The online version of this article (doi:10.1007/s00330-016-4671-1) contains supplementary material, which is available to authorized users.
To evaluate in a prospective study the possibility of visualization and diagnostic assessment of the recurrent motor branch (RMB) of the median nerve with high-resolution ultrasound (HRUS).
HRUS with high-frequency probes (18–22 MhZ) was used to locate the RMB in eight fresh cadaveric hands. To verify correct identification, ink-marking and consecutive dissection were performed. Measurement of the RMB maximum transverse-diameter, an evaluation of the origin from the median nerve and its course in relation to the transverse carpal ligament, was performed in both hands of ten healthy volunteers (n = 20). Cases referred for HRUS examinations for suspected RMB lesions were also assessed.
The RMB was clearly visible in all anatomical specimens and all volunteers. Dissection confirmed HRUS findings in all anatomical specimens. Mean RMB diameter in volunteers was 0.7 mm ± 0.1 (range, 0.6–1). The RMB originated from the radial aspect in 11 (55%), central aspect in eight (40%) and ulnar aspect in one (5%) hand. Nineteen (95%) extraligamentous courses and one (5%) subligamentous course were detected. Three patients with visible RMB abnormalities on HRUS were identified.
HRUS is able to reliably visualize the RMB, its variations and pathologies.
• Ultrasound allows visualization of the recurrent motor branch of the median nerve.
• Ultrasound may help clinicians to assess patients with recurrent motor branch pathologies.
• Patient management may become more appropriate and targeted therapy could be improved.
Movie Anatomical variant. Video sequence of sonographic findings in a volunteer with a recurrent motor branch originating from the ulnar aspect of the median nerve, crossing the anterior aspect of the median and coursing beneath the TCL (subligamentous) toward the thenar musculature (MP4 40229 kb)330_2016_4671_MOESM1_ESM.mp4
Mazurek MT, Shin AY (2001) Upper extremity peripheral nerve anatomy: current concepts and applications. Clin Orthop Relat Res 7–20
Mumford J, Morecraft R, Blair WF (1987) Anatomy of the thenar branch of the median nerve. J Hand Surg 12:361–365 CrossRef
Benson LS, Bare AA, Nagle DJ et al (2006) Complications of endoscopic and open carpal tunnel release. Arthrosc: J Arthrosc Related Surg: Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc 22:919–924, 924 e911–912 CrossRef
Hurwitz PJ (1996) Variations in the course of the thenar motor branch of the median nerve. J Hand Surg 21:344–346 CrossRef
Al-Qattan MM (2010) Variations in the course of the thenar motor branch of the median nerve and their relationship to the hypertrophic muscle overlying the transverse carpal ligament. J Hand Surg 35:1820–1824 CrossRef
Kozin SH (1998) The anatomy of the recurrent branch of the median nerve. J Hand Surg 23:852–858 CrossRef
Lanz U (1977) Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg 2:44–53 CrossRef
Tountas CP, Bihrle DM, MacDonald CJ et al (1987) Variations of the median nerve in the carpal canal. J Hand Surg 12:708–712 CrossRef
Fiaschi P, Pacetti M, Secci F et al (2015) A rare case of first motor branch of median nerve schwannoma. Neur Sci: Off J Italian Neurol Soc Italian Soc Clin Neurophysiol 36:659–661 CrossRef
Squarzina PB, Adani R, Cerofolini E et al (1993) Ancient schwannoma of the motor branch of the median nerve: a clinical case. La Chirurgia Degli Organi Di Movimento 78:19–23 PubMed
Jensen TT (1990) Isolated compression of the motor branch of the median nerve by a ganglion. Case report. Scan J Plastic Reconstruc Surg Hand Surg/Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb Handkirurgi 24:171 CrossRef
Kato H, Ogino T, Nanbu T et al (1991) Compression neuropathy of the motor branch of the median nerve caused by palmar ganglion. J Hand Surg 16:751–752 CrossRef
Widder S, Shons AR (1988) Carpal tunnel syndrome associated with extra tunnel vascular compression of the median nerve motor branch. J Hand Surg 13:926–927 CrossRef
Yamanaka K, Horiuchi Y, Yabe Y (1994) Compression neuropathy of the motor branch of the median nerve due to an anomalous thenar muscle. J Hand Surg 19:711–712 CrossRef
Ali E, Delamont RS, Jenkins D et al (2013) Bilateral recurrent motor branch of median nerve neuropathy following long-distance cycling. Clin Neurophysiol: Of J Int Fed Clin Neurophysiol 124:1258–1260 CrossRef
Haussmann P (1980) Isolated traumatic lesions of the motor nerve branches in the hand. Handchirurgie 12:23–25 PubMed
Nara Y, Hasegawa O, Matsumoto M et al (1995) Electrophysiologic evaluation of entrapment neuropathy caused by scar formation in recurrent motor branch of the median nerve. No to Shinkei Brain Nerve 47:779 PubMed
Bennett JB, Crouch CC (1982) Compression syndrome of the recurrent motor branch of the median nerve. J Hand Surg 7:407–409 CrossRef
Cosgrove JL, Chase PM, Mast NJ (2002) Thenar motor syndrome: median mononeuropathy of the hand. Am J Phys Med Rehab/Assoc Acad Phys 81:421–423 CrossRef
Mondelli M, Aretini A, Ginanneschi F et al (2010) Thenar motor neuropathy electrophysiological study of 28 cases. J Clin Neurophysiol: Off Publ Am Electroencephalographic Soc 27:344–349 CrossRef
Repaci M, Torrieri F, Di Blasio F et al (1999) Exclusive electrophysiological motor involvement in carpal tunnel syndrome. Clin Neurophysiol: Off J Int Fed Clin Neurophysiol 110:1471–1474 CrossRef
Eskandari MM, Yilmaz C, Oztuna V et al (2005) Topographic localization of the motor branch of the median nerve. J Hand Surg 30:803–807 CrossRef
Rodriguez R, Strauch RJ (2013) The middle finger flexion test to locate the thenar motor branch of the median nerve. J Hand Surg 38:1547–1550 CrossRef
Wang Y, Zhu S (1997) Transfer of a branch of the anterior interosseus nerve to the motor branch of the median nerve and ulnar nerve. Chin Med J 110:216–219 PubMed
Palmer AK, Toivonen DA (1999) Complications of endoscopic and open carpal tunnel release. J Hand Surg 24:561–565 CrossRef
Lilly CJ, Magnell TD (1985) Severance of the thenar branch of the median nerve as a complication of carpal tunnel release. J Hand Surg 10:399–402 CrossRef
Virgilio C (2014) Surgery. Springer Science + Business Media, New York
Green DP, Morgan JP (2008) Correlation between muscle morphology of the transverse carpal ligament and branching pattern of the motor branch of median nerve. J Hand Surg 33:1505–1511 CrossRef
Mondelli M, Baldasseroni A, Aretini A et al (2010) Prevalent involvement of thenar motor fibres in vineyard workers with carpal tunnel syndrome. Clin Neurophysiol:Off J Int Fed Clin Neurophysiol 121:1251–1255 CrossRef
- High-resolution ultrasound visualization of the recurrent motor branch of the median nerve: normal and first pathological findings
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