“…The hand and fingers receive sensory and motor innervation through the nerve plexus originating from the median, radial, and ulnar nerves (schematic drawings 3 and 4 ). After crossing the carpal tunnel, the median nerve divides into lateral and medial branches, with the former originating a motor recurrent branch for the thenar eminence muscles and three proper volar digital nerves for the thumb and radial aspect of the second finger [ 4 ]. The medial branch originates cutaneous sensory common volar digital nerves, each further branching into two proper volar digital nerves for the second and third fingers and the radial side of the fourth finger [ 4 ].…”
Macrodactyly, a often congenital anomaly, entails abnormal enlargement of digits, predominantly affecting hands or feet, either in isolation or as part of a syndromic condition. The authors present a case of Macrodystrophia Lipomatosa (ML), a form of macrodactyly, in a 62-year-old patient, emphasizing macrodactyly manifestations through clinical and radiological assessments. Additionally, the authors explore anatomical aspects related to nerve distribution in affected digits, providing a comprehensive understanding of ML.
Teaching Point:
Explore macrodactyly, emphasizing digits nerve plexus anatomy, which can reveal crucial clues for diagnosing a specific form of this anomaly.
“…The hand and fingers receive sensory and motor innervation through the nerve plexus originating from the median, radial, and ulnar nerves (schematic drawings 3 and 4 ). After crossing the carpal tunnel, the median nerve divides into lateral and medial branches, with the former originating a motor recurrent branch for the thenar eminence muscles and three proper volar digital nerves for the thumb and radial aspect of the second finger [ 4 ]. The medial branch originates cutaneous sensory common volar digital nerves, each further branching into two proper volar digital nerves for the second and third fingers and the radial side of the fourth finger [ 4 ].…”
Macrodactyly, a often congenital anomaly, entails abnormal enlargement of digits, predominantly affecting hands or feet, either in isolation or as part of a syndromic condition. The authors present a case of Macrodystrophia Lipomatosa (ML), a form of macrodactyly, in a 62-year-old patient, emphasizing macrodactyly manifestations through clinical and radiological assessments. Additionally, the authors explore anatomical aspects related to nerve distribution in affected digits, providing a comprehensive understanding of ML.
Teaching Point:
Explore macrodactyly, emphasizing digits nerve plexus anatomy, which can reveal crucial clues for diagnosing a specific form of this anomaly.
“…Digital PNSTs mostly occurs from digital nerves. The clinical and imaging findings of digital PNSTs have been reported as cases, but have not been described in a specific study [3,5,8]. Therefore, the clinical symptoms and MRI findings of them are still uncertain.…”
Section: Discussionmentioning
confidence: 99%
“…The cases of digital benign PNST were selected consecutively from August 2004 to June 2019 during which 660 MRIs of PNSTs were performed. Among this group of subjects who underwent MRI for PNST, we identified 16 cases of digital benign PNST involving an area from the digital phalangeal level to the web space level where each common digital nerve is divided into proper digital nerves [3,16]. Subjects from the control group of 20 cases of major-nerve benign PNSTs were selected out of the MRIs performed in our institution with inclusion criteria of benign PNST involving the major nerves of the upper or lower extremities during the same study period.…”
Section: Study Populationmentioning
confidence: 99%
“…Various soft tissue masses may be encountered in the digit, and the majority are benign [1,2]. The most common soft tissue masses in the digit are ganglions followed by tenosynovial giant cell tumor (GCT) [3]. Most soft tissue masses in the digit occur as a small nodule which may or may not present clinical symptoms.…”
Objective To compare the symptoms and magnetic resonance imaging (MRI) findings between digital peripheral nerve sheath tumor (PNST) and major-nerve PNST. Methods A total 36 cases with benign PNSTs (16 digital, 20 major-nerve) were enrolled. Chief complaint and Tinel sign were reviewed. Five classic MRI features of PNST, the signal intensity (SI), the enhancement, and the shape of tumor were evaluated on MRI. Results Half of each group showed tenderness. Tinel sign was less frequent in digital PNST (12.5%) than major-nerve PNST (95.0%, P < 0.001). Split fat sign, entering and exiting nerve, target sign, and thin hyperintense rim were only observed in major-nerve PNST (P = <0.001, <0.001, 0.492, and 0.002, respectively). Fascicular sign was found in digital PNSTs (31.3%), but more frequent in major-nerve PNST (P < 0.001). In digital PNSTs, mild hyperintense SIs (56.2%) on T1-weighted images (T1-WI) was noted, but none in major-nerve PNST (P < 0.001). Both groups showed hyperintense SIs on T2-WI (P = 0.371). Homogeneity on T2-WI was noted in 43.8% of digital PNSTs, but none in major-nerve PNSTs (P = 0.004). Both groups showed heterogeneous enhancement (P = 0.066), but four (25%) digital PNSTs showed homogeneous enhancement. Lobulated shape was noted in 50% of digital PNSTs but none of major-nerve PNSTs (P = 0.001). Digital nerve was involved at 81.3% of digital PNSTs. Three foot cases showed unusual manifestations: bone destruction, skin thickening, and subungual location. Conclusion In digital PNSTs, Tinel sign is not commonly found and classic MRI findings is insufficient. In addition, some digital PNSTs show different SI and enhancement from major-nerve PNSTs.
“…They are most commonly damaged by trauma (including surgical as shown in Fig. 17 ), but other causes of entrapment include inflammation, vascular malformations and neoplasms [ 18 ]. Fig.…”
Peripheral nerves of the upper limb may become entrapped at various points during their anatomical course. While physical examination and nerve conduction studies are the mainstay of diagnosis, there are multiple imaging options, specifically ultrasound and magnetic resonance imaging (MRI), which offer important information about the potential cause and location of nerve entrapment that can help guide management. This article overviews the anatomical course of various upper limb nerves, including the long thoracic, spinal accessory, axillary, suprascapular, radial, median, ulnar, and musculocutaneous nerves, and describes the common locations and causes of entrapments for each of the nerves. Common ultrasound and MRI findings of nerve entrapments, direct or indirect, are described, and various examples of the more commonly observed cases of upper limb nerve entrapments are provided.
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