An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome
Purpose: Isolated anterior interosseous nerve (AIN) syndrome is a forearm compression neuropathy. A viable treatment for the syndrome is distal nerve transfer. However, the option of a donor nerve branch from the median nerve remains debated. This study aimed to identify the most suitable median ner...
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Elsevier
2025-07-01
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| Series: | Journal of Hand Surgery Global Online |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589514125000593 |
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| author | Krit Utrapat, MD Nuttapat Khusritheppratan, MD Parunyu Vilai, MD Vichununt Kerdput, PhD Wisuit Pradidarcheep, PhD |
| author_facet | Krit Utrapat, MD Nuttapat Khusritheppratan, MD Parunyu Vilai, MD Vichununt Kerdput, PhD Wisuit Pradidarcheep, PhD |
| author_sort | Krit Utrapat, MD |
| collection | DOAJ |
| description | Purpose: Isolated anterior interosseous nerve (AIN) syndrome is a forearm compression neuropathy. A viable treatment for the syndrome is distal nerve transfer. However, the option of a donor nerve branch from the median nerve remains debated. This study aimed to identify the most suitable median nerve branch for distal nerve transfer in AIN syndrome patients by evaluating nerve diameter, fascicle and axon count, and distance between donor and recipient nerves. Methods: Twenty cadaveric arms were dissected to examine the AIN as the recipient nerve. Candidate donor nerves included branches to the palmaris longus (PL), flexor carpi radialis (FCR), and first and second branches of the flexor digitorum superficialis (FDS1 and FDS2). Each nerve length and the distance between donor and recipient nerves were measured. Histochemical staining was used to measure cross-sectional diameter and axon count. Results: All donor nerves had sufficient length for transfer, with FCR providing the greatest length (32.8 mm) and causing the least postoperative tension. Among the studied nerves, AIN had the largest diameter (2.3 ± 0.4 mm), followed by FCR (2.1 ± 0.3 mm), PL (2.0 ± 0.4 mm), FDS2 (1.6 ± 0.6 mm), and FDS1 (1.5 ± 0.3 mm). The AIN also had the highest average axon count (2747 ± 710), compared with FDS2 (888 ± 458), FCR (869 ± 366), PL (678 ± 277), and FDS1 (426 ± 192). Conclusions: The FCR branch transfer may not be the definitive best option for AIN palsy; however, it remains a highly viable and effective choice for reinnervation, providing a good alternative in cases where other donor nerves present anatomical or functional limitations Clinical relevance: This study provides anatomical and histological insights into the optimal median nerve branches for AIN transfer. |
| format | Article |
| id | doaj-art-894f811c35bb4ea8a4e3958975aedcb0 |
| institution | DOAJ |
| issn | 2589-5141 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Hand Surgery Global Online |
| spelling | doaj-art-894f811c35bb4ea8a4e3958975aedcb02025-08-20T03:13:30ZengElsevierJournal of Hand Surgery Global Online2589-51412025-07-017410073910.1016/j.jhsg.2025.100739An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve SyndromeKrit Utrapat, MD0Nuttapat Khusritheppratan, MD1Parunyu Vilai, MD2Vichununt Kerdput, PhD3Wisuit Pradidarcheep, PhD4Department of Anatomy, Faculty of Medicine, Srinakharinwirot University, Bangkok, ThailandDepartment of Anatomy, Faculty of Medicine, Srinakharinwirot University, Bangkok, ThailandDepartment of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, ThailandDepartment of Anatomy, Faculty of Medicine, Srinakharinwirot University, Bangkok, ThailandDepartment of Anatomy, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand; Corresponding author: Wisuit Pradidarcheep, PhD, Department of Anatomy, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand.Purpose: Isolated anterior interosseous nerve (AIN) syndrome is a forearm compression neuropathy. A viable treatment for the syndrome is distal nerve transfer. However, the option of a donor nerve branch from the median nerve remains debated. This study aimed to identify the most suitable median nerve branch for distal nerve transfer in AIN syndrome patients by evaluating nerve diameter, fascicle and axon count, and distance between donor and recipient nerves. Methods: Twenty cadaveric arms were dissected to examine the AIN as the recipient nerve. Candidate donor nerves included branches to the palmaris longus (PL), flexor carpi radialis (FCR), and first and second branches of the flexor digitorum superficialis (FDS1 and FDS2). Each nerve length and the distance between donor and recipient nerves were measured. Histochemical staining was used to measure cross-sectional diameter and axon count. Results: All donor nerves had sufficient length for transfer, with FCR providing the greatest length (32.8 mm) and causing the least postoperative tension. Among the studied nerves, AIN had the largest diameter (2.3 ± 0.4 mm), followed by FCR (2.1 ± 0.3 mm), PL (2.0 ± 0.4 mm), FDS2 (1.6 ± 0.6 mm), and FDS1 (1.5 ± 0.3 mm). The AIN also had the highest average axon count (2747 ± 710), compared with FDS2 (888 ± 458), FCR (869 ± 366), PL (678 ± 277), and FDS1 (426 ± 192). Conclusions: The FCR branch transfer may not be the definitive best option for AIN palsy; however, it remains a highly viable and effective choice for reinnervation, providing a good alternative in cases where other donor nerves present anatomical or functional limitations Clinical relevance: This study provides anatomical and histological insights into the optimal median nerve branches for AIN transfer.http://www.sciencedirect.com/science/article/pii/S2589514125000593Anterior interosseous nerve syndromeCadaveric studyDonor morbidityNerve transferPeripheral nerve injury |
| spellingShingle | Krit Utrapat, MD Nuttapat Khusritheppratan, MD Parunyu Vilai, MD Vichununt Kerdput, PhD Wisuit Pradidarcheep, PhD An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome Journal of Hand Surgery Global Online Anterior interosseous nerve syndrome Cadaveric study Donor morbidity Nerve transfer Peripheral nerve injury |
| title | An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome |
| title_full | An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome |
| title_fullStr | An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome |
| title_full_unstemmed | An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome |
| title_short | An Anatomical Study of Median Nerve Branches for Distal Nerve Transfer in Isolated Anterior Interosseous Nerve Syndrome |
| title_sort | anatomical study of median nerve branches for distal nerve transfer in isolated anterior interosseous nerve syndrome |
| topic | Anterior interosseous nerve syndrome Cadaveric study Donor morbidity Nerve transfer Peripheral nerve injury |
| url | http://www.sciencedirect.com/science/article/pii/S2589514125000593 |
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