RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0041-1724044
Anastomosis Patterns between the Median and Ulnar Nerves in the Upper Limbs
Padrões de anastomose entre os nervos mediano e ulnar nos membros superiores![](https://www.thieme-connect.de/media/10.1055-s-00028832/202102/lookinside/thumbnails/10-1055-s-0041-1724044_2000051-1.jpg)
Abstract
There are four types of anastomoses between the median and ulnar nerves in the upper limbs. It consists of crossings of axons that produce changes in the innervation of the upper limbs, mainly in the intrinsic muscles of the hand. The forearm has two anatomical changes – Martin-Gruber: branch originating close to the median nerve joining distally to the ulnar nerve; and Marinacci: branch originating close to the ulnar nerve and distally joining the median nerve. The hand also has two types of anastomoses, which are more common, and sometimes considered a normal anatomical pattern – Berrettini: Connection between the common digital nerves of the ulnar and median nerves; and Riche-Cannieu: anastomosis between the recurrent branch of the median nerve and the deep branch of the ulnar nerve. Due to these connection patterns, musculoskeletal disorders and neuropathies can be misinterpreted, and nerve injuries during surgery may occur, without the knowledge of these anastomoses. Therefore, knowledge of them is essential for the clinical practice. The purpose of the present review is to provide important information about each type of anastomosis of the median and ulnar nerves in the forearm and hand.
Resumo
Existem quatro tipos de anastomoses entre os nervos mediano e ulnar nos membros superiores. Elas consistem em cruzamentos de axônios que produzem mudanças na inervação dos membros superiores, principalmente na musculatura intrínseca da mão. O antebraço apresenta duas variações anatômicas – Martin-Gruber: ramo que se origina proximalmente ao nervo mediano e se une distalmente ao nervo ulnar; e Marinacci: ramo que se origina proximalmente ao nervo ulnar e se une distalmente ao nervo mediano. A mão apresenta também dois tipos de anastomoses, mais comuns, por vezes considerados padrão anatômico normal – Berrettini: conexão entre os nervos digitais comuns dos nervos ulnar e mediano; e Riche-Cannieu: anastomose entre o ramo recorrente do nervo mediano e o ramo profundo do nervo ulnar. Devido a esses padrões de conexões, distúrbios musculoesqueléticos e neuropatias podem ser mal interpretadas, e lesões nervosas durante as cirurgias podem ocorrer, sem o conhecimento dessas anastomoses. Portanto, o conhecimento delas é fundamental para a prática clínica. O objetivo desta revisão é fornecer informações importantes acerca de cada tipo de anastomose dos nervos mediano e ulnar no antebraço e na mão.
Keywords
Martin Gruber - Marinacci - Berrettini - Riche-Cannieu - median nerve - ulnar nerve - anastomosisPalavras-chave
Martin-Gruber - Marinacci - Berrettini - Riche-Cannieu - nervo mediano - nervo ulnar - anastomosesPublikationsverlauf
Eingereicht: 13. Juli 2020
Angenommen: 16. November 2020
Artikel online veröffentlicht:
29. März 2021
© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Mannerfelt L. Studies on the hand in ulnar nerve paralysis. A clinical-experimental investigation in normal and anomalous innervation. Acta Orthop Scand 1966; (Suppl. 87) 1
- 2 Kimura J, Murphy MJ, Varda DJ. Electrophysiological study of anomalous innervation of intrinsic hand muscles. Arch Neurol 1976; 33 (12) 842-844
- 3 Greenberg MS. Manual de Neurocirurgia.7.ed – Porto Alegre. Art Med 2013
- 4 Dogan NU, Uysal II, Seker M. The communications between the ulnar and median nerves in upper limb. Neuroanat 2009; 8: 15-19
- 5 Loukas M, Louis Jr 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 (05) 887-893
- 6 Meenakshi-Sundaram S, Sundar B, Arunkumar MJ. Marinacci communication: an electrophysiological study. Clin Neurophysiol 2003; 114 (12) 2334-2337
- 7 Riechers II RG, Landau ME, Farber G, Campbell WW. Damage to sensory fibers in a martin-gruber anomaly after biceps tendon repair. J Clin Neuromuscul Dis 2005; 6 (04) 162-166
- 8 Martin R. Tal om Nervus alimanna Egenskaper I Maniskans Kropp. 1763
- 9 Gruber W. Ueber die Verbindung des Nervus medianus mit dem Nervus ulnaris am Unterame des Menschen um der Saugethiere. 1870
- 10 Nakashima T. An anatomic study on the Martin-Gruber anastomosis. Surg Radiol Anat 1993; 15 (03) 193-195
- 11 Thomson A, Hollinshead W. Anatomy for surgeons. The back and the limbs. 1958
- 12 Hirasawa K. Untersuchungen uber das periphere nervensystem, plexus brachialis and die nerven der oberen extremitat. 1931
- 13 Taams KO. Martin–Gruber connections in South Africa. An anatomical study. J Hand Surg Br 1997; 22 (03) 328-330
- 14 Roy J, Henry BM, PĘkala PA. et al. Median and ulnar nerve anastomoses in the upper limb: A meta-analysis. Muscle Nerve 2016; 54 (01) 36-47
- 15 Cavalheiro CS, Filho MR, Pedro G, Caetano MF, Vieira LA, Caetano EB. Clinical repercussions of Martin-Gruber anastomosis: anatomical study. Rev Bras Ortop 2016; 51 (02) 214-223
- 16 Villar F. Quelques recherché sur les anastomoses des nerfs der member superier. 1905
- 17 Goss CM. Gray anatomia. 29 ed.. Rio de Janeiro: Guanabara Koogan; 1988
- 18 Sirinivasan R, Rhodes J. The median-ulnar anastomosis (Martin-Gruber) in normal and congenenitally abnormal fetuses. Arch Neurol 1981; 38 (07) 418-419
- 19 Crutchfield Ca. Gutmann L. Hereditary aspects of median-ulnar nerve communications. J Neurol Neurosurg Psychiatry 1980; 43 (01) 53-55
- 20 Piza-Katzer H. [Familial occurrence of Martin-Gruber anastomosis.]. Handchirurgie 1976; 8 (04) 215-218
- 21 Caetano EB, Vieira LÂ, Caetano MF, Cavalheiro CS, Razuk M, Sabongi JJ. Intramuscular Martin-Gruber anastomosis. Acta Ortop Bras 2016; 24 (02) 94-97
- 22 Brandsma J. Intrinsic minus hand. 1993
- 23 Hopf HC. Forearm ulnar-to-median nerve anastomosis of sensory axons. Muscle Nerve 1990; 13 (07) 654-656
- 24 Marinacci AA. The problem of unusual anomalous innervations of hand muscles:the value of electrodiagnosis in its evaluation. Bull Los Angel Neuro Soc 1964; 29: 133-142
- 25 Almeida A, Vitti M, Garbino J. Estudo anatômico da anastomose de Martin-Gruber. Hansen Int 1999; 24 (01) 15-20
- 26 Sperino G. Anatomia Del cimpanzé. 1888
- 27 Rosen AD. Innervation of the hand: an electromyographic study. Electromyogr Clin Neurophysiol 1973; 13 (02) 175-178
- 28 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 (01) 31-34
- 29 Felippe MM, Telles FL, Soares ACL, Felippe FM. Anastomosis Between the median nerve and ulnar nerve in the forearm. J Morphol Sci 2012; 29 (01) 23-26
- 30 Sraj SA, Moussallem CD, Stafford JB. Cubital tunnel syndrome presenting with carpal tunnel symptoms: clinical evidence for sensory ulnar-to-median nerve communication. Am J Orthop 2009; 38 (06) E104-E106
- 31 Federative Committee on Anatomy Technology. Terminologia anatomica. Stuttgart thieme; 1998
- 32 Ferrari GP, Gilbert A. The superficial anastomosis on the palm of the hand between the ulnar and median nerves. J Hand Surg [Br] 1991; 16 (05) 511-514
- 33 Don Griot JPWD, Zuidam JM, van Kooten EO, Prosé LP, Hage JJ. Anatomic study of the ramus communicans between the ulnar and median nerves. J Hand Surg Am 2000; 25 (05) 948-954
- 34 Tagil SM, Bozkurt MC, Ozçakar L, Ersoy M, Tekdemir I, Elhan A. Superficial palmar communications between the ulnar and median nerves in Turkish cadavers. Clin Anat 2007; 20 (07) 795-798
- 35 Meals RA, Calkins ER. Anomalous innervation of the upper extremity in Gelberman RH: Operative nerve repair and reconstruction. Philadelphia, JB: Lippincott; 1991: 197-204
- 36 Anson BJ. Human anatomy. New York: McGraw-Hill; 1966
- 37 Berrettini P. Tabulae anatomicae. Roma: F. Amidei; 1741
- 38 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 (03) 269-274
- 39 Rollins J, Meals RA. Recognition of acutely lacerated ulnar nerve-median nerve palmar communicating branch. A case report. Clin Orthop Relat Res 1985; (201) 91-93
- 40 Grant JCB. Atlas de anatomia. Rio de Janeiro: Editora Guanabara koogan; 1946
- 41 Wolf-Heidegger G. Atlas of sistematic human anatomy. New York: S.Karger; 1962
- 42 Ferner H, Staubesand J. Sobotta, atlas de anatomia humana. Rio de janeiro: editora Koogan; 1984
- 43 Rojas RL, Nieto RLE, Sepúlveda C. Proyección topográfica de las anastomosis entre nervios mediano y cubital en antebrazo y mano. Cirurgía Plástica 2014; 24 (02) 82-87
- 44 Russomano S, Herbison GJ, Baliga A, Jacobs SR, Moore J. Riche-Cannieu anastomosis with partial transection of the median nerve. Muscle Nerve 1995; 18 (01) 120-122
- 45 Gutmann L. AAEM minimonograph #2: important anomalous innervations of the extremities. Muscle Nerve 1993; 16 (04) 339-347
- 46 Riche D. Le nerf cubital et les muscles de l'eminence thenar. Bull Mem Soc Anat Paris 1897; •••: 251-252
- 47 Cannieu A. Recherche sur l'innervation de l'eminence thenar par le cubital. J Med Bordeaux 377-379 1896;
- 48 Bölükbaşi O, Turgut M, Akyol A. Ulnar to median nerve anastomosis in the palm (Riches-Cannieu anastomosis). Neurosurg Rev 1999; 22 (2-3): 138-139
- 49 Yang H, Gil Y, Kim S, Bang J, Choi H, Lee HY. From the brachial plexus to the hand, multiple connections between the median and ulnar nerves may serve as bypass routes for nerve fibres. J Hand Surg Eur Vol 2016; 41 (06) 648-656
- 50 Souza OM. Contribuição ao estudo da inervação dos Musculi Hypotenaris et tenaris no homem. São Paulo: 1975. . Tese: Escola Paulista de Medicina
- 51 Harness D, Sekeles E. The double anastomotic innervation of thenar muscles. J Anat 1971; 109 (Pt 3): 461-466
- 52 Caetano EB, Vieira LA, Sabongi Neto JJ, Caetano MF, Sabongi RG. Anastomose de Riche-Cannieu: estrutura, função e significância clínica. Rev Bras Ortop 2019; 54: 564-571
- 53 Boland RA, Krishnan AV, Kiernan MC. Riche-Cannieu anastomosis as an inherited trait. Clin Neurophysiol 2007; 118 (04) 770-775
- 54 Caetano EB, Morad JFM. Estudo anatômico da anastomose entre o nervo mediano e o ramo profundo do nervo ulnar (anastomose de Cannieu e Riché). Rev. bras. ciênc. Morfol 247 1987;
- 55 Brown JV, Landau ME. Sparing of the second lumbrical in a Riche-Cannieu anastomosis: the nearly all-ulnar hand. J Clin Neuromuscul Dis 2013; 14 (04) 184-187
- 56 Saperstein DS, King RB. Motor neuron presentation of an ulnar neuropathy and Riche-Cannieu anastomosis. Electromyogr Clin Neurophysiol 2000; 40 (02) 119-122
- 57 Kazakos KJ, Smyrnis A, Xarchas KC, Dimitrakopoulou A, Verettas DA. Anastomosis between the median and ulnar nerve in the forearm. An anatomic study and literature review. Acta Orthop Belg 2005; 71 (01) 9-35
- 58 Duran JTC, Arquez HF. Anastomosis between median and ulnar nerve in forearm and hand. Journal of Chemical and Pharmaceutical Research 2016; 8 (08) 675-680