Communications of the median nerve in foetuses
Abstract
Background: Communications between the median, ulnar and musculocutaneous nerves in the arm, forearm and hand were reported in adult cadaveric and electrophysiological studies. These communicant branches may lead conflicting clinical and electrodiagnostic outcomes. While there are many studies on adult patients or cadavers, there is poor regarding foetuses. The present study was conducted to examine the frequencies of these communications and their coexistences in human foetuses.
Materials and methods: Anterior aspect of the forearms of 50 foetuses (29 females, 20 males, and 1 unknown) were dissected bilaterally (totally 100 sides) for this purpose.
Results: Communications between the median and the musculocutaneous nerves in the arm were found unilaterally in 4%. Communications from the median to the ulnar nerve in the forearm were encountered unilaterally in 22%, and bilaterally in 12%; from the ulnar to the median nerve in the hand unilaterally in 28%, and bilaterally in 12%. Coexistence of all these variations was not encountered in any foetus. But coexistence of two different types of communicant branch was encountered in 4%.
Conclusions: Precise knowledge of nerve communications, variations and rate of coexistences in foetuses may have significance for clinicians and researchers dealing with subjects in foetal period.
Keywords: median nerveulnar nervemusculocutaneous nervefoetuscommunicationcoexistence
References
- Dogan UN, Uysal II, Karabulut AK, et al. The motor branches of median and ulnar nerves that innervate superficial flexor muscles: a study in human fetuses. Surg Radiol Anat. 2010; 32(3): 225–233.
- Kazakos KJ, Smyrnis A, Xarchas KC, et al. Anastomosis between the median and ulnar nerve in the forearm. An anatomic study and literature review. Acta Orthop Belg. 2005; 71(1): 29–35.
- Kosugi K, Mortia T, Yamashita H. Branching pattern of the musculocutaneous nerve.1. Cases possessing normal bíceps brachii. Jikeakai Med J. 1986; 33: 63–71.
- Kumar N, Guru A, D'Souza MR, et al. Incidences and clinical implications of communications between musculocutaneous nerve and median nerve in the arm - a cadaveric study. West Indian Med J. 2013; 62(8): 744–747.
- Lee KS, Oh CS, Chung IH, et al. An anatomic study of the Martin-Gruber anastomosis: electrodiagnostic implications. Muscle Nerve. 2005; 31(1): 95–97.
- Leibovic SJ, Hastings H. Martin-Gruber revisited. J Hand Surg Am. 1992; 17(1): 47–53.
- Loukas M, Louis RG, Stewart L, et al. The surgical anatomy of ulnar and median nerve communications in the palmar surface of the hand. J Neurosurg. 2007; 106(5): 887–893.
- Marras C, Midroni G. Proximal Martin-Gruber anastomosis mimicking ulnar neuropathy at the elbow. Muscle Nerve. 1999; 22(8): 1132–1135.
- Nakashima T. An anatomic study on the Martin-Gruber anastomosis. Surg Radiol Anat. 1993; 15(3): 193–195.
- Narayana K, Narendiran K, Shetty KP. and Prashanthi N. A case of coexistence of three anatomical Variations in the forearm: Gantzer’s muscles, Martin-Gruber anastomosis, and nerve of Henle. Eur J Anat. 2004; 8(2): 81–84.
- Oztürk NC, Uzmansel D, Oztürk H. An unreported pattern of musculocutaneous and median nerve communication with multiple variations of biceps brachii: a case report. Surg Radiol Anat. 2010; 32(9): 887–890.
- Prates LC, Clóris de, Prates JC, et al. and Marretto Esquisatto MA. The Martin-Gruber Anastomosis in Brazilians: An Anatomical Study. Braz J Morphol Sci. 2003; 20(3): 177–180.
- Rodriguez-Niedenführ M, Vazquez T, Ferreira B, et al. Intramuscular Martin-Gruber anastomosis. Clin Anat. 2002; 15(2): 135–138.
- Rodriguez-Niedenführ M, Vazquez T, Parkin I, et al. Martin-Gruber anastomosis revisited. Clinical Anatomy. 2002; 15(2): 129–134.
- Sarikcioglu L, Sindel M, Ozkaynak S, et al. Median and ulnar nerve communication in the forearm: an anatomical and electrophysiological study. Med Sci Monit. 2003; 9(9): BR351–BR356.
- Srinivasan R, Rhodes J. The median-ulnar anastomosis (Martin-Gruber) in normal and congenitally abnormal fetuses. Arch Neurol. 1981; 38(7): 418–419.
- Stancić MF, Burgić N, Mićović V. Marinacci communication. Case report. J Neurosurg. 2000; 92(5): 860–862.
- Stancić MF, Mićović V, Potocnjak M. The anatomy of the Berrettini branch: implications for carpal tunnel release. J Neurosurg. 1999; 91(6): 1027–1030.
- Sundaram SM, Sundar B, Arunkumar MJ. Marinacci communication: an electrophysiological study. Clin Neurophysiol. 2003; 114(12): 2334–2337.
- Uchida Y, Sugioka Y. Electrodiagnosis of Martin-Gruber connection and its clinical importance in peripheral nerve surgery. J Hand Surg Am. 1992; 17(1): 54–59.
- Uyaroğlu FG. Anastomotic branch from the median nerve to the musculocutaneous nerve: a case report. Anatomy. 2008; 2: 63–66.
- Uzun A, Seelig LL. A variation in the formation of the median nerve: communicating branch between the musculocutaneous and median nerves in man. Folia Morphol. 2001; 60(2): 99–101.
