[Results following primary nerve sutures].
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Abstract:
143 primary nerve sutures in the upper extremity were examined for sensory and motor recovery according to the scheme of Highet (1954). The majority of the patients had digital nerve lesions (72.3%). Different factors were evaluated for their influence on nerve regeneration. Using a standard operative technique static two-point discrimination returns in two thirds of the cases.Keywords:
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Objective To provide the transected anatomical data for the clinical retransplation of a palm harmed severely. Methods The 30 newly-unfixed adult cadaver hands were cut into 7 identical parts from the midpoint of the distal wrist crease to the midpoint of the proximal transverse crease of the third finger. In every section, the area, traveling, branches and distribution of nerves were observed, measured and analyzed.Results The transverse diameter (TD) of the median nerve was (6.7±1.0) mm amd the area was (13.8±0.8) mm~2 In the first and the second sections. The recurrent branch of the median nerve appeared in the second section. The palmar proper digital nerve of thumb emerged between the third and the fourth section, and the palmar proper digital nerve occurred between the fifth and the sixth section. Within the first section, about 80 % of vlnar nerve gave off two branches: the palmar proper digital nerve of vlnar side of little finger and the fourth palmar common digital nerve. Within the third or the fourth section, the fourth palmar common digital nerve fell into the palmar proper digital nerve of radilis of little finger and the palmar proper digital nerve of vlnar side of ring-finger. The dorsal branches of the vlnar nerve and the superficial branches of the radial nerve innervated the medial and lateral halves of the dorsum. Conclusion The experimental results supported the classification method that transverse palm should be divided into 3 types: near-palm-part, mid-palm-part and far-palm-part.
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Little finger
Middle finger
Radial nerve
Cutaneous nerve
Epineurial repair
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Radial nerve
Digital nerve
Phalanx
Numerical digit
Cadaveric spasm
Sensory nerve
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The third common digital nerve (TCDN) has been described as the most commonly injured digital nerve during carpal tunnel release (CTR). Anatomic variations of the origin and course of the TCDN from the median nerve may place this structure at risk. Anatomic landmarks may be useful to predict the location of the TCDN to minimize the risk for injury to this structure during CTR.Twenty cadaveric hands were used to determine the origin and course of the TCDN. The origin of the TCDN from the median nerve was identified in relation to the transverse carpal ligament (TCL), cardinal line, and superficial palmar arch. The course of the TCDN was inspected in relation to the scaphoid tubercle and ring finger.Three specific anatomic variations for the origin of the TCDN were identified: type 1 originating proximal to the distal edge of the TCL (3 of 20 patients), type 2 originating distal to the TCL but proximal to the superficial palmar arch (14 of 20 patients), and type 3 originating distal to the TCL and at or distal to the superficial palmar arch (3 of 20 patients). The origin of the TCDN was measured as an average of 5.0 +/- 1.2 mm distal to the cardinal line. The TCDN coursed along an oblique vector from the scaphoid tubercle to the midpoint of the palmar digital crease of the ring finger for type 2 or type 3 variations. Near the cardinal line, the oblique course of the TCDN traverses the vector of the longitudinal incision used for CTR.The TCDN is one of the most frequently damaged neurological structures during CTR. Iatrogenic injury to this structure can be disabling and even devastating to patients. A detailed knowledge of the carpal tunnel and its underlying structures can prevent inadvertent injury to the TCDN. Anatomic landmarks to predict the origin and the course of the TCDN allow the surgeon to preoperatively predict the possible locations and paths of this important structure. This information can prove to be useful in avoiding injury to the TCDN by clinicians performing CTR in their practice, whether via the open or via endoscopic technique.
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Abstract Comparison of sensory nerve conductions in palmar cutaneous branch (PCB) and digit I nerves was applied in 50 patients suspected of having carpal tunnel syndrome (CTS) and 40 healthy persons. The abnormalities were defined as the differences in latencies and sensory nerve conduction velocities (SNCVs) of more than mean plus 2.5 SD of controls. Comparing these 2 sensory nerves, statistical differences were seen in 83.7% (36 of 43 patients) of their sensory latencies and 76.7% (33 of 43 patients) of their SNCVs. This excluded 7 patients who had unobtainable sensory nerve action potentials in digit I nerves. This method may serve as an adjunctive technique in the diagnosis of CTS. Its diagnostic sensitivity was high in comparison with other testing methods.
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Sensation
Nerve conduction study
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Sensory threshold
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Digital nerve
Branching (polymer chemistry)
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Neurovascular bundle
Digital nerve
Digital artery
Nerve repair
Epineurial repair
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A dissection of four unembalmed human fingers demonstrated a branch from the digital nerve which enters the flexor tendon sheath at the same place as the transverse branch of the digital artery. We conclude that this branch supplies the nerve fibres found within the vinculum.
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The communications between the median and ulnar innervated territories on the palm of the hand have been studied anatomically and microscopically. A communicating branch is well appreciated but its description has had little emphasis in anatomical or surgical literature. 50 cadaveric palms were dissected in both sexes and an anastomotic branch was found in 45 hands. In 43 of them it originated proximally from the ulnar nerve and proceeded distally to enter the third common digital nerve; in the other two hands it left the median nerve to reach the fourth common digital nerve. By microscopic dissection we have seen that the ulnar fibres of the anastomotic branch which join the median nerve may contribute to the sensory innervation of the radial half of the ring finger and ulnar side of the middle finger on its palmar surface. We have therefore described a cutaneous area on the palm where care must be taken to avoid surgical damage to this branch.
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Numerical digit
Little finger
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Rare type of division of the median nerve in proximal 1/3 of the forearm was described. The finding was made during autopsy of 53 years old white man. A nerve branch that run separately from the main trunk of the median nerve appeared to be the common digital nerve to the 3rd and 4th finger. Between this branch and the main trunk the radial head of the flexor digitorum superficialis muscle was situated, that eventually converged into the tendon of the superficial flexor of the middle finger.
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