be on the ulnar side of the wrist around the ulnar styloid (US) when the forearm was in supination or a neutral position to avoid injury to the dorsal branch of the ulna nerve (DBUN). Care must be taken around the US due to the density of nerves and the proximity of the last motor branch of the posterior interosseous nerve to the ulnar head. This review highlighted the proximity of nerves to the three most common surgical incisions used to access the forearm. In addition, anatomical variations may exist, and each of the nerves identified as being at risk has multiple branches. Both factors increase the potential of intraoperative damage if the anatomy is not properly understood. The surgeon must adhere carefully to the established approaches to the wrist and distal forearm to minimize damage to nerves and optimize surgical outcomes for the patient.

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Section: Median Nervesupporting

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Bridgwater,

Mertz,

Brassett

et al. 2023

Clinical Anatomy

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“…Incisions induced painful scars that may also present after surgical release [19]. For surgical incision making, one group reported an anatomical safe space to avoid iatrogenic injury by palpating and measuring the distance between the flexor carpi radialis and flexor carpi ulnaris tendon [20]. Our entry and exit points described before are all located in this safe area.…”

Section: Plos Onementioning

confidence: 83%

A clinical study of thread carpal tunnel release with a newly developed thread: A retrospective pilot study

Park

Kim²,

Park³

et al. 2022

PLoS ONE

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Introduction Previous studies have shown that, thread carpal tunnel release (TCTR), an ultrasound-guided transverse carpal ligament (TCL) transection procedure through needle and thread, to be a safe and effective technique for carpal tunnel release, compared to an open and endoscopic technique. We developed a newly improved thread (Smartwire-01, 0.27mm in diameter, Korea). This pilot study was performed to propose the effectiveness of TCTR with Smartwire-01 compared to the commercial thread in clinical settings. Methods A total of 22 TCTR procedures have been performed on 19 patients by one physiatrist during a 42-month period. The diagnosis of carpal tunnel syndrome was based on standard clinical criteria including electromyography (EMG). Patients were divided into two groups, one dissected with commercial thread and the other with Smartwire-01. The technique was standardized by keeping the entry point at the middle of the palm and the exit point at just medial to the palmaris longus tendon. The Numeric Rating Scale and Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were used to assess monthly outcomes for 6 months following the procedure. The Wilcoxon signed rank test and the Mann-Whitney-U test were performed to analyze the above variables in the two groups. Results There was no definite evidence that the two groups have significant differences for any of the surveyed variables. The TCTR procedure with our newly developed thread also had significant improvements for all variables, showing its effectiveness in both pain and functional ability. The NRS and BCTQ severity and functional scales showed significant decreases just after the dissection and progressive improvement during each monthly follow-up of our study until the last assessment at 6 months. Conclusion The study suggests that, our newly developed thread is as safe and effective as the commercial thread in TCTR, we therefore recommend a randomize controlled trial with above methodology.

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“…Some researchers suggest that the FCU is an important anatomical landmark for surgeons and ultrasonographers. Knowledge of the variability of the terminal segment of this muscle is therefore not only of cognitive importance but also of profound clinical significance (Mizia et al 2021).…”

Section: Discussionmentioning

confidence: 99%

Anatomical variations of the flexor carpi ulnaris in the fetal period

Siwek

Krupa

Mrożek

et al. 2023

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Introduction: The Flexor Carpi Ulnaris (FCU) is a part of the palmar the forearm muscle group and one of the most important muscles for upper limb functioning - is responsible for flexion and adduction of the hand at the radio-carpal joint. There are clinically significant but rare anatomical variations of FCU. The variability of the FCU has not been described up to now, and no typology of the muscle based on its more variable terminal attachment has been created. Aim of the study: Determination of FCU muscle typology based on available fetal material. Material and methods: A total of 114 human fetuses (53 female, 61 male) between 117 and 197 days of fetal life were eligible for the study. Preparations were carried out using classical anatomical techniques based on a previously published procedure. Thanks to that significant anthropometric landmarks were visible for the gathering of metric measurements. Metric measurements were taken and statistically analysed using R-Project software. Results: A new typology was created based on variable muscle insertions. Additionally, the presence of an atypically located, additional, separated muscle belly was described. A comparison of measurements of the left upper limb in relation to the right upper limb showed significant differences for forearm length to the anthropometric point of the stylion radiale, limb length, total FCU length and FCU length which means that the left limb is longer than the right limb. A comparison of FCU insertion types between left and right upper limb showed there’s no significant difference between counts of each type. Conclusion: The FCU is a muscle that is easy to palpate and may therefore act as a topographical marker for healthcare professionals. Knowledge of its variability is not only of theoretical importance but also has clinical significance. The current publication demonstrates presence of variability in FCU terminal attachment. Certainly, this topic requires further research and continued work on a detailed understanding of forearm anatomy in the fetal period.

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The anatomical landmarks effective in the localisation of the median nerve during orthopaedic procedures

Cited by 5 publications

References 24 publications

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

A clinical study of thread carpal tunnel release with a newly developed thread: A retrospective pilot study

Anatomical variations of the flexor carpi ulnaris in the fetal period

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