Motor branches of the ulnar nerve to the forearm: an anatomical study and guidelines for selective neurectomy

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Citações na Scopus
22
Tipo de produção
article
Data de publicação
2015
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGER FRANCE
Autores
LECLERCQ, Caroline
Citação
SURGICAL AND RADIOLOGIC ANATOMY, v.37, n.9, p.1043-1048, 2015
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Purpose Precise knowledge of motor nerve branches is critical to plan selective neurectomies for the treatment of spastic limbs. Our objective is to describe the muscular branching pattern of the ulnar nerve in the forearm and suggest an ideal surgical approach for selective neurectomy of the flexor carpi ulnaris. Methods The ulnar nerve was dissected under loop magnification in 20 upper limbs of fresh frozen cadavers and its branches to the flexor carpi ulnaris muscle (FCU) and to the flexor digitorum profundus muscle (FDP) were quantified. We measured their diameter, length and distance between their origin and the medial epicondyle. The point where the ulnar artery joined the nerve was observed. The position in which the ulnar nerve gave off each branch was noted (ulnar, posterior or radial) and the Martin-Gruber connection, when present, had its origin observed and its diameter measured. Results The ulnar nerve gave off two to five muscular branches, among which, one to four to the FCU and one or two to the FDP. In all cases, the first branch was to the FCU. It arose on average 1.4 cm distal to the epicondyle, but in four specimens it arose above or at the level of the medial epicondyle (2.0 cm above in one case, 1.5 cm above in two cases, and at the level of the medial epicondyle in one). The first branch to the FDP arose on average 5.0 cm distal to the medial epicondyle. All the branches to FDP but one arose from the radial aspect of the ulnar nerve. A Martin-Gruber connection was present in nine cases. All motor branches arose in the proximal half of the forearm and the ulnar nerve did not give off branches distal to the point where it was joined by the ulnar artery. Conclusions The number of motor branches of the ulnar nerve to the FCU varies from 2 to 4. An ideal approach for selective neurectomy of the FCU should start 4 cm above the medial epicondyle, and extend distally to 50 % of the length of the forearm or just to the point where the ulnar artery joins the nerve.
Palavras-chave
Selective neurectomy, Branching patterns, Ulnar nerve, Spastic limb, Motor branches
URI
https://observatorio.fm.usp.br/handle/OPI/12561
Referências
  1. Decq P, 2000, NEUROSURGERY, V47, P1154, DOI 10.1097/00006123-200011000-00027
  2. Bhadra N, 1999, J HAND SURG-AM, V24A, P700, DOI 10.1053/jhsu.1999.0700
  3. Oh CS, 2009, MUSCLE NERVE, V39, P498, DOI 10.1002/mus.21281
  4. GARLAND DE, 1980, J BONE JOINT SURG AM, V62, P108
  5. Marur T, 2005, SURG RADIOL ANAT, V27, P322, DOI 10.1007/s00276-005-0325-8
  6. Contreras MG, 1998, CLIN ANAT, V11, P372, DOI 10.1002/(SICI)1098-2353(1998)11:6<372::AID-CA2>3.0.CO;2-R
  7. SUNDERLAND S, 1945, ANAT REC, V93, P317, DOI 10.1002/ar.1090930402
  8. KEENAN MAE, 1987, J HAND SURG-AM, V12A, P734
  9. Tubbs RS, 2006, J NEUROSURG, V104, P800, DOI 10.3171/jns.2006.104.5.800
  10. GUTMANN L, 1993, MUSCLE NERVE, V16, P339, DOI 10.1002/mus.880160402
  11. WATCHMAKER GP, 1994, J HAND SURG-AM, V19A, P915, DOI 10.1016/0363-5023(94)90090-6
  12. Gonzalez MH, 2001, J HAND SURG-BRIT EUR, V26, P142, DOI 10.1054/jhsb.2000.0532
  13. [Anonymous], 1995, CURR ORTHOPAED, DOI 10.1016/0268-0890(95)90012-8
  14. NAKASHIMA T, 1993, SURG RADIOL ANAT, V15, P193, DOI 10.1007/BF01627703
  15. SUNDERLAND S, 1946, J COMP NEUROL, V85, P113, DOI 10.1002/cne.900850109
  16. Lepage D, 2005, SURG RADIOL ANAT, V27, P420, DOI 10.1007/s00276-005-0012-9
  17. Leclercq C, 2003, HAND CLIN, V19, P557, DOI 10.1016/S0749-0712(03)00059-3
  18. SRINIVASAN R, 1981, ARCH NEUROL-CHICAGO, V38, P418
  19. Backhouse KM, 1981, HAND, V1, P275
  20. Bergman RA, 2006, ULNAR NERVE
  21. Botte MJ, 2003, SURG ANATOMY HAND UP, P185
  22. BRUNELLI G, 1983, Microsurgery, V4, P221, DOI 10.1002/micr.1920040404
  23. Cambon-Binder A, 2015, SURG RADIOL ANAT, V37, P341, DOI 10.1007/s00276-014-1371-x
  24. Carlson MG, 2011, GREENS OPERATIVE HAN, P1139
  25. Gruber W, 1870, ARCH ANAT PHYSL WISS, V37, P501
  26. LEIBOVIC SJ, 1992, J HAND SURG-AM, V17A, P47, DOI 10.1016/0363-5023(92)90112-3
  27. Puligopu AK, 2011, J PEDIAT NEUROSCI S1, V6, P118
  28. Rodriguez-Niedenführ Marc, 2002, Clin Anat, V15, P129, DOI 10.1002/ca.1107
  29. Shu HS, 1997, SURG RADIOL ANAT, V21, P115
  30. Stoffel A, 1912, AM J ORTHOP SURG, V10, P611
  31. Taams KO, 1997, J HAND SURG-BRIT EUR, V22B, P328, DOI 10.1016/S0266-7681(97)80396-8
  32. Unver Dogan N, 2010, SURG RADIOL ANAT, V32, P225
  33. Williams PL, 1999, GRAYS ANATOMY, P1270

Coleções
Artigos e Materiais de Revistas Científicas - HC/IOT