The Anatomical Relationship Between the Dorsal Cutaneous Branch of the Ulnar Nerve and the Ulnar Styloid Process with Variations in Forearm Position

Jung, Hyung Suk; Lee, Yong Beom; Lee, Jae Sung

doi:10.1142/s2424835516500090

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…The DBUN crossed the ulna at a mean distance of 1.4 cm (range 0.6–2.5) proximal to the US (Le Corroller, 2013), and Uerpairojkit et al (2019) found the DBUN crossed the vertical axis through the US a median of 1.0 cm distal to the US and 14% crossed at the level of the tip of the US. Jung et al (2016) also found the DBUN crossed the ulna distal to the US and moved closer to the US in an ulnar‐radial direction with a forearm position change from supination to pronation.…”

Section: Resultsmentioning

confidence: 93%

“…The origin of the dorsal branch of the ulnar nerve (DBUN) from the ulnar nerve remained consistent in all studies, including in vivo, cadaveric studies, and ultrasound. Uerpairojkit et al (2019), Jung et al (2016), and Root et al (2013) noted that the DBUN originated 6.8, 4.92, and 5.1 cm proximal to the tip of the US, respectively, in cadaveric studies (Figure 2). In ultrasound studies on cadavers, Sulaiman et al (2013) noted that the DBUN originated 6.97 ± 2.39 cm proximal to the US.…”

Section: Resultsmentioning

confidence: 97%

“…Jung et al (2016) indicated a potential safe zone on the ulnar side of the wrist around the US when the forearm was in supination or a neutral position. However, multiple branches of the DBUN were identified by Tryfonidis et al (2010) and demonstrated in Figure 10B.…”

Section: Discussionmentioning

confidence: 99%

“…found on average 2 branches at the level of the distal ulnar articular surface and on average found 2.2 branches (range 1-4) 2 cm distal to the ulna articular surface. In 20 of 28 specimens (71%), a transverse branch of the DBUN to the distal radioulnar joint was present.The DBUN crossed the ulna at a mean distance of 1.4 cm (range 0.6-2.5) proximal to the US (Le Corroller, 2013), andUerpairojkit et al (2019) found the DBUN crossed the vertical axis through the US a median of 1.0 cm distal to the US and 14% crossed at the level of the tip of the US Jung et al (2016). also found the DBUN crossed the ulna distal to the US and moved closer to the US in an ulnar-radial direction with a forearm position change from supination to pronation.…”

mentioning

confidence: 99%

“…In 27 of 28 specimens, all longitudinal branches of the DBUN coursed between the dorsal-volar midline of the subcutaneous ulnar border and the pisotriquetral joint(Root et al, 2013). Incisions in this area should be avoided due to the high likelihood of a branch being present Jung et al (2016). indicated a potential safe zone on the ulnar side of the wrist around the US when the forearm was in supination or a neutral position.…”

mentioning

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: Resultsmentioning

confidence: 93%