Thenmozhi, M D (2010) The Palmar Cutaneous Branch of Median Nerve - Its Clinical importance in Carpal Tunnel Release: A Cadaver study. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the median nerve at the wrist. In patients with carpal tunnel syndrome, the median nerve under the flexor retinaculum is tightly packed with the long flexor tendons of the fingers with their surrounding synovial sheaths. The decompression of median nerve by sectioning the transverse carpal ligament (flexor retinaculum) is well accepted as the treatment of choice for patients with carpal tunnel syndrome. It is assumed that most of the postoperative complications are due to injuries to the distal branches of the median nerve. The palmar cutaneous branch of the median nerve was one of the main branches of median nerve that can easily get injured during open carpal tunnel release. The precise zone of sensation in the palm is difficult to define, due to the extensive overlap of sensory supply from the main median nerve. The evolution of the technique of carpal tunnel release reflects growing awareness of the cutaneous innervations of the palm and its implication on postoperative scar tenderness. AIMS OF THE STUDY: 1. To study and trace the anatomic course of palmar cutaneous branch of the median nerve. 2. To analyze the variations of palmar cutaneous branch of the median nerve. 3. To assess the other sensory nerve contributions to the palm. 4. To analyze the post operative sequelae following accidental division of palmar cutaneous branch of median nerve in carpal tunnel release. MATERIALS AND METHODS: 24 hands of 12 cadavers were dissected. The incision was made from mid-forearm, extending vertically up to distal wrist crease. The incision turned towards the ulnar half of ring finger up to distal palmar crease. Then the incision turned towards the ulnar aspect of thumb. The incision was deepened. The palmar cutaneous branch of median nerve was traced from midforearm and traced along its course. The median nerve was identified between the tendon of flexor Carpi radialis and Palmaris longus (PL) and then was picked up. Each PCN was identified using blunt dissection, and was traced proximally to its intraneural origin from the median nerve. Each PCBMN was then carefully dissected distally, dividing the skin overlying its course and tracing individual branches radially, and towards the ulnar side until its termination in the undersurface of the skin. The variations and other sensory nerve contributions were noted. The findings were recorded, photographed and tabulated. CONCLUSIONS: Palmar Cutaneous branch of Median nerve is not a myth. • But it is not present as it is described in text books. • It is not a constant branch of Median nerve. • It could be absent unilaterally or bilaterally. • Our dissections show that PCBMN supplies mainly thenar eminence. • So, accidental division of Palmar Cutaneous Branch of Median Nerve may not cause sensory loss in the palm as there are additional contributions from branches from median nerve and common digital nerves.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Palmar Cutaneous Branch of Median Nerve, Clinical importance, Carpal Tunnel Release, A Cadaver study. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2020 03:50 |
| Last Modified: | 15 Feb 2020 01:57 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11930 |
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