High-resolution sonographic study of the communicating branch of Berrettini: an anatomical feasibility study

Sensory changes are common manifestations of nerve complications of carpal tunnel surgery. Division or contusion of a superficial communicating branch between the median nerve and the ulnar nerve, the communicating branch of Berrettini, can explain these symptoms. The aim of this study was to describe the potential value of high-resolution sonography to examine this branch. We conducted a study on eight fresh cadaver hands. An ultrasound assessment of the communicating branch of Berrettini, accompanied by an injection of methylene blue, was performed by a senior radiologist. Subsequent dissections confirmed that the eight guided ultrasound injections allowed the methylene blue to be placed around the origin and termination of the communicating branch of Berrettini. This study extends the limits of ultrasound both in the postoperative diagnosis of potential nerve complications and its possible use in ultrasound-guided carpal tunnel release.

Comprehensive Summary of Anastomoses between the Median and Ulnar Nerves in the Forearm and Hand

Four main presentations of median-ulnar anastomosis exist. Those manifesting in the forearm include Martin-Gruber and Marinacci, while those found in the hand are referred to as Riche-Cannieu and Berrettini. Martin-Gruber anastomosis involves branching of the median nerve proximally to ulnar nerve distally. Marinacci anastomosis, the rarest of all the presentations, is often termed reverse Martin-Gruber, with the ulnar nerve stemming proximally to meet the median nerve distally in the forearm. Riche-Cannieu anastomosis occurs as an interconnection between the recurrent branch of the median nerve and the deep branch of the ulnar nerve in the hand. Berrettini anastomosis is the most frequently encountered of the anomalies and is described as a neural connection between common digital nerves of the ulnar and median nerves. Due to altered innervation patterns, musculoskeletal disorders of the forearm and hand may present with misleading symptoms. Additionally, existence of an anastomosis may require an alteration of surgical methods or be a source of iatrogenic injury. Consequently, knowledge of these anastomoses is crucial to clinical practice. Therefore, the objective of this review is to concisely present the most relevant information regarding median and ulnar anastomoses in the forearm and hand.

Connections between the median and ulnar nerves evidenced by electromyography in Lima, Peru, 2016

INTRODUCTION

Connections are common communications between 2similar anatomical elements. Some of the most common are in the forearm between the median and ulnar nerves and are clinically important because they produce variations in motor and sensory innervation and can cause confusion when diagnosing peripheral nerve pathology.

METHOD

Descriptive, cross-sectional, observational study. A total of 127 patients older than 18 years were studied, electromyography was performed on the upper limbs and the frequency of presentation of the connections was obtained.

RESULT

The Riche-Cannieu connection was present in 16.5% of the total patients studied, of which 42.9% presented in the left arm and 89.3% in isolation. The Marinacci connection was the second in frequency with 15.7%, of which 40% was presented in the left arm and 45.8% coexisted with another connection. The Berrettini connection was the third in frequency with 9.4%, 50% presented in the left arm and 53.3% of the sample was found in isolation. Martin-Grüber's connection was the least frequent at 7.1% of our cases, of which 44.5% presented bilaterally and 90% associated with another connection.

CONCLUSION

It is concluded that of the 4types of connection studied the most frequent in our environment was the Riche-Cannieu with predominance of the left arm and in isolation.