PubMed · 7238173
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E H Kuner, W Schlickewei. 1981. [Wrist dislocations].. https://pubmed.ncbi.nlm.nih.gov/7238173/
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The thenar branch of the median nerve can be injured during carpal tunnel release. The purpose of this study was to identify surface landmarks to consistently predict the location of the thenar branch of the median nerve. Surface landmarks were marked and incised in 28 cadaveric hands. The incisions were made along the longitudinal line of the third web space and the horizontal cardinal line from the hamate hook to the ulnar border of the thumb. The origin of the thenar branch was determined in relation to these longitudinal and horizontal vectors. The origin of the thenar nerve branch was consistently observed in the radial proximal quadrant formed by the aforementioned longitudinal and horizontal vectors. The thenar branch origin was observed to be an average of 8.6 +/- 1.9 mm radial to the longitudinal axis along the third web space. The origin of the thenar branch was observed to be an average of 6.3 +/- 2.0 mm proximal to the horizontal axis between the hamate hook and the ulnar border of the thumb. The thenar branch was observed precisely at the intersection of the longitudinal vector from the second web space to the scaphoid tubercle and the horizontal vector from the hamate hook to the radial edge of the proximal metacarpophalangeal crease in all 28 cadaveric hands. On the basis of these 28 cadaveric dissections, the location of the thenar branch of the median nerve can be predicted by the intersection of the longitudinal vector from the second web space to the scaphoid tubercle and the horizontal vector from the hamate hook to the radial aspect of the metacarpophalangeal crease.
PURPOSE: This study was designed to provide quantitative information concerning the functions of the ligaments that stabilize the distal radioulnar joint (DRUJ). This joint permits the radius to rotate around a nearly fixed ulna allowing supination and pronation of the hand. Understanding their function is important in developing procedures for reconstruction. METHODS: Using a ligament tension transducer that hooked under the center of the ligament and deflected it laterally while measuring the force required, we determined the tensions in 6 ligaments in 9 cadaver arms in pronation and supination of the hand. These ligaments included those of the DRUJ: palmar distal radioulnar ligament (PDRUL) and dorsal distal radioulnar ligament (DDRUL); and the ulnocarpal joint ligaments: ulnolunate ligament (ULL), ulnotriquetral ligament (UTL), and the ulnocarpal collateral ligament (UCCL), which includes the subsheath of the extensor carpi ulnaris, and the dorsal ulnocarpal ligament (DUCL). RESULTS: For the ligaments of the DRUJ in supination, the mean tension in the PDRUL (2.6 N) was greater than that of the DDRUL (0.8 N), whereas in pronation the mean tension in the PDRUL (1.1 N) was less than that of the DDRUL (1.7 N). For the ulnocarpal ligaments in supination, the ligament tensions in the ULL, UTL, and the UCCL were significantly greater than the same ligaments with the forearm pronated. The DUCL tension remained unchanged throughout supination and pronation. CONCLUSIONS: In supination of the forearm all ligaments except for the DDRUL had equivalent tensions, indicating their role in stabilizing the joint to this motion. In pronation ligament tensions generally were lower but were distributed over all 6 ligaments tested. DUCL tension was equivalent in both supination and pronation, unlike the other ligaments that had greater tensions in supination.
Distal radioulnar joint disorders have become increasingly recognized. Over the past decade, advances in functional anatomy, kinematics, advanced imaging, and arthroscopy have improved understanding of distal radioulnar joint disorders and their management. In the past, injuries to the triangular fibrocartilage complex and distal radioulnar joint have been regarded as related but separate entities. The authors' classification and treatment algorithm perceives these injuries as a single entity, differing only in their progressively severe anatomic pathology and subsequent clinical manifestations. A discussion of pertinent anatomy, clinical characteristics, ancillary studies, and a new classification system help establish recommended management options of this disorder.