A CASE OF DISTAL ULNAR NERVE VARIATION – PRESENCE OF SENSORY LOOP AROUND THE HOOK OF THE HAMATE BONE. Un caso de variación distal del nervio ulnar – Presencia de un bucle alrededor del gancho del hueso ganchoso

Autores/as

  • Alexander K Angelov Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia
  • Lazar Jelev Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia

DOI:

https://doi.org/10.31051/1852.8023.v6.n2.14131

Palabras clave:

ulnar nerve variation, neural loop, hamate bone, flexor retinaculum, clinical implications, variación del nervio ulnar, lazo neural, hueso ganchoso, retináculo flexor, implicaciones clínicas

Resumen

Las variaciones del nervio cubital ulnar en la muñeca son extrañas, pero todavía tienen importancia clínica. Durante una disección de rutina de la mano derecha de un hombre europeo de 67 años, se encontró en la muñeca  un nervio ulnar aberrante. Su rama superficial se bifurcó y formó un lazo completo alrededor del gancho del hueso ganchoso. Los nervios sensoriales de los dedos surgieron de las diferentes partes de este lazo. La presencia de dicha variación predispone al nervio a una neuropatía por compresión incluyendo una lesión accidental ocasionada durante las intervenciones quirúrgicas.

 

Ulnar nerve variations in the wrist are rare but still have clinical importance. In the course of a routine dissection of the right hand of a 67-y-old Caucasian male cadaver an aberrant ulnar nerve at the wrist was found. Its superficial branch bifurcated and formed a complete loop around the hook of the hamate bone. The sensory digital nerves arose from the different parts of this loop. The presence of such a variant neural loop predisposes the nerve to compression neuropathy and accidental injury during surgical interventions.

Citas

Ablett CT, Hackett LA. 2008. Hypothenar hammer syndrome: case reports and brief review. Clin Med Res 6: 3-8.

Aguiar PH, Bor-Seng-Shu E, Gomes-Pinto F, Almeida- Leme RJ, Freitas AB, Martins RS, Nakagawa ES, Tedesco-Marchese AJ. 2001. Surgical management of Guyon's canal syndrome, an ulnar nerve entrapment at the wrist: report of two cases. Arq Neuropsiquiatr 59: 106-11.

Ayan I, Serinsöz E. 2014. Osteoblastoma in the os hamatum: a rare case report. Eklem Hastalik Cerrahisi 25: 56-59.

Banasik M, Madziarska K, Weyde W, Kusztal M, Gołębiowski T, Zmonarski S, Krajewska M, Janczak D, Klinger M. 2011. A rare variant route of the ulnar artery does not contraindicate the creation of a fistula in the wrist of a diabetic patient with end-stage renal disease. Postepy Hig Med Dosw 65: 654-57.

Chan JC, Tiong WH, Hennessy MJ, Kelly JL. 2008. A Guyon's canal ganglion presenting as occupational overuse syndrome: A case report. J Brachial Plex Peripher Nerve Inj 3: 4.

Chuckpaiwong B, Harnroongroj T. 2009. Palmar pressure distribution during push-up exercise. Singapore Med J 50: 702-04.

Dodds GA 3rd, Hale D, Jackson WT. 1990. Incidence of anatomic variants in Guyon's canal. J Hand Surg Am 15: 352-55.

Elias DA, Lax MJ, Anastakis DJ. 2001. Musculo-skeletal images. Ganglion cyst of Guyon's canal causing ulnar nerve compression. Can J Surg 44: 331-32.

Fenning JB. 1965. Deep ulnar-nerve paralysis resulting from an anatomical abnormality. A case report. J Bone Joint Surg Am 47: 1381-82.

Georgiev GP, Jelev L. 2011. An aberrant flexor digiti minimi brevis manus muscle. J Hand Surg Am 36: 1965-67.

Haase J. 2010. Distal median- and ulnar nerve compression syndromes. Pan Arab Journal of Neurosurgery 14: 38-45.

Helal B. 1978. Chronic overuse injuries of the piso-triquetral joint in racquet game players. Br J Sports Med 12: 195-98.

Hill ML, Shoja MM, Salter EG, Tubbs RS. 2006. An unusual muscle of the wrist with potential compression of the ulnar nerve. Folia Morphol (Warsz) 65: 178-80.

Lassa R, Shrewsbury MM. 1975. A variation in the path of the deep motor branch of the ulnar nerve at the wrist. J Bone Joint Surg Am 57: 990-91.

Lokanathan TH, Surendra M, Ajay N, Rajendra RR. 2014. Unusual Co-existence of Biapo-neurotic Palmaris Longus and Accessory Abductor Digiti Minimi in Man. J Clin Diagn Res 8: 146-47.

Moffat JH. 1964. Traumatic neuritis of the deep palmar branch of the ulnar nerve. Can Med Assoc J 91: 230-31.

Musthyala S, Jones WA. 2005. Symptomatic ulnar neural loop at the wrist. J Hand Surg Br 30: 326-27.

Ogun TC, Karalezli N, Ogun CO. 2007. The concomitant presence of two anomalous muscles in the forearm. Hand (N Y) 2: 120-22.

Olave E, Del Sol M, Gabrielli C, Rodrigues CF. 1999. Abnormal disposition of a branch of the ulnar nerve in the flexor retinaculum. J Anat 194: 473-74.

Osborne G. 1959. Ulnar neuritis. Postgrad Med J 35: 392-96.

Pearce C, Feinberg J, Wolfe SW. 2009. Ulnar neuropathy at the wrist. HSS J 5: 180-83.

Rohilla S, Yadav RK, Dhaulakhandi DB. 2009. Lipoma of Guyon's canal causing ulnar neuropathy. J Orthop Traumatol 10: 101-03.

Shea JD, McClain EJ. 1969. Ulnar nerve compression syndromes at and below the wrist. J Bone Joint Surg Am 51: 1095-103.

Standring S. 2005. Gray's Anatomy. The Anatomical Basis of Clinical Practice. 39th Ed. Churchill Livingstone: Elsevier. p. 913.

Yasen S. 2012. Acute calcific tendinitis of the flexor carpi ulnaris causing acute compressive neuropathy of the ulnar nerve: a case report. J Orthop Surg (Hong Kong) 20: 414-16.

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Publicado

2016-03-28

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Presentación de Casos