Anastomosis Between Ulnar And Radial Nerve: A Cadaveric Study

  • Humberto Ferreira Arquez Colombian Association Morphology.

Abstract

Background: Brachial plexus variations are not rare. Variations in its terminal branches in the arm or forearm are frequently reported. Communications between branches of the brachial plexus are also not uncommon findings; however there is very little mention of communication between the radial and ulnar nerves in the literature. In view of this significance is performed this study with the purpose to determine any communications of radial nerve with neighboring peripheral nerves at level of axilla, arm, forearm.


Methods and Findings: A total of 17 cadavers with different age groups were used for this study. The upper limbs region (34 sides) were dissected carefully and photographed in the Morphology Laboratory at the University of Pamplona. Of the 34 upper limbs studied 33 showed normal morphology, the course and branching patterns of the nerves was normal (97.06%). In 1 specimen in the left forearm (2.94%), the radial and ulnar nerves were dissected and communicating branches were observed originating near the upper third in the posterior aspect of the forearm traveling from the ulnar to the radial nerve. The communicating branch was approximately 5.84 cm long and 1.73 mm in diameter. This anastomotic branch is an unusual anastomosis, no described in the literature between radial and ulnar nerve in forearm. Knowledge on the variant pattern of peripheral nerves is imperative not only for the surgeons, but also for the radiologists during image technology and MRI interpretations and for the anesthesiologists before administering anesthetic agents thus in diagnostic approaches.  


Conclusions: Lack of understanding of these variations can also confound the assessment of the severity of nerve injury as well as recovery. Awareness of such anatomical variations is very important in order to proper diagnosis of sensorimotor symptoms.

Author Biography

Humberto Ferreira Arquez, Colombian Association Morphology.
Professor Human Morphology, Medicine Program, University of Pamplona   Morphology Laboratory Coordinator- University of Pamplona

References

1. Swamy RS, Kumar N, Nayak SB, Shetty SD, Aithal A. Presence of communication between radial and ulnar nerve at high humeral level and its distribution to triceps brachii muscle. IJHAS. 2015; 4(1):39-41.
2. Taheri MMH, Afshar M. Connection between radial and ulnar nerves at humeral level and its clinical significance: A cadaveric case report. Int. J. Morphol. 2015; 33(4):1559-62.
3. Ferreira H. Communication between the median and musculocutaneous nerve. An anatomical study. Int J Pharm Bio Sci. 2015 April; 6(2): (B) 951 – 7.
4. Ferreira H, Arias DK. An anatomical study of formation of the median nerve. Journal of Chemical and Pharmaceutical Research. 2016; 8(5):22-6.
5. Casadiego JT, Ferreira H. Anastomosis between median and ulnar nerve in forearm and hand. Journal of Chemical and Pharmaceutical Research. 2016; 8(8):675-80.
6. Ferreira H, Arias DK. An anatomical study of formation of the median nerve. Journal of Chemical and Pharmaceutical Research. 2016, 8(5):22-6
7. Aktan ZA, Öztürk L, Bilge O, Özer MA, Pinar YA. A cadaveric study of the anatomic variations of the brachial plexus nerves in the axillary region and arm. Turk. J. Med. Sci. 2001; 31:147-50.
8. Guru A, Kumar N, Shanthakumar SR, et al. “Anatomical Study of the Ulnar Nerve Variations at High Humeral Level and Their Possible Clinical and Diagnostic Implications,” Anatomy Research International. 2015; Article ID 378063, doi:10.1155/2015/378063.
9. Loukas M, Louis RG Jr, Wartmann CT, Tubbs RS, Turan-Ozdemir S, Kramer J. The clinical anatomy of the communications between the radial and ulnar nerves on the dorsal surface of the hand. Surg Radiol Anat. 2008; 30: 85–90.
10. Leis AA, Wells KJ. Radial nerve cutaneous innervation to the ulnar dorsum of the hand. Clin Neuropysiol. 2008; 119: 662–6.
11. Lalit M, Kullar JS, Piplani S. Communication between radial and ulnar nerve at a high humeral level: A case report. Int J Anat Res. 2014;2(2):315-7.
12. Chiarapattanakom P, Leechavengvons S, Witoonchart K, Uerpairojkit C, Thuvasethakul P. Anatomy and internal topography of the musculocutaneous nerve: The nerves to the biceps and brachialis muscle. J Hand Surg. 1998; 23A: 250-55.
13. Lombardo DJ, Buzas D, Siegel G, Afsari A. Aberrant radial-ulnar nerve communication in the upper arm presenting as an unusual radial nerve palsy: a case report. Surg Radiol Anat. 2015; 37:411–13.
14. Ajayi NO, Lazarus L, Satyapal KS. Multiple variations of the branches of the brachial plexus with bilateral connections between ulnar and radial nerves. Int. J. Morphol. 2012; 30(2):656-60.
15. Kroll DA, Caplan RA, Posner K, Ward RJ, Cheney FW. Nerve injury which is associated with anaesthesia. Anesthesiology. 1990; 73(2): 202–7.
16. Sachdeva K, Singla RK. An unusual origin of an ulnar nerve from a median nerve—a case report. Journal of Clinical and Diagnostic Research. 2011; 5 (6): 1270–1.
17. Hoogbergenand MM, Kauer JMG. An unusual ulnar nerve median nerve communicating branch. Journal of Anatomy. 1992;181(3):513–6.
18. Collins JD, Shaver ML, Disher AC, Miller TQ. Compromising abnormalities of the brachial plexus as displayed by magnetic resonance imaging. Clinical Anatomy. 1995;8(1): 1–16.
19. Sunderland S. The median nerve: anatomical and physiological features. In Nerves and Nerve Injury. 2nd edition. Churchill Livingstone, Edinburgh, UK, 1978: 672–7.
Published
2017-06-21
How to Cite
FERREIRA ARQUEZ, Humberto. Anastomosis Between Ulnar And Radial Nerve: A Cadaveric Study. International Archives of Medicine, [S.l.], v. 10, june 2017. ISSN 1755-7682. Available at: <http://imedicalsociety.org/ojs/index.php/iam/article/view/2330>. Date accessed: 15 oct. 2018. doi: https://doi.org/10.3823/2479.
Section
Human Anatomy

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