Anatomical Variants of the Upper Limb Nerves: Clinical and Preoperative Relevance

Overview

Journal Semin Musculoskelet Radiol

Publisher Thieme

Specialties Orthopedics
Physiology
Radiology

Date 2023 Apr 3

PMID 37011614

Authors

Christoph Schwabl

Romed Hormann

Carola Johanna Strolz

Elena Drakonaki

Robert Zimmermann

Andrea Sabine Klauser

Affiliations

Soon will be listed here.

Abstract

Profound knowledge of nerve variations is essential for clinical practice. It is crucial for interpreting the large variability of a patient's clinical presentation and the different mechanisms of nerve injury. Awareness of nerve variations facilitates surgical safety and efficacy. Clinically significant anatomical variations can be classified into two main groups: variability in the course of the nerve and variability of structures surrounding the nerve. In this review article we focus on the most common nerve variants of the upper extremity and their clinical relevance.

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References

Hunter D, Skrzat J, Zdilla M . Bilateral absence of the musculocutaneous nerve: implications for humerus fracture and atypical median nerve palsy. Folia Med Cracov. 2021; 60(3):27-32. DOI: 10.24425/fmc.2020.135793. View

Guerri-Guttenberg R, Ingolotti M . Classifying musculocutaneous nerve variations. Clin Anat. 2009; 22(6):671-83. DOI: 10.1002/ca.20828. View

Olewnik L, Zielinska N, Karauda P, Duparc F, Georgiev G, Polguj M . The co-occurrence of a four-headed coracobrachialis muscle, split coracoid process and tunnel for the median and musculocutaneous nerves: the potential clinical relevance of a very rare variation. Surg Radiol Anat. 2020; 43(5):661-669. PMC: 8105253. DOI: 10.1007/s00276-020-02580-x. View

Granata G, Caliandro P, Pazzaglia C, Minciotti I, Russo G, Martinoli C . Prevalence of bifid median nerve at wrist assessed through ultrasound. Neurol Sci. 2011; 32(4):615-8. DOI: 10.1007/s10072-011-0582-8. View

Sur A, Sinha M, Ughade J . Prevalence of Martin-Gruber Anastomosis in Healthy Subjects: An Electrophysiological Study from Raigarh, Chhattisgarh. Neurol India. 2021; 69(4):950-955. DOI: 10.4103/0028-3886.325369. View

Suwannakhan A, Chaiyamoon A, Yammine K, Yurasakpong L, Janta S, Limpanuparb T . The prevalence of anconeus epitrochlearis muscle and Osborne's ligament in cubital tunnel syndrome patients and healthy individuals: An anatomical study with meta-analysis. Surgeon. 2021; 19(6):e402-e411. DOI: 10.1016/j.surge.2020.12.006. View

Welle K, Prangenberg C, Hackenberg R, Gathen M, Dehghani F, Kabir K . Surgical Anatomy of the Radial Nerve at the Dorsal Region of the Humerus: A Cadaveric Study. J Bone Joint Surg Am. 2022; 104(13):1172-1178. DOI: 10.2106/JBJS.21.00482. View

Guru A, Kumar N, Shanthakumar S, Patil J, Badagabettu S, Padur A . Anatomical Study of the Ulnar Nerve Variations at High Humeral Level and Their Possible Clinical and Diagnostic Implications. Anat Res Int. 2015; 2015:378063. PMC: 4515264. DOI: 10.1155/2015/378063. View

Sapage R, Pereira P, Vital L, Madeira M, Pinho A . Surgical anatomy of the radial nerve in the arm: a cadaver study. Eur J Orthop Surg Traumatol. 2021; 31(7):1457-1462. DOI: 10.1007/s00590-021-02916-2. View

10.

Klauser A, Faschingbauer R, Bauer T, Wick M, Gabl M, Arora R . Entrapment neuropathies II: carpal tunnel syndrome. Semin Musculoskelet Radiol. 2010; 14(5):487-500. DOI: 10.1055/s-0030-1268069. View

11.

Veltre D, Naito K, Li X, Stein A . Aberrant positioning of the ulnar nerve found during carpal tunnel release: A case report. Orthop Rev (Pavia). 2019; 11(3):7795. PMC: 6776921. DOI: 10.4081/or.2019.7795. View

12.

Athlani L, Delgove A, Dautel G, Casoli V . Anatomy of the ulnar nerve in the posterior compartment of the upper arm: Relationships with the triceps brachii muscle. Morphologie. 2020; 104(345):85-90. DOI: 10.1016/j.morpho.2019.11.001. View

13.

Granger A, Sardi J, Iwanaga J, Wilson T, Yang L, Loukas M . Osborne's Ligament: A Review of its History, Anatomy, and Surgical Importance. Cureus. 2017; 9(3):e1080. PMC: 5383373. DOI: 10.7759/cureus.1080. View

14.

Kadar I, Virag T, Matei I, Georgescu A . High Division of the Median Nerve with Unusually High Origin of the 3rd Space Common Digital Nerve. Injury. 2020; 51 Suppl 4:S96-S102. DOI: 10.1016/j.injury.2020.03.024. View

15.

Noh J, Park J, Kwon H . Palmar Digital Neuropathy With Anatomical Variation of Median Nerve: Usefulness of Orthodromic Technique: A Case Report. Ann Rehabil Med. 2019; 43(3):341-346. PMC: 6637065. DOI: 10.5535/arm.2019.43.3.341. View

16.

Kowalska B, Sudol-Szopinska I . Ultrasound assessment of selected peripheral nerves pathologies. Part II: Entrapment neuropathies of the lower limb. J Ultrason. 2015; 12(51):463-71. PMC: 4603240. DOI: 10.15557/JoU.2012.0033. View

17.

Karatas A, Apaydin N, Uz A, Tubbs R, Tubbs S, Loukas M . Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. J Shoulder Elbow Surg. 2009; 18(4):627-31. DOI: 10.1016/j.jse.2009.03.004. View

18.

Le Minor J . [A rare variation of the median and musculocutaneous nerves in man]. Arch Anat Histol Embryol. 1990; 73:33-42. View

19.

Klauser A, Halpern E, Faschingbauer R, Guerra F, Martinoli C, Gabl M . Bifid median nerve in carpal tunnel syndrome: assessment with US cross-sectional area measurement. Radiology. 2011; 259(3):808-15. DOI: 10.1148/radiol.11101644. View

20.

Bianchi S, Beaulieu J, Poletti P . Ultrasound of the ulnar-palmar region of the wrist: normal anatomy and anatomic variations. J Ultrasound. 2020; 23(3):365-378. PMC: 7441134. DOI: 10.1007/s40477-020-00468-5. View