Relationships of the palmar cutaneous branch of the median nerve: a morphometric study

• Published in: Surgical and radiologic anatomy (English ed.) Vol. 26; no. 4; pp. 275 - 280
• Main Authors: CHAYNES, P, BECUE, J, VAYSSE, P, LAUDE, M
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.08.2004; Springer Nature B.V
• Subjects: Biological and medical sciences; Carpal Tunnel Syndrome; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Decompression, Surgical; Dissection; Female; Hand - anatomy & histology; Humans; Male; Median Nerve; Medical sciences; Nervous system; Nervous system (semeiology, syndromes); Neurology; Surgery; Carpal tunnel syndrome; Nervous system diseases; Compression; Disease; Scar; Thumb; Diseases of the osteoarticular system; Sequela; Anatomy; Section; Base; Pressure relief; Symptomatology; Pain; Cutaneous nerve; Treatment; Characteristics; Surgery; Emergence; Median nerve; Anesthesia; Peripheral nerve disease; Lesion; Morphometry
• ISSN: 0930-1038; 1279-8517
• DOI: 10.1007/s00276-004-0226-2

Treatment of carpal tunnel syndrome consists in decompression of the median nerve by section of the flexor retinaculum. Usually, this surgery improves the disease with disappearance of the symptoms. However, some painful sequelae may remain such as painful discharges, paresthesiae or permanent anesthesia of the base of the thumb or of the scar related to an injury of the palmar cutaneous branch of the median nerve (PCBm). This study was performed to define the accurate emergence and the anatomic characteristics of this nerve in relation to stable landmarks. Moreover, it assessed the importance of the visual identification of the branch during section of the flexor retinaculum. Thirty-five hands were dissected under macroscopic examination and under magnification of the thinnest branches. Measurements were performed with a caliper and the forearm in supination. Determination of the bistyloid line showed variability in the location of the distal wrist crease. Thus, it could not be used as a landmark to locate the PCBm. The palmar cutaneous branch is the distal collateral branch of the median nerve in the forearm. It emerges on its radial side, on average 44.3 mm before the bistyloid line. It courses in line with the third finger and perforates the antebrachial aponeurosis about 5.7 mm from the bistyloid line. This emergence can be located in the palm, where it can be injured if the incision is performed in line with the third finger. The PCBm usually ends in the palm by division into two or three branches. The lateral branch supplies the skin of the thenar eminence while the medial, usually shorter branch supplies the midline part of the palm. This study has shown the importance of performing the cutaneous incision in line with the fourth finger to avoid injury to the PCBm.