Neural interconnections between the nerves of the upper limb and surgical implications

A review

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The knowledge of neural interconnections between adjacent nerves of the upper limb is important to the surgeon as such variations may lead to issues with surgical identification and thus iatrogenic injury. Trauma or entrapment of these nerves may cause functional losses different from those expected and thus result in misdiagnosis. The authors review the literature regarding such nervous system derangements.

Abbreviations used in this paper: CMAP = compound muscle action potential; LPN = lateral pectoral nerve; MGA = Martin-Grüber anastomosis; MPN = medial pectoral nerve.

Article Information

Address correspondence to: R. Shane Tubbs, M.S., P.A.-C., Ph.D., Pediatric Neurosurgery, Children's Hospital, 1600 7th Avenue South, ACC 400, Birmingham, Alabama 35233. email: rstubbs@uab.edu.

Please include this information when citing this paper: published online May 21, 2010; DOI: 10.3171/2010.3.JNS10144.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Schematic drawing illustrating a neural communication between the right musculocutaneous and median nerves.

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    Schematic drawing of the right axilla noting the ansa pectoralis connecting the medial and lateral pectoral nerves (n.). Note the relationship between this neural loop and the axillary artery.

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    Left: Schematic drawing illustrating the MGA between the distal ulnar and median nerves. Right: In this cadaveric specimen, the communication between the median and ulnar nerves is seen. Reproduced with permission from Loukas et al., J Neurosurg 106:887–893, 2007.

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    Schematic drawing illustrating the Marinacci anastomosis or reversed MGA.

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    A: Schematic drawing of the nerves of the anterior hand. Note the Riché-Cannieu and Berrettini anastomoses and the nerve of Lejars connecting the superficial radial nerve to the palmar cutaneous branch (br.) of the median nerve. B: Close view of a left superficial hand demonstrating the communication between the median and ulnar nerves. C: Photographs of a cadaveric hand and forearm showing a series of dissections in the same specimen, starting superficially (upper), reflecting palmaris longus and the palmar aponeurosis to expose the flexor retinaculum (center). After the flexor retinaculum is identified, it is retracted to observe the communicating branch between the median and ulnar nerves (lower), which is marked with an asterisk. Reproduced with permission from Loukas et al., J Neurosurg 106:887–893, 2007. D: Photographs of a cadaveric hand showing a deep communication between the median and the ulnar nerves (asterisk) underneath the flexor digitorum superficialis and flexor digitorum profundus muscles (upper). Both muscles have been retracted. The same specimen and the deep communication between the ulnar and median nerves (lower).

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    Schematic drawing of the nerves of the dorsum of the hand. Note the neural connection between the superficial radial nerve and dorsal branch of the ulnar nerve.

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