Anatomic Variations and Malformations as Rare Causes of Median Nerve Compression in Adults

Peperkamp, Kirsten; Natroshvili, Tina; Malyar, Masoud A; Heine, Erwin P.; Walbeehm, Erik T.

doi:10.1097/sap.0000000000002813

Cited by 6 publications

(2 citation statements)

References 23 publications

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“…In addition to lipomas, entrapment neuropathy may be caused following the trans-muscular course of a MN branch in the forearm, with symptoms resembling CTS (15). Other anatomical factors causing CTS include accessory and variant muscles (elongated bellies or tendons of distal flexor muscles) in the distal forearm area, a bifid MN that may be compressed along its course, and the presence of a persistent median artery (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

A Giant Lipoma in the Distal Forearm of a Cadaver

Natsis,

Achlatis,

Piagkou

et al. 2023

ama

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Objective. Lipomas are very common tumors which usually prefer the upper limbs and, depending on their size, may cause nerve compression, or may be asymptomatic. The current cadaveric report describes a giant lipoma in the distal forearm area. Case Report. A large mass (5.1 × 3.2 × 1.6 cm) was identified on the palmar surface of the distal forearm, during dissection of a 63-year-old male cadaver. The mass caused anteromedial displacement and flattening of the median nerve (MN). Despite the lack of information about the subject’s medical history, MN compression was assumed on the basis of the lipoma’s size, its vicinity to neural structures, and the MN displacement and flattening. Conclusion. The enlarged distal forearm lipoma, located adjacent to the carpal tunnel, displaced and flattened the MN. The cadaveric finding described is clinically relevant for both differential diagnosis and surgical treatment of carpal tunnel syndrome.

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Section: Discussionmentioning

confidence: 99%

A Giant Lipoma in the Distal Forearm of a Cadaver

Natsis,

Achlatis,

Piagkou

et al. 2023

ama

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“…Variations causing entrapment syndromes are most often related to the median or ulnar nerves. Muscular, vascular, or combined anomalies in the (fore)arm, when overlooked, may be mistaken for carpal tunnel syndrome or compression at Guyon's canal or misdiagnosed as pronator teres or cubital tunnel syndrome (Peperkamp et al, 2022).…”

Section: Differential Diagnosismentioning

confidence: 99%

Upper Limb Nerve Variations May Alter Clinical Diagnosis: A Scoping Review

Scafoglieri,

Wynant,

Héréus

et al. 2023

Int. J. Morphol.

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Upper limb nerve variations may be related to the absence of a nerve, an interconnection between two nerves or a variant course. The purpose of this review is to screen the existing literature on upper limb nerve variations that may alter the neurologic diagnostic process. A scoping review was performed following PRISMA for Scoping Reviews guidelines. Initially, 1331 articles were identified by searching Pubmed and Web of Science until the 22nd of October 2022. After screening, reading, and additional searching 50 articles were included in this review. Variations were divided into two categories: 1) variations causing a different innervation pattern involving sensory, motor, or both types of fibers, and 2) variations causing or related to compression syndromes. Two-thirds of the included articles were cadaver studies. Nine articles were diagnostic studies on symptomatic or healthy individuals involving medical imaging and/or surgery. Nerve variations that may cause a different innervation pattern concern most frequently their interconnection. The connection between the median and musculocutaneous nerve in the upper limb and the connection between the median and ulnar nerve in the forearm (Martin-Gruber) or hand (Riche-Cannieu) may be present in half of the population. Injury to these connections may cause compound peripheral neuropathies a result of variant sensory and motor branching patterns. Muscular, vascular, or combined anomalies in the forearm were reported as causes of entrapment neuropathies. These nerve variations may mimic classical entrapment syndromes such as carpal tunnel syndrome or compression at ulnar canal (Guyon's canal). Knowledge of frequent nerve variations in the arm may be important during the diagnostic process and examination. Variant innervation patterns may explain non-classical clinical signs and/or symptoms during provocative tests. Classical nerve compression syndromes in the arm may warrant for differential diagnosis, especially in the case of persistent or recurrent symptoms.

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