The superficial anatomical landmarks are not reliable for predicting the recurrent branch of the median nerve

Surg Radiol Anat. 2020 Aug;42(8):939-943. doi: 10.1007/s00276-020-02475-x. Epub 2020 Apr 24.


Purpose: The variability of the recurrent branch (RB) of the median nerve lends itself to an increased risk of injury when performing the minimally invasive approach for carpal tunnel release without its direct visualization. This risk is less so when it is released via the more invasive open approach as the RB can be easily identified, but the drawback is that of longer postoperative patient recovery time. Therefore, performing these releases via the less invasive approach should be more favorable for patients providing it could be done safely. Hence with there being a positive link between the hypertrophy of the thenar musculature and the course of RB according to previous studies.

Methods: We dissected 28 hands of 14 donated bodies fixed using Thiel's method to try to demonstrate these findings of the associations among the RB, palmar creases and other superficial anatomical landmarks. Fisher's exact test was conducted to verify the relationship between those structures statistically.

Results: Statistically significant links were found between the type of the RB and the type of the palmar creases (p value = 0.0094) and between the RB type and the palmaris longus muscle presence (p value = 0.028).

Conclusion: It was inferred that palmar creases and other superficial anatomical landmarks listed in the text could not be used to predict the variability of the RB and the choice of mini-invasive approach should not be based on their course.

Keywords: Anatomical variation; Carpal tunnel syndrome; Hand surgery; Median nerve; Palmar creases; Recurrent branch.

Publication types

  • Evaluation Study

MeSH terms

  • Anatomic Landmarks*
  • Anatomic Variation*
  • Cadaver
  • Carpal Bones / innervation
  • Carpal Tunnel Syndrome / surgery
  • Female
  • Hand / anatomy & histology*
  • Humans
  • Intraoperative Complications / etiology
  • Intraoperative Complications / prevention & control
  • Male
  • Median Nerve / abnormalities*
  • Median Nerve / injuries
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / methods
  • Risk Assessment / methods