Topographic Localization of the Motor Branch of the Median Nerve

Eskandari, Metin Manouchehr; Yılmaz, Cengiz; Öztuna, Volkan; Kuyurtar, Fehmi

doi:10.1016/j.jhsa.2005.03.010

Cited by 11 publications

(23 citation statements)

References 17 publications

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“…The included study characteristics are summarized in Table 1 , which contains the prevalence data on TMB variations as reported and described in each individual study. A total of 31 studies (n = 3918 hands) were included in the meta-analysis, with 6 intraoperative studies [ 1 , 6 , 7 , 10 , 20 , 22 ], 23 cadaveric studies [ 2 , 3 , 8 , 9 , 16 – 19 , 21 , 23 – 36 ] and 1 study [ 37 ] which included both a cadaveric and an intraoperative study group, which for the purposes of this analysis was analyzed as two individual studies. The study with both cadaveric and intraoperative groups by Tountas et al [ 37 ], contained two separate intraoperative groups—a prospective group and a retrospective group, of which only the prospective data was included in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 27 studies (n = 3506 hands), 21 cadaveric [ 2 , 3 , 8 , 9 , 16 , 17 , 19 , 21 , 23 , 24 , 26 – 29 , 31 – 37 ] and 6 intraoperative [ 6 , 7 , 10 , 20 , 22 , 37 ], reported prevalence data on the course of the TMB. The most common course of the TMB was extraligamentous, with a pooled prevalence of 75.2% (95% CI: 55.4%- 84.7%).…”

Section: Resultsmentioning

confidence: 99%

“…In the subgroup analysis of the 21 cadaveric studies only (n = 1250 hands) [ 2 , 3 , 8 , 9 , 16 , 17 , 19 , 21 , 23 , 24 , 26 – 29 , 31 – 37 ], the pooled prevalence of extraligamenous ( Fig 4A ), subligamentous ( Fig 4B ), and transligamentous ( Fig 4C ) types were 76.4% (95% CI: 63.9%- 81.1%), 11.4% (95% CI: 5.5%- 7.7%), and 12.2% (95% CI: 6.1%- 18.6%), respectively (Cochran's Q, p = 0.000; I 2 = 91.2%, 95% CI: 88.0%- 93.6%). In the subgroup analysis of the 6 intraoperative studies (n = 2256) [ 6 , 7 , 10 , 20 , 22 , 37 ], the pooled prevalence of extraligamenous ( Fig 5A ), subligamentous ( Fig 5B ), and transligamentous ( Fig 5C ) types were 66.8% (95% CI: 21.0%- 100%), 24.5% (95% CI: 0%- 65.8%), and 8.7% (95% CI: 0%- 40.9%), respectively (Cochran's Q, p = 0.000; I 2 = 99.6%; 95% CI: 99.5%- 99.7%).…”

Section: Resultsmentioning

confidence: 99%

“…In the subgroup of 7 European studies (n = 611 hands) [ 3 , 8 , 9 , 17 , 20 , 22 , 28 ] the pooled prevalence of extraligamentous, subligamentous, and transligamentous courses were 63.7% (95% CI: 44.3%- 77.8%), 24.6% (95% CI: 10.5%- 40.2%), and 11.7% (95% CI: 2.3%- 24.9%), respectively (Cochran's Q, p = 0.000; I 2 = 94.3%, 95% CI: 90.5%- 96.5%). While in the subgroup of 8 Asian studies (n = 747 hands) [ 2 , 6 , 7 , 16 , 31 , 33 , 34 , 36 ], the pooled prevalence of extraligamentous, subligamentous, and transligamentous courses were 78.7% (95% CI: 54.7%- 90.1%), 12.6% (95% CI: 1.5%- 28.5%), and 8.7% (95% CI: 0.1%- 23.4%), respectively (Cochran's Q, p = 0.000; I 2 = 96.1%, 95% CI: 94.0%- 97.4%).…”

Section: Resultsmentioning

confidence: 99%

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The Prevalence of Anatomical Variations of the Median Nerve in the Carpal Tunnel: A Systematic Review and Meta-Analysis

et al. 2015

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Background and ObjectiveThe course and branches of the median nerve (MN) in the wrist vary widely among the population. Due to significant differences in the reported prevalence of such variations, extensive knowledge on the anatomy of the MN is essential to avoid iatrogenic nerve injury. Our aim was to determine the prevalence rates of anatomical variations of the MN in the carpal tunnel and the most common course patterns and variations in its thenar motor branch (TMB).Study DesignA systematic search of all major databases was performed to identify articles that studied the prevalence of MN variations in the carpal tunnel and the TMB. No date or language restrictions were set. Extracted data was classified according to Lanz's classification system: variations in the course of the single TMB—extraligamentous, subligamentous, and transligamentous (type 1); accessory branches of the MN at the distal carpal tunnel (type 2); high division of the MN (type 3); and the MN and its accessory branches proximal to the carpal tunnel (type 4). Pooled prevalence rates were calculated using MetaXL 2.0.ResultsThirty-one studies (n = 3918 hands) were included in the meta-analysis. The pooled prevalence rates of the extraligamentous, subligamentous, and transligamentous courses were 75.2% (95%CI:55.4%-84.7%), 13.5% (95%CI:3.6%-25.7%), and 11.3% (95%CI:2.4%-23.0%), respectively. The prevalence of Lanz group 2, 3, and 4 were 4.6% (95%CI:1.6%-9.1%), 2.6% (95%CI:0.1%-2.8%), and 2.3% (95%CI:0.3%-5.6%), respectively. Ulnar side of branching of the TMB was found in 2.1% (95%CI:0.9%-3.6%) of hands. The prevalence of hypertrophic thenar muscles over the transverse carpal ligament was 18.2% (95%CI:6.8%-33.0%). A transligamentous course of the TMB was more commonly found in hands with hypertrophic thenar muscles (23.4%, 95%CI:5.0%-43.4%) compared to those without hypertrophic musculature (1.7%, 95%CI:0%-100%). In four studies (n = 423 hands), identical bilateral course of the TMB was found in 72.3% (95%CI:58.4%-84.4%) of patients.ConclusionsAnatomical variations in the course of the TMB and the MN in the carpal tunnel are common in the population. Thus, we recommend an ulnar side approach to carpal tunnel release, with a careful layer by layer dissection, to avoid iatrogenic damage to the TMB.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The Prevalence of Anatomical Variations of the Median Nerve in the Carpal Tunnel: A Systematic Review and Meta-Analysis

et al. 2015

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“…A recently published article also analyzed the MBMN and its relation to KCL. 17 The investigators reported similar results in that the MBMN was consistently located proximal and ulnar to KCL and its intersection with a longitudinal line from the second web space. Our study corroborates their conclusion that the MBMN is closer to carpal tunnel incisions than KCL would estimate.…”

Section: Discussionmentioning

confidence: 68%

Kaplan’s Cardinal Line

Vella

Hartigan

Stern

2006

The Journal of Hand Surgery

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High-resolution ultrasound visualization of the recurrent motor branch of the median nerve: normal and first pathological findings

et al. 2016

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PurposeTo evaluate in a prospective study the possibility of visualization and diagnostic assessment of the recurrent motor branch (RMB) of the median nerve with high-resolution ultrasound (HRUS).Materials and methodsHRUS with high-frequency probes (18–22 MhZ) was used to locate the RMB in eight fresh cadaveric hands. To verify correct identification, ink-marking and consecutive dissection were performed. Measurement of the RMB maximum transverse-diameter, an evaluation of the origin from the median nerve and its course in relation to the transverse carpal ligament, was performed in both hands of ten healthy volunteers (n = 20). Cases referred for HRUS examinations for suspected RMB lesions were also assessed.ResultsThe RMB was clearly visible in all anatomical specimens and all volunteers. Dissection confirmed HRUS findings in all anatomical specimens. Mean RMB diameter in volunteers was 0.7 mm ± 0.1 (range, 0.6–1). The RMB originated from the radial aspect in 11 (55%), central aspect in eight (40%) and ulnar aspect in one (5%) hand. Nineteen (95%) extraligamentous courses and one (5%) subligamentous course were detected. Three patients with visible RMB abnormalities on HRUS were identified.ConclusionHRUS is able to reliably visualize the RMB, its variations and pathologies.Key Points• Ultrasound allows visualization of the recurrent motor branch of the median nerve.• Ultrasound may help clinicians to assess patients with recurrent motor branch pathologies.• Patient management may become more appropriate and targeted therapy could be improved.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4671-1) contains supplementary material, which is available to authorized users.

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Topographic Localization of the Motor Branch of the Median Nerve

Cited by 11 publications

References 17 publications

The Prevalence of Anatomical Variations of the Median Nerve in the Carpal Tunnel: A Systematic Review and Meta-Analysis

The Prevalence of Anatomical Variations of the Median Nerve in the Carpal Tunnel: A Systematic Review and Meta-Analysis

Kaplan’s Cardinal Line

High-resolution ultrasound visualization of the recurrent motor branch of the median nerve: normal and first pathological findings

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