ANATOMY OF THE PALMAR CUTANEOUS BRANCH OF THE MEDIAN NERVE - CLINICAL-SIGNIFICANCE

A detailed anatomic, histologic, and immunohistochemical study of the palmar cutaneous branch of the median nerve (PCBMN) and its distal arb orization was undertaken on 12 fresh human cadaveric hands. Small unmy elinated fibers terminated in the superficial loose connective tissue of the transverse carpal ligament. There were no nerve fibers detected in the deep, dense collagen aspect of the ligament. Based on these fi ndings, during open carpal tunnel release, the skin incision should be placed along the axis of the ring finger to avoid injury to the super ficial branches of the PCBMN. When open release is used, the very smal l terminal branches in the loose tissue of the ligament will be transe cted; this may in part be responsible for postoperative soft tissue pa in. For endoscopic releases, some risk for transection of the main tru nk of the PCBMN at the proximal incision exists. Repeated passes of th e endoscopic knife should be avoided in an attempt to limit damage to the small fibers in the superficial aspect of the ligament.