Anatomical Findings and Preservation of Transverse Sensory Branches of the Palmar Cutaneous Nerve during Carpal Tunnel Decompression

Abstract

Of the possible complications following carpal tunnel release, one of the most distressing to the patient is a painful surgical scar. In this clinical study, 89 hands were examined at the time of surgery in order to identify the precise location, number and size of transverse sensory branches of the median palmar cutaneous nerve (PCN) and to preserve these during the procedure. Without the aid of operating microscope or loupes, a longitudinal interthenar incision was made, followed by careful splitting dissection of the subcutaneous fat. Transverse branches of the PCN, arising from the median nerve, were found in 85.4% of hands. Both median and ulnar nerve branches were found in 3.4% of hands, only ulnar nerve branches were found in 1.12% of hands and no branches were identified in 13.5% of hands. Multiple branches were found in 32.6% of cases. On average, these branches crossed the palm 1.5 cm from the distal wrist crease and were preserved 95% of the time without the use of operating microscope or loupes. Preservation of these small sensory nerves may prevent neuroma formation and, thereby, reduce the incidence of painful scars following carpal tunnel release.