Anatomic study of the ramus communicans between the ulnar and median nerves

The communicating branch between the fourth and third common digital nerves in the palm of the hand was studied. The incidence and branching pattern w ere studied in 53 dissected cadaveric hands. The "danger zone" in which the nerve is at risk during surgery was established using morphometric data. A communicating branch was found in 50 hands. It originated proximally from the fourth common digital nerve to join the third common digital nerve dist ally in 44 hands and traversed perpendicularly between the third and fourth common digital nerves in 4 hands. In the 2 remaining hands the branch left the third common digital nerve proximally to join the fourth digital commo n nerve distally. In 90% of the hands the ramus communicans crossed over in the middle third of the palm of the hand. As a cautious measure, hand surg eons should rake into account that this structure could cross over anywhere in the middle three fifths of the palm. (J Hand Surg 2000;25A:948-954. Cop yright (C) 2000 by the American Society for Surgery of the Hand.).