PubMed^® Literature Review

The palmar cutaneous branch of the median nerve (PCBMN) exhibits significant anatomical variability that has critical implications for surgical interventions in the wrist and hand region. Anatomical variations can influence surgical approaches, risk assessment for iatrogenic injury, and diagnostic evaluations [1-12].

The PCBMN typically originates from the radial side of the median nerve but may exhibit several variations concerning its origin point relative to fixed anatomical landmarks such as the distal wrist crease or palmaris longus tendon [4], [6]. Its branching pattern is highly variable; it may bifurcate into radial and ulnar branches at different distances proximal to the distal wrist crease [6], [10]. This variability necessitates a careful dissection during surgeries like carpal tunnel release or volar approach procedures for fractures to avoid inadvertent damage leading to sensory deficits or painful neuromas postoperatively.

Several studies have documented anomalous courses of PCBMN relative to other structures such as flexor carpi radialis (FCR), where it might run superficially, within its sheath, or cross over it in unusual patterns [3], [7], [9]. Such anomalies significantly increase the risk of iatrogenic injury during common orthopedic procedures like open reduction internal fixation (ORIF) for distal radius fractures when using FCR approaches. Glickel et al. reported an incidence rate of approximately 18.8% concerning anomalous branching patterns around FCR sheath based on their prospective study findings, suggesting these variations are more common than previously thought [7].

Furthermore, ultrasonographic evaluation has emerged as a valuable tool in preoperative planning by identifying normal and variant anatomy thereby potentially reducing risks associated with surgical intervention on or near the median nerve including its palmar cutaneous branch. Nulle et al.'s work underscores this utility by highlighting how ultrasound can reveal variants that may not be well-documented otherwise due to their rarity or subclinical presentation until surgically encountered [5].

Given these complexities surrounding PCBMN's course and relationships with adjacent structures coupled with potential functional consequences following iatrogenic injuries - adopting strategies aimed at minimizing risks becomes paramount. Recommendations include utilizing detailed preoperative imaging techniques like high-resolution ultrasound when feasible alongside employing refined surgical techniques that prioritize nerve preservation through enhanced visibility via magnification aids during dissections within high-risk zones identified through anatomic studies discussed herein.