Relationships of the palmar cutaneous branch of the median nerve: a morphometric study

[Anatomical landmarks for peripheral neural blocks of the forearm and the wrist: A cadaveric study]

BACKGROUND

There are no data ensuring a standardized landmark-based-technique for blocking sensitive nerves of the forearm.

PURPOSE

To identify locations were with use of good palpable bony landmarks and lines between them sensitive nerve blocks on the forearm can be done with great success.

MATERIAL AND METHODS

Dissection of the superficial branch of the radial nerve (SBRN), the dorsal branch of the ulnar nerve (DBUN), the lateral, medial and dorsal antebrachial cutaneous nerve (LACN, MACN, and DACN) as well as the palmar branch of the median nerve (PBMN) was performed on five upper limbs of five different Caucasian cadavers. With respect to radius and ulnar styloid, Lister's tubercle, and the medial and lateral epicondyle of the humerus as well as connecting lines between these bony landmarks locations were defined, where the mentioned nerves can be found and blocked.

RESULTS

The six nerves can be safely blocked at the following sites: the SBRN 85 mm proximal to Lister's tubercle on a line drawn between the latter and the medial humeral epicondyle; the LACN 38 mm and the dorsal one 32 mm ulnar from the lateral epicondyle; the MACN 14 mm radial to the medial epicondyle; the DBUN 27 mm proximal to the ulnar styloid in direction to the lateral epicondyle; the PBMN 45 mm proximal to the radial styloid following a line between the latter and the medial epicondyle and 21 mm ulnarwards perpendicular to this line.

CONCLUSION

Using superficial good palpable landmarks at the wrist and elbow as well as connecting lines between them the SBRN, DBUN, PBMN, LACN, MACN, and DACN can easily be located.