A comprehensive review of motor innervation of the hand: variations and clinical significance
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Purpose The objective of the present review is to assemble the recognized anatomical variations, classifications, and clinical evidence with regard to innervation of the hand and discuss the clinical significance of these variations. Methods The material for this review was obtained by exploring PubMed and Google Scholar (search terms: hand innervation, variations of ulnar nerve, variations of median nerve, variations of radial nerve) as well as from standard anatomy texts. This initial search returned approximately 300 articles, which was reduced by abstract or title review. Reviewing the reference lists of significant papers uncovered further studies missed in the initial search. A few standard anatomy texts were also consulted for normal anatomy. Results The median and ulnar nerves frequently display a number of significant deviations from the traditionally taught branching patterns. The traditionally taught innervation of the hand is also found to be highly variable. This is especially evident with regard to the motor innervation of thenar muscles. These variations may be explained by the often under-recognized anastomoses that exist in the hand, such as the motor Riche–Cannieu Anastomosis. Some of these variations are associated significant clinical consequences. Conclusions The median and ulnar nerves display many anatomical variations, often with significant clinical implications. Awareness about these variations is clinically important when interpreting clinical examination findings, electrophysiological and radiological investigation as well as during management of patients in terms of surgical and anesthetic procedures.
Surgical and Radiologic Anatomy
© Springer-Verlag France SAS 2017 This is an electronic version of an article published in Surgical and Radiologic Anatomy, 1-11,2017. Surgical and Radiologic Anatomy is available online at: http://link.springer.com/ with the open URL of your article.
This publication has been entered into Griffith Research Online as an Advanced Online Version.
Medical Physiology not elsewhere classified