Sacha Wynter1, Lakal Dissabandara2. 1. School of Medicine, Griffith University, Gold Coast, 4215, Australia. 2. School of Medicine, Griffith University, Gold Coast, 4215, Australia. l.dissabandara@griffith.edu.au.
Abstract
PURPOSE: The objective of the present review is to assemble the recognized anatomical variations, classifications, and clinical evidence with regard to innervation of the hand and discuss the clinical significance of these variations. METHODS: The material for this review was obtained by exploring PubMed and Google Scholar (search terms: hand innervation, variations of ulnar nerve, variations of median nerve, variations of radial nerve) as well as from standard anatomy texts. This initial search returned approximately 300 articles, which was reduced by abstract or title review. Reviewing the reference lists of significant papers uncovered further studies missed in the initial search. A few standard anatomy texts were also consulted for normal anatomy. RESULTS: The median and ulnar nerves frequently display a number of significant deviations from the traditionally taught branching patterns. The traditionally taught innervation of the hand is also found to be highly variable. This is especially evident with regard to the motor innervation of thenar muscles. These variations may be explained by the often under-recognized anastomoses that exist in the hand, such as the motor Riche-Cannieu Anastomosis. Some of these variations are associated significant clinical consequences. CONCLUSIONS: The median and ulnar nerves display many anatomical variations, often with significant clinical implications. Awareness about these variations is clinically important when interpreting clinical examination findings, electrophysiological and radiological investigation as well as during management of patients in terms of surgical and anesthetic procedures.
PURPOSE: The objective of the present review is to assemble the recognized anatomical variations, classifications, and clinical evidence with regard to innervation of the hand and discuss the clinical significance of these variations. METHODS: The material for this review was obtained by exploring PubMed and Google Scholar (search terms: hand innervation, variations of ulnar nerve, variations of median nerve, variations of radial nerve) as well as from standard anatomy texts. This initial search returned approximately 300 articles, which was reduced by abstract or title review. Reviewing the reference lists of significant papers uncovered further studies missed in the initial search. A few standard anatomy texts were also consulted for normal anatomy. RESULTS: The median and ulnar nerves frequently display a number of significant deviations from the traditionally taught branching patterns. The traditionally taught innervation of the hand is also found to be highly variable. This is especially evident with regard to the motor innervation of thenar muscles. These variations may be explained by the often under-recognized anastomoses that exist in the hand, such as the motor Riche-Cannieu Anastomosis. Some of these variations are associated significant clinical consequences. CONCLUSIONS: The median and ulnar nerves display many anatomical variations, often with significant clinical implications. Awareness about these variations is clinically important when interpreting clinical examination findings, electrophysiological and radiological investigation as well as during management of patients in terms of surgical and anesthetic procedures.
Authors: Nicolette Driscoll; Brian Erickson; Brendan B Murphy; Andrew G Richardson; Gregory Robbins; Nicholas V Apollo; Georgios Mentzelopoulos; Tyler Mathis; Kanit Hantanasirisakul; Puneet Bagga; Sarah E Gullbrand; Matthew Sergison; Ravinder Reddy; John A Wolf; H Isaac Chen; Timothy H Lucas; Timothy R Dillingham; Kathryn A Davis; Yury Gogotsi; John D Medaglia; Flavia Vitale Journal: Sci Transl Med Date: 2021-09-22 Impact factor: 19.319
Authors: Michele R Colonna; Maria Piagkou; Andrea Monticelli; Cesare Tiengo; Franco Bassetto; Regina Sonda; Bruno Battiston; Paolo Titolo; Pierluigi Tos; Antonina Fazio; Alfio Luca Costa; Mariarosaria Galeano; Andrea Porzionato; Raffaele De Caro; Filippo Cucinotta; Nikolaos Anastasopoulos; Nikolaos A Papadopulos; Stefano Geuna; Konstantinos Natsis Journal: Hand (N Y) Date: 2020-12-21