Research Article
BibTex RIS Cite

Fetal Kadavralarda Nervus Medianus’un Oluşumu, Dallanması ve Anastomozlarının Varyasyonları

Year 2021, Volume: 12 Issue: 3, 289 - 296, 25.12.2021
https://doi.org/10.22312/sdusbed.921367

Abstract

Amaç: Nervus medianus’un varyasyonları klinik ve cerrahi yaklaşımlar açısından önemlidir. Bu çalışmanın amacı, fetal kadavralarda nervus medianus'un oluşumunu, dallanmasını ve anastomozlarını belirlemektir.

Materyal-Metod: Bu çalışma, Süleyman Demirel Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı laboratuvarında bulunan yaşları 18-40 gebelik haftası arasında değişen ve eksternal anomali ya da patolojisi olmayan 40 (22 dişi, 18 erkek) fetal kadavraya ait 80 üst ekstremite üzerinde gerçekleştirildi. Nervus medianus, n. ulnaris ve n. musculocutaneus’un dalları tanımlanarak bu dalların dağılımı belirlendi. Nervus medianus’un dallanması ve oluşumu ile onun anatomozları incelendi.

Bulgular: Bu çalışmada n. medianus’un 80 üst ekstremitenin 6'sında (%7,5) üç kökten oluştuğu görüldü. Nervus medianus’un, 2 (%2,5) ekstremitede, n. musculocutaneus mevcut olmasına rağmen kolun fleksor komparmanındaki kasları innerve ettiği görüldü. Nervus musculocutaneus’un olmadığı 1 (%1,25) ekstremitede ise n. medianus’un kolun fleksor komparmanındaki kasları innerve ettiği görüldü. Ayrıca 3 ekstremitede (%3,75) n. musculocutaneus ile n. medianus arasında anastomoz saptandı. Son olarak çalışmamızda %3,75 oranında Martin-Gruber anastomozu bulunurken Marinacci anatomozuna rastlanmamıştır.

Sonuç: Bu çalışmada, fetal kadavra diseksiyonu ile n. medianus'un varyasyonları ve anastomozları tanımlandı. Bu varyasyonlar üst ekstremite yaralanmalarında doğru tanı ve tedavi planlamasını olumsuz etkileyecektir. Bu nedenle, n. medianus'un varyasyonları ve anastomozları hakkında yeterli bilgi sahibi olunması, cerrahların bu bölgeye yapılan müdahaleler sırasında iyatrojenik yaralanmalardan kaçınması için yararlı olacaktır.

References

  • [1] Dursun A, Bilkay C, Albay S. A rare variation in the branching pattern of posterior cord. Int J Anat Var.2016;9:29-31.
  • [2] Budhiraja V, Rastogi R, Asthana AK. Anatomical variations of median nerve formation: Embryological and clinical correlation. J Morphol Sci. 2011;28:283-6.
  • [3] Satyanarayana N, Vishwakarma N, Kumar GP, Guha R, Dattal AK, Sunitha P. Rare variations in the formation of median nerve-embryological basis and clinical significance. Nepal Med Coll J.2009;11:287-90.
  • [4] 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: 99-101.
  • [5] Ballesteros LE, Forero PL, Buıtrago ER. Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications. Rev Bras Ortop.2015;50:567-72.
  • [6] Candan B, Öztürk K, Albay S. Bilateral absence of musculocutaneous nerve with unusual communicating branch between radial and ulnar nerves. Int J Anat Var.2016;9:39-42.
  • [7] Gümüşburun E, Adıgüzel E. A variatiaon of the brachial plexus characterized by the absence of the musculocutaneous nerve: a case report. Surg Radiol Anat.2000;22:63-5.
  • [8] Sarıkçıoğlu L, Sindel M, Özkaynak S, Aydın H. Median and ulnar nerve communication in the forearm: an anatomical and electrophysiological study. Med Sci Monit.2003;9:351-6.
  • [9] Chauhan R, Roy TS. Communication between the median and musculocutaneous nerve- a case report. J Anat Soc India.2002;51:72-5.
  • [10] Sontakke BR, Tarnekar AM, Waghmare Je, Ingole IY. An unusual case of asymmetrical formation and distribution of median nerve. Int J Anat Var.2011;4:57-60.
  • [11] Nayak S. Absence of musculocutaneous nerve associated with clinically important variations in the formation, course and distribution of the median nerve – a case report. Neuroanatomy.2007;6:49-50.
  • [12] Ramachandran K, Kanakasabapathy I, Holla SJ. Multiple variations involving all the terminal branches of the brachial plexus and the axillary artery - a case report. Eur J Anat.2006;10:61-6.
  • [13] Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and median nerves. Clin Anat.1998;11:327-31.
  • [14] Arquez HF. Communication between the median and musculocutaneous nerve. An anatomical study. Int J Pharma Bio Sci. 2015;6:951-7.
  • [15] Guerri-Guttenberg RA, Ingolotti M. Classifying musculocutaneous nerve variations. Clin Anat.2009;22:671-83.
  • [16] Maeda S, Kawai K, Koizumi M, Ide J, Tokiyoshi A, Mizuta H, Kodama K. Morphological study of the communication between the musculocutaneous and median nerves. Anat Sci Int. 2009;84:34-40.
  • [17] Mariya NJ. Patterns of communications between musculocutaneous and median nerve: a cadaveric study. Int J Med Res Heal Sci.2013;2:425-30.
  • [18] Wantanabe M, Takatsujı K, Sakamoto N, Morit Y, Ito H. Two cases of fusion of the musculocutaneous and median nerves. Kaibogaku Zasshi, 1985;60:1-7.
  • [19] Ihunwo AO, Osinde SP, Mukhtar AU. Distribution of median nerve to muscles of the anterior compartment of the arm. Cent Afr J Med.1997;43:359-60.
  • [20] Sud M, Sharma A. Absence of musculocutaneous nerve and the innervation of coracobrachialis, biceps brachii and brachialis from the median nerve. J Anat Soc India.2000; 49:176-7.
  • [21] Prasada Rao PVV, Chaudhary SC. Absence of musculocutaneous nerve: two case reports. Clin Anat.2001;14:31-5.
  • [22] Beheiry EE. Anatomical variations of the median nerve distribution and communication in the arm. Folia Morphol.2004;63:313-8.
  • [23] Crutchfield CA, Gutmann L. Hereditary aspects of median-ulnar nerve communications. J Neurol Neurosurg Psychiatry.1980;43:53-5.
  • [24] Lee KS, Oh CS, Chung IH, Sunwoo IN. An anatomic study of the Martin-Gruber anastomosis: electrodiagnostic implications. Muscle Nerve.2005;31:95-7.
  • [25] Kawashima T, Sato K, Sasaki H. Stratification of the flexor retinaculum and the course and distribution of the ulnar, median, and palmar digital nerves: an anatomical study. Clin Anat.2004;17:643-50.
  • [26] Nakashima T. An anatomic study on the Martin-Gruber anastomosis. Surg Radiol Anat.1993;15:193-5.
  • [27] Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Logan B, Sanudo JR. Martin-Gruber anastomosis revisited. Clin Anat. 2002;15:129-34.
  • [28] Shu HS, Chantelot C, Oberlın C, Alnot JY, Shao H. Martin-Gruber communicating branch: Anatomical and histological study. Surg Radiol Anat.1999;21:115-8.
  • [29] Taams KO. Martin-gruber connections in South Africa: an anatomical study. J Hand Surg Br Eur Vol.1997;22:328-30.
  • [30] Srinivasan R, Rhodes J. The median-ulnar anastomosis (Martin-Gruber) in normal and congenitally abnormal fetuses. Arch Neurol. 1981;38:418-9.
  • [31] Doğan NU, Uysal II, Karabulut AK, Fazlıoğulları Z. The motor branches of median and ulnar nerves that innervate superficial flexor muscles: A study in human fetuses. Surg Radiol Anat.2010;32:225-33.
  • [32] Unver Doğan N, Uysal II, Şeker M. The communications between the ulnar and median nerves in upper limb. Neuroanatomy.2009;8:15-9.
  • [33] Kimura I, Ayyar DR, Lippmann SM. Electrophysiological verification of the ulnar to median nerve communications in the hand and forearm. Tohoku J Exp Med.1983;141:269-74.
  • [34] Meenakshi-Sundaram S, Sundar B, Arunkumar MJ. Marinacci communication: an electrophysiological study. Clin Neurophysiol.2003;114:2334–7.
  • [35] Golovchinsky V. Ulnar-to-median anastomosis and its role in the diagnosis of lesions of the median nerve at the elbow and the wrist. Electromyogr Clin Neurophysiol.1990;30:31-4.
  • [36] Amoiridis G, Vlachonikolis IG. Verification of the median-to-ulnar and ulnar-to-median nerve motor fiber anastomosis in the forearm: An electrophysiological study. Clin Neurophysiol. 2003;114:94-8.

Variations of Formation, Distribution and Communications of Median Nerve in Fetal Cadavers

Year 2021, Volume: 12 Issue: 3, 289 - 296, 25.12.2021
https://doi.org/10.22312/sdusbed.921367

Abstract

Objective: Variations of the median nerve (MN) are important for clinical and surgical approaches. In this study, it was aimed to determine the formation, distribution and communication of the MN in fetal cadavers.

Material and Method: This study was carried out on 80 upper extremities obtained from 40 spontaneously aborted human fetuses (22 females, 18 males) aged between 18 and 40 weeks. Median, ulnar and musculocutaneous nerve (MSCN) and their branches were identified and distribution of their branches was determined. The distribution, formation and communications of the MN were examined.

Results: In this study, it was seen that the MN was composed of three roots in the 6 (7.5%) of 80 upper limbs. It was also found that the MN innervated the flexor muscles of the arm in two extremities despite MSCN was present (2.5%). It has also been determined that the MN innervated the flexor muscles of the arm in one extremity where MSCN was absent (1.25%). In addition, communications between the MSCN and the MN was detected in 3 (3.75%) extremities. Finally, in our study, Martin-Gruber communication was found 3.75% while Marinacci communication was not determined.

Conclusions: This study identified variations and communications of the MN by means of fetal cadaveric dissection. These variations will adversely affect the correct diagnosis and treatment planning in upper extremity injuries. Therefore, precise knowledge of the variations and communications of the MN will be useful for surgeons to avoid iatrogenic injuries during surgical interventions in this region. 

References

  • [1] Dursun A, Bilkay C, Albay S. A rare variation in the branching pattern of posterior cord. Int J Anat Var.2016;9:29-31.
  • [2] Budhiraja V, Rastogi R, Asthana AK. Anatomical variations of median nerve formation: Embryological and clinical correlation. J Morphol Sci. 2011;28:283-6.
  • [3] Satyanarayana N, Vishwakarma N, Kumar GP, Guha R, Dattal AK, Sunitha P. Rare variations in the formation of median nerve-embryological basis and clinical significance. Nepal Med Coll J.2009;11:287-90.
  • [4] 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: 99-101.
  • [5] Ballesteros LE, Forero PL, Buıtrago ER. Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications. Rev Bras Ortop.2015;50:567-72.
  • [6] Candan B, Öztürk K, Albay S. Bilateral absence of musculocutaneous nerve with unusual communicating branch between radial and ulnar nerves. Int J Anat Var.2016;9:39-42.
  • [7] Gümüşburun E, Adıgüzel E. A variatiaon of the brachial plexus characterized by the absence of the musculocutaneous nerve: a case report. Surg Radiol Anat.2000;22:63-5.
  • [8] Sarıkçıoğlu L, Sindel M, Özkaynak S, Aydın H. Median and ulnar nerve communication in the forearm: an anatomical and electrophysiological study. Med Sci Monit.2003;9:351-6.
  • [9] Chauhan R, Roy TS. Communication between the median and musculocutaneous nerve- a case report. J Anat Soc India.2002;51:72-5.
  • [10] Sontakke BR, Tarnekar AM, Waghmare Je, Ingole IY. An unusual case of asymmetrical formation and distribution of median nerve. Int J Anat Var.2011;4:57-60.
  • [11] Nayak S. Absence of musculocutaneous nerve associated with clinically important variations in the formation, course and distribution of the median nerve – a case report. Neuroanatomy.2007;6:49-50.
  • [12] Ramachandran K, Kanakasabapathy I, Holla SJ. Multiple variations involving all the terminal branches of the brachial plexus and the axillary artery - a case report. Eur J Anat.2006;10:61-6.
  • [13] Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and median nerves. Clin Anat.1998;11:327-31.
  • [14] Arquez HF. Communication between the median and musculocutaneous nerve. An anatomical study. Int J Pharma Bio Sci. 2015;6:951-7.
  • [15] Guerri-Guttenberg RA, Ingolotti M. Classifying musculocutaneous nerve variations. Clin Anat.2009;22:671-83.
  • [16] Maeda S, Kawai K, Koizumi M, Ide J, Tokiyoshi A, Mizuta H, Kodama K. Morphological study of the communication between the musculocutaneous and median nerves. Anat Sci Int. 2009;84:34-40.
  • [17] Mariya NJ. Patterns of communications between musculocutaneous and median nerve: a cadaveric study. Int J Med Res Heal Sci.2013;2:425-30.
  • [18] Wantanabe M, Takatsujı K, Sakamoto N, Morit Y, Ito H. Two cases of fusion of the musculocutaneous and median nerves. Kaibogaku Zasshi, 1985;60:1-7.
  • [19] Ihunwo AO, Osinde SP, Mukhtar AU. Distribution of median nerve to muscles of the anterior compartment of the arm. Cent Afr J Med.1997;43:359-60.
  • [20] Sud M, Sharma A. Absence of musculocutaneous nerve and the innervation of coracobrachialis, biceps brachii and brachialis from the median nerve. J Anat Soc India.2000; 49:176-7.
  • [21] Prasada Rao PVV, Chaudhary SC. Absence of musculocutaneous nerve: two case reports. Clin Anat.2001;14:31-5.
  • [22] Beheiry EE. Anatomical variations of the median nerve distribution and communication in the arm. Folia Morphol.2004;63:313-8.
  • [23] Crutchfield CA, Gutmann L. Hereditary aspects of median-ulnar nerve communications. J Neurol Neurosurg Psychiatry.1980;43:53-5.
  • [24] Lee KS, Oh CS, Chung IH, Sunwoo IN. An anatomic study of the Martin-Gruber anastomosis: electrodiagnostic implications. Muscle Nerve.2005;31:95-7.
  • [25] Kawashima T, Sato K, Sasaki H. Stratification of the flexor retinaculum and the course and distribution of the ulnar, median, and palmar digital nerves: an anatomical study. Clin Anat.2004;17:643-50.
  • [26] Nakashima T. An anatomic study on the Martin-Gruber anastomosis. Surg Radiol Anat.1993;15:193-5.
  • [27] Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Logan B, Sanudo JR. Martin-Gruber anastomosis revisited. Clin Anat. 2002;15:129-34.
  • [28] Shu HS, Chantelot C, Oberlın C, Alnot JY, Shao H. Martin-Gruber communicating branch: Anatomical and histological study. Surg Radiol Anat.1999;21:115-8.
  • [29] Taams KO. Martin-gruber connections in South Africa: an anatomical study. J Hand Surg Br Eur Vol.1997;22:328-30.
  • [30] Srinivasan R, Rhodes J. The median-ulnar anastomosis (Martin-Gruber) in normal and congenitally abnormal fetuses. Arch Neurol. 1981;38:418-9.
  • [31] Doğan NU, Uysal II, Karabulut AK, Fazlıoğulları Z. The motor branches of median and ulnar nerves that innervate superficial flexor muscles: A study in human fetuses. Surg Radiol Anat.2010;32:225-33.
  • [32] Unver Doğan N, Uysal II, Şeker M. The communications between the ulnar and median nerves in upper limb. Neuroanatomy.2009;8:15-9.
  • [33] Kimura I, Ayyar DR, Lippmann SM. Electrophysiological verification of the ulnar to median nerve communications in the hand and forearm. Tohoku J Exp Med.1983;141:269-74.
  • [34] Meenakshi-Sundaram S, Sundar B, Arunkumar MJ. Marinacci communication: an electrophysiological study. Clin Neurophysiol.2003;114:2334–7.
  • [35] Golovchinsky V. Ulnar-to-median anastomosis and its role in the diagnosis of lesions of the median nerve at the elbow and the wrist. Electromyogr Clin Neurophysiol.1990;30:31-4.
  • [36] Amoiridis G, Vlachonikolis IG. Verification of the median-to-ulnar and ulnar-to-median nerve motor fiber anastomosis in the forearm: An electrophysiological study. Clin Neurophysiol. 2003;114:94-8.
There are 36 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Araştırma Articlesi
Authors

Kenan Öztürk 0000-0002-5552-8684

Büşra Candan 0000-0002-5138-5583

Ahmet Dursun 0000-0003-4568-8761

Yadigar Kastamoni 0000-0002-3504-5853

Selçuk Tunalı 0000-0003-3553-7660

Soner Albay 0000-0001-8438-8628

Publication Date December 25, 2021
Submission Date April 20, 2021
Published in Issue Year 2021 Volume: 12 Issue: 3

Cite

Vancouver Öztürk K, Candan B, Dursun A, Kastamoni Y, Tunalı S, Albay S. Variations of Formation, Distribution and Communications of Median Nerve in Fetal Cadavers. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2021;12(3):289-96.

SDÜ Sağlık Bilimleri Dergisi, makalenin gönderilmesi ve yayınlanması dahil olmak üzere hiçbir aşamada herhangi bir ücret talep etmemektedir. Dergimiz, bilimsel araştırmaları okuyucuya ücretsiz sunmanın bilginin küresel paylaşımını artıracağı ilkesini benimseyerek, içeriğine anında açık erişim sağlamaktadır.