Martin Gruber Anastomosis: Difference between revisions
Nehal Shah (talk | contribs) (Added innervation pattern of hand muscles) |
Nehal Shah (talk | contribs) (Added basic of common patterns of anomalous innervation) |
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== Introduction == | == Introduction == | ||
Anomalous means deviated from normal / routine. Anomalous innervations are routinely a normal occurrence. But if these are not recognised, they may be mistaken for technical pitfall or an actual pathology which may not be present <ref name=":0">Aziz Saba EK. Electrophysiological study of Martin—Gruber anastomosis in a sample of Egyptians. Egyptian Rheumatology and Rehabilitation. 2017 Oct;44:153-8.</ref> Nerve communication between the median and ulnar nerves in the forearm, is known as Martin-Gruber anastomosis. This implies that nerve fascicles from Median nerve transfers to Ulnar nerve<ref>Cavalheiro CS, Razuk Filho M, Pedro G, Caetano MF, Vieira LA, Caetano EB. Clinical repercussions of Martin-Gruber anastomosis: anatomical study. Revista Brasileira de Ortopedia. 2016 Mar;51:214-23.</ref> | Anomalous means deviated from normal / routine. Anomalous innervations are routinely a normal occurrence. But if these are not recognised, they may be mistaken for technical pitfall or an actual pathology which may not be present <ref name=":0">Aziz Saba EK. Electrophysiological study of Martin—Gruber anastomosis in a sample of Egyptians. Egyptian Rheumatology and Rehabilitation. 2017 Oct;44:153-8.</ref> Nerve communication between the median and ulnar nerves in the forearm, is known as Martin-Gruber anastomosis. This implies that nerve fascicles from Median nerve transfers to Ulnar nerve<ref name=":1">Cavalheiro CS, Razuk Filho M, Pedro G, Caetano MF, Vieira LA, Caetano EB. Clinical repercussions of Martin-Gruber anastomosis: anatomical study. Revista Brasileira de Ortopedia. 2016 Mar;51:214-23.</ref> | ||
The prevalence of Martin Gruber Anastomosis (MGA) is between 3.3 to 40% of population <ref name=":0" />with a prevalence of 11.6 % in Indian population <ref>Kaur N, Singla RK, Kullar JS. Martin–Gruber Anastomosis-A cadaveric study in north indian population. Journal of Clinical and Diagnostic Research: JCDR. 2016 Feb;10(2):AC09.</ref>Median to Ulnar nerve communication was first described by Martin in 1763 <ref>Martin R. Tal om nervers allmänna egenskaper i människans kropp.</ref>who proposed the possibility of such a communication. This finding was finally confirmed after 100 years by Gruber in in 1870 <ref>Gruber W. Ueber die verbindung des nervus medianus mit dem nervus ulnaris am unterarme des menshen und der saugethiere. Arch Anat Phisiol. 1870;37:501.</ref> | The prevalence of Martin Gruber Anastomosis (MGA) is between 3.3 to 40% of population <ref name=":0" />with a prevalence of 11.6 % in Indian population <ref>Kaur N, Singla RK, Kullar JS. Martin–Gruber Anastomosis-A cadaveric study in north indian population. Journal of Clinical and Diagnostic Research: JCDR. 2016 Feb;10(2):AC09.</ref>Median to Ulnar nerve communication was first described by Martin in 1763 <ref>Martin R. Tal om nervers allmänna egenskaper i människans kropp.</ref>who proposed the possibility of such a communication. This finding was finally confirmed after 100 years by Gruber in in 1870 <ref>Gruber W. Ueber die verbindung des nervus medianus mit dem nervus ulnaris am unterarme des menshen und der saugethiere. Arch Anat Phisiol. 1870;37:501.</ref> | ||
== | == Innervation Pattern of Hand == | ||
{| class="wikitable" | {| class="wikitable mw-collapsible" | ||
|+Standard innervation Pattern of muscles of hand as described in text books. | |+Standard innervation Pattern of muscles of hand as described in text books. | ||
!Median Nerve | !Median Nerve | ||
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Studies suggest that this standard pattern is seen in 33% of cases<ref>Rowntree T. Anomalous innervation of the hand muscles. The Journal of Bone and Joint Surgery. British volume. 1949 Nov;31(4):505-10.</ref> | Studies suggest that this standard pattern is seen in 33% of cases<ref>Rowntree T. Anomalous innervation of the hand muscles. The Journal of Bone and Joint Surgery. British volume. 1949 Nov;31(4):505-10.</ref> | ||
== | == Common Patterns of Anamolous Innervations of Median and Ulnar nerves == | ||
Due to the complexity of anatomy of upper extremity especially the brachial plexus and strategical anatomical zones as cubital tunnel, Guyon canal, carpal tunnel, results in anomalous branching of nerves. They may form anastomosis <ref name=":1" />To understand them better, Mennerfelt et al divided Ulnar nerve in four zones <ref>Mannerfelt L. Studies on the hand in ulnar nerve paralysis: a clinical-experimental investigation in normal and anomalous innervation. Acta Orthopaedica Scandinavica. 1966 Mar 1;37(sup87):3-176.</ref> | |||
== Resources == | == Resources == | ||
Revision as of 19:45, 27 January 2024
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Introduction[edit | edit source]
Anomalous means deviated from normal / routine. Anomalous innervations are routinely a normal occurrence. But if these are not recognised, they may be mistaken for technical pitfall or an actual pathology which may not be present [1] Nerve communication between the median and ulnar nerves in the forearm, is known as Martin-Gruber anastomosis. This implies that nerve fascicles from Median nerve transfers to Ulnar nerve[2]
The prevalence of Martin Gruber Anastomosis (MGA) is between 3.3 to 40% of population [1]with a prevalence of 11.6 % in Indian population [3]Median to Ulnar nerve communication was first described by Martin in 1763 [4]who proposed the possibility of such a communication. This finding was finally confirmed after 100 years by Gruber in in 1870 [5]
Innervation Pattern of Hand[edit | edit source]
| Median Nerve | Ulnar Nerve |
|---|---|
| Abductor Pollicis Brevis | Abductor Digiti Minimi |
| Opponens Pollicis Brevis | Flexor Digiti Minimi |
| Flexor Pollicis Brevis | Opponens Digiti Minimi |
| 1st and 2nd Lumbrical | 3rd and 4th Lumbrical |
| Dorsal and Palmar Interossei | |
| Deep Head of Flexor Pollices Brevis | |
| Adductor Pollices |
Studies suggest that this standard pattern is seen in 33% of cases[6]
Common Patterns of Anamolous Innervations of Median and Ulnar nerves[edit | edit source]
Due to the complexity of anatomy of upper extremity especially the brachial plexus and strategical anatomical zones as cubital tunnel, Guyon canal, carpal tunnel, results in anomalous branching of nerves. They may form anastomosis [2]To understand them better, Mennerfelt et al divided Ulnar nerve in four zones [7]
Resources[edit | edit source]
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- numbered list
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References[edit | edit source]
- ↑ 1.0 1.1 Aziz Saba EK. Electrophysiological study of Martin—Gruber anastomosis in a sample of Egyptians. Egyptian Rheumatology and Rehabilitation. 2017 Oct;44:153-8.
- ↑ 2.0 2.1 Cavalheiro CS, Razuk Filho M, Pedro G, Caetano MF, Vieira LA, Caetano EB. Clinical repercussions of Martin-Gruber anastomosis: anatomical study. Revista Brasileira de Ortopedia. 2016 Mar;51:214-23.
- ↑ Kaur N, Singla RK, Kullar JS. Martin–Gruber Anastomosis-A cadaveric study in north indian population. Journal of Clinical and Diagnostic Research: JCDR. 2016 Feb;10(2):AC09.
- ↑ Martin R. Tal om nervers allmänna egenskaper i människans kropp.
- ↑ Gruber W. Ueber die verbindung des nervus medianus mit dem nervus ulnaris am unterarme des menshen und der saugethiere. Arch Anat Phisiol. 1870;37:501.
- ↑ Rowntree T. Anomalous innervation of the hand muscles. The Journal of Bone and Joint Surgery. British volume. 1949 Nov;31(4):505-10.
- ↑ Mannerfelt L. Studies on the hand in ulnar nerve paralysis: a clinical-experimental investigation in normal and anomalous innervation. Acta Orthopaedica Scandinavica. 1966 Mar 1;37(sup87):3-176.
