Topographic anatomy of the recurrent branch of the median nerve using bony landmarks: a clinical-surgical study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The recurrent branch of the median nerve (RBMN) is a critical structure in carpal tunnel surgery, where inadvertent injury can lead to significant functional impairment. Although soft tissue landmarks are commonly used for RBMN localization, they often vary between individuals and are susceptible to intraoperative shifts. This study aimed to establish fixed bony landmarks for reliable localization of the RBMN, potentially reducing the risk of iatrogenic nerve injury. MATERIALS AND METHODS: This clinical-surgical study included 58 patients (59 hands) who underwent open carpal tunnel release between January 2020 and September 2022. Intraoperative measurements were taken from the origin of the RBMN to three fixed bony landmarks: the apex of the first metacarpal head, the apex of the third metacarpal head, and the tip of the radial styloid process. Distances were recorded by two independent observers using a sterile, millimeter-calibrated ruler. Statistical analysis included interobserver and intraobserver reliability assessments. RESULTS: The mean distance from the RBMN origin to the first metacarpal head was 39.7 ± 5.2 mm, that to the third metacarpal head was 50.2 ± 4.7 mm, and that to the radial styloid process was 59.4 ± 4.9 mm. There were no statistically significant differences in these measurements between male and female patients (p > 0.05). Most RBMN branches (67%) were extraligamentous, followed by subligamentous (25%) and transligamentous (8%) branches, according to the Lanz classification. Postoperative clinical evaluations using the Boston Carpal Tunnel Questionnaire (BCTQ) showed significant improvements in both symptom severity and functional status (p < 0.001). CONCLUSIONS: Fixed bony landmarks provide a reliable and reproducible method for localizing the RBMN during carpal tunnel release, potentially reducing the risk of nerve injury. These findings support the use of bony reference points as consistent intraoperative guides to safer surgical outcomes.
Source: Folia Morphologica
DOI: 10.5603/fm.106205
Language: English
Topic: Peripheral Nerve Disorders
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413137998