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Czasopismo

2014 | 73 | 4 |

Tytuł artykułu

Determination of the median nerve safe-zone in the carpal tunnel using the distal forearm bony prominences

Warianty tytułu

Języki publikacji

EN

Abstrakty

EN
Background: The compression of the median nerve (MN) in the carpal tunnel (CT) is one of the most common aetiologies of entrapment neuropathy syndromes in clinical practice. The aim of this study was to investigate the relationship of the palpable bony prominences of the distal forearm (radial styloid process [RSP] and ulnar styloid process [USP]) with MN in the CT, in order to determine a safe-zone of the MN during carpal tunnel procedures. Materials and methods: This study involved the bilateral dissection of the CT region of 30 adult cadaveric specimens (n = 60). Results: The mean distance between the RSP and USP was 49.34 mm. The mean distance of the MN from the RSP and the USP were 22.44 mm and 26.66 mm, respectively. The mean diameter of the MN within the CT deep to the flexor retinaculum was 5.93 mm. In addition, the MN was located postero-lateral and postero-medial to palmaris longus tendon (PLT) in 78.33% and 21.67% of specimens, respectively. Conclusions: This study found that the MN was located less than 60% of the RSP-USP distance from the RSP. Furthermore, the MN was mostly located postero-lateral to the PLT. Therefore, injection or surgical incision made at/medial to a point 60% of the RSP-USP distance from the RSP will be outside the safe-zone of the MN. The knowledge of this surface anatomical relationship of the MN may be useful during decompression for CT syndrome. (Folia Morphol 2014; 73, 4: 409–413)

Słowa kluczowe

Wydawca

-

Czasopismo

Rocznik

Tom

73

Numer

4

Opis fizyczny

p.409-413,fig.,ref.

Twórcy

autor
  • Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
autor
  • Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
autor
  • Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
  • Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, South Africa

Bibliografia

  • 1. Abdel Raouf H, Abdel Kader G, Jaradat A, Dharap A, Fadel R, Salem A (2013) Frequency of palmaris longus absence and its association with other anatomical variations in the Egyptian population. Clin Anat, 26: 572–577.
  • 2. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I (1999) Prevalence of Carpal tunnel syndrome in a general population. JAMA, 281: 153–158.
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  • 4. Demircay E, Civelek E, Cansever T, Kabatas S, YIlmaz C (2011) Anatomic variations of the median nerve in the carpal tunnel: a brief review of the literature. Turkish Neurosurgery, 21: 388–396.
  • 5. Dubert T, Racasan O (2006) A reliable technique for avoiding the median nerve during carpal tunnel injections. Joint Bone Spine, 73: 77–79.
  • 6. Eric M, Koprivcic I, Vucinic N, Radic R, Krivokuca D, Leksan I, Selthofer R (2011) Prevalence of the palmaris longus in relation to the hand. Dominance Surg Radiol Anat, 33: 481–484.
  • 7. Frederick HA, Carter PR, Littler JW (1992) Injection injuries to the median and ulnar nerves at the wrist. J Hand Surg, 17: 645–647.
  • 8. Gelberman RH, Aronson D, Weiman MH (1980) Carpal tunnel syndrome. J Bone Joint Surg, 62: 1181–1184.
  • 9. Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH (1981) The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am, 63: 380–383.
  • 10. Graham RG, Hudson DA, Solomons M, Singer M (2004) A prospective study to assess the outcome of steroid injections and wrist splinting for the treatment of carpal tunnel syndrome. Plast Reconstr Surg, 113: 550–556.
  • 11. Koo JT, Szabo RM (2004. Compression neuropathies of the median nerve. J Am Soc Surg Hand, 4: 156–175.
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  • 13. McConnell JR, Bush DC (1990) Intraneural steroid injection as a complication in the management of carpal tunnel syndrome. Clin Orthop, 250: 181–184.
  • 14. Ozcanli H, Coskun HK, Cengiz M, Oguz N, Sindel M (2010) Definition of a safe-zone in open carpal tunnel surgery: a cadaver study. Surg Radiol Anat, 32: 203–206.
  • 15. Racasan O, Dubert T (2005) The safest location for steroid injection in the treatment of carpal tunnel syndrome. J Hand Surg Br, 30: 412.
  • 16. Roohi SA, Choon-Sian L, Shalimar A, Tan GH, Naicker AS (2007) A study on the absence of palmaris longus in a multiracial population. Malaysian Orthopaedic J, 1: 26–28.
  • 17. Sater MS, Dharap AS, Abu-Hijleh MF (2010) The prevalence of absence of the palmaris longus muscle in the Bahraini population. Clin Anat, 23: 956–961.
  • 18. Sebastin SJ, Lim AY, Wong HB (2006) Clinical assessment of absence of the palmaris longus and its association with other anatomical anomalies: a Chinese population study. Ann Acad Med Singapore, 35: 249–253.
  • 19. Skie M, Zeiss J, Ebraheim NA, Jackson WT (1990) Carpal tunnel changes and median nerve compression during wrist flexion and extension seen by magnetic resonance imaging. J Hand Surg, 315A: 934–939.
  • 20. Smith J, Wisniewski SJ, Finnoff JT, Payne JM (2008) Sonographically guided carpal tunnel injections: the ulnar approach. J Ultrasound Med, 27: 1485–1490.
  • 21. Standring S (2012) Evidence-based surface anatomy. Clin Anat, 25: 813–815.
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  • 23. Tavares SP, Giddins GES (1996) Nerve injury following steroid injection for carpal tunnel syndrome: a report of two cases. J Hand Surg Br, 21: 208–209.

Typ dokumentu

Bibliografia

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