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Letter to the Editor
Sensory innervation of the dorsomedial segment of the hand due to the radial nerve as deviation from normal: Traumatic injury of this anomalous branch
Inervación sensitiva de la porción dorsomedial de la mano por parte del nervio radial como variante de la normalidad: lesión traumática de esta rama anómala
S. Parra
Corresponding author
parra_sil@yahoo.es

Corresponding author.
, J.V. Orenga, M.J. Estarelles, A.D. Ghinea, A.J. Gomis
Servicio de Neurofisiología Clínica, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Anatomical variations often exist in the innervation of the upper and lower limbs&#46; The best-known of these are Martin-Gruber medial-cubital anastomosis and the presence of an accessory peroneal nerve&#59; nevertheless&#44; there are many others&#46; Although they do not imply the existence of disease&#44; it is of crucial importance to know them for diagnostic purposes as well as to minimise inappropriate treatment and prevent iatrogenic lesions&#46; The sensory-cutaneous innervation of the dorsomedial segment of the hand and the 4th and 5th fingers habitually depends on the cubital nerve &#40;the dorsal cubital branch&#41;&#59; nevertheless&#44; the presence of a variation from normality has been described&#44; in which this area of the skin is innervated by a branch of the superficial radial nerve&#46; In these cases the back of the hand is therefore completely innervated by sensory branches of the radial nerve<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Very few cases have been published in the literature of lesions to variant branch&#44; all of which occurred following surgery to the back of the wrist&#46; We present the case of a lesion to this anomalous branch after local trauma&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">This is the case of a 20-year-old patient who after falling from his bicycle and bruising his left hand presented pain in the distal part of the radius and tingling in the dorsomedial segment of the hand and the back of his 4th and 5th fingers&#46; He was referred by his traumatologist for electromyography due to the suspicion of an injury to the cubital nerve&#46; Physical examination showed pain in the distal edge of the radius and a positive Tinel sign towards the dorsomedial segment of the hand&#46; He presented hypoesthesia in the dorsomedial area of the hand and the 4th and 5th fingers&#44; with normal motor balance and bone-tendon reflexes&#46; 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either completely in the absence of the dorsal cubital nerve or by both nerves simultaneously&#44; was described by Hepburn<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> in 1887&#46; Since then several anatomical as well as electrophysiological series have corroborated this finding&#46; In 6&#46;6&#37; of hands innervation is exclusively by the superficial radial nerve&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> while innervation is by both nerves in up to 60&#37; of cases&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> through a connection between them or by dual innervation&#46; In spite of its frequent occurrence there is very little awareness of this variation&#44; and very few cases of a lesion to this branch have been published&#46; All such cases were iatrogenic&#44; following wrist surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5&#44;6</span></a> The case we describe is caused by trauma&#44; and this cause has not been described before in the literature&#46; The suspicion of an anatomical variation in cases with atypical symptoms&#44; together with adequate knowledge of the same&#44; is fundamental for the correct diagnosis of nerve lesions&#44; as well as to prevent iatrogenic injuries&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical responsibilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments took place with human beings or animals for this research&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that this paper contains no patient data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that this paper contains no patient data&#46;</p></span></span></span>"
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ISSN: 19888856
Original language: English
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