CONCLUZII JE

The superficial palmar arch and deep palmar arch were found to be on average 15.3 +/- 8.60 mm and 6.70
+/- 4.82 mm distal to Kaplan's cardinal line, respectively.

. In no case did a branch of the palmar cutaneous nerve extend ulnar to the axial line of the ring finger

The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the
PL in carpal tunnel surgeries in Nigerians.

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https://www.ncbi.nlm.nih.gov/pubmed/18176219?log$=activity

Anatomical landmarks to the superficial and deep palmar arches.

RESULTS:

The superficial palmar arch and deep palmar arch were found to be on average 15.3 +/- 8.60 mm and 6.70
+/- 4.82 mm distal to Kaplan's cardinal line, respectively. The superficial palmar arch was found to be on
average 51.8 +/- 7.56 mm distal to the distal wrist crease, while the deep palmar arch was only 40.1 +/- 7.92
mm from the distal wrist crease. The average distances from the superficial palmar arch and deep palmar arch
to the carpometacarpal joint of the ring finger were 32.2 +/- 6.33 mm and 18.3 +/- 4.64 mm, respectively. On
arteriography, the superficial palmar arch and deep palmar arch were on average 50.3 +/- 8.61 mm and 44.89
+/- 4.77 mm, respectively, from the radiocarpal joint.

CONCLUSIONS:

The superficial and deep palmar arches were located at consistent distances from easily identifiable surface
and bony landmarks. Knowledge of these predictable anatomical relations would aid clinicians in surgical
dissection, treatment of vascular occlusive disease, and interpretation of abnormal arteriograms when only
one arch is present.

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https://www.ncbi.nlm.nih.gov/pubmed/2299166?log$=activity

Palmar cutaneous branch of the median nerve.

Abstract

The palmar cutaneous branch of the median nerve was dissected in 25 fresh cadavers. The origin from the
median nerve, the course, termination, and variability of the palmar cutaneous nerve are described in relation
to two reference lines. In no case did a branch of the palmar cutaneous nerve extend ulnar to the axial line of
the ring finger. The planning of incisions around the palmar aspect of the palm and wrist should be based on
this anatomical knowledge.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762000/?log$=activity

Anatomic variations in the palmar cutaneous branch of the median nerve among adults in Lagos, Nigeria

Results:

The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of
the radial branch to PL was 0.81 cm (SD 0.3 cm), while the ulnar branch was 0.3 cm (SD 0.1 cm). from same
structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD 2.1 cm). We noted the
terminal distal branching pattern of the nerve to be highly variable.

PL = palmar longus

Conclusion:

The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the
PL in carpal tunnel surgeries in Nigerians.

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https://www.ncbi.nlm.nih.gov/pubmed/16543870

RESULTS:

The anatomic relationships between the TCL and vascular and neural structures were measured. The ulnar
neurovascular structures usually passed just over ulnar to the superior portion of the hook of the hamate.
However, in 11 hands, a looped ulnar artery coursed 1 to 4 mm radial to the hook of the hamate and continued
to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-2-2 mm
radial to the hook of the hamate) with the wrist in radial flexion (of the wrist). During ulnar flexion of the wrist,
the ulnar artery shifts more radially beyond the hook of the hamate (2-7 mm).

CONCLUSION:

It is appropriate to transect the ligament over 4 mm apart from the lateral margin of the hook of the hamate
without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting
the TCL in the ulnar flexed wrist position to protect the ulnar neurovascular structure. The proximal portal
could be made just ulnar to the palmaris longus tendon to spare the neurovascular structures in the proximal
portion of the TCL.

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https://www.ncbi.nlm.nih.gov/pubmed/8842959?log$=activity
Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release.

Abstract

The course of the palmar cutaneous branch of the median nerve (PCBMN) was studied in 25 fresh cadaveric
upper extremities in order to identify its relation to local structures and commonly used incisions for carpal
tunnel release. The PCBMN was found to closely underlie the thenar crease (average, 0-2 mm radial to
crease; range, 6 mm ulnar to 6 mm radial to thenar crease), suggesting that an incision fashioned in the thenar
crease would lead to frequent PCBMN injury. The PCBMN was also found to cross the axis of the ring finger
when the axis was determined with the finger flexed into the palm. The axis of the ring finger, as drawn with
the ring finger extended, projected in a more ulnar direction. The PCBMN was an average of 9 mm radial to
this projection (range, 1-16 mm). An analysis of 100 human volunteer hands demonstrated that the deepest
point between the thenar and hypothenar eminencies was a constant landmark in the proximal palm
(interthenar depression). The PCBMN traveled an average of 5 mm radial to the interthenar depression
(range, 0-12 mm radial). Thenar crease anatomy and ring finger projection were highly variable both in
absolute location and configuration, providing a poor basis for incision placement. An incision placed
approximately 5 mm ulnar to the interthenar depression, extending in the direction of the third web space,
will decrease the incidence of injury to the PCBMN.

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https://www.ncbi.nlm.nih.gov/pubmed/19540078

The palmar fat pad is a reliable intraoperative landmark during carpal tunnel release.

RESULTS:

The proximal aspect of the palmar fat pad is 2.0 mm proximal to the distal edge of the TCL. The distal end of
the TCL, as measured along the axis of the radial border of the ring finger is 12.7 mm from the most proximal
aspect of the palmar arch and 6.5 mm from the nearest aspect of the motor branch. Flexing the fingers
decreases the distance between the distal end of the TCL and the fat pad while not markedly affecting the
distance between the TCL and the palmar arch or the motor branch.

CONCLUSIONS:

The palmar fat pad is a reliable anatomic landmark during carpal tunnel release. When dividing the TCL from
proximal to distal, visualization of the proximal aspect of the fat pad indicates that the distal edge of the TCL is
within approximately 2 mm and indicates that distal dissection beyond this extent is unnecessary.