Miki Roberto Augusto, Kam Check C, Gennis Elisabeth R, Barkin Jodie A, Riel Ryan U, Robinson Philip G, Owens Patrick W
The Miami Hand Center, FL, USA.
Iowa Orthop J. 2011;31:225-30.
Thumb carpometacarpal (CMC) joint arthritis is one of the most common problems addressed by hand surgeons. The gold standard of treatment for thumb CMC joint arthritis is trapeziectomy, ligament reconstruction and tendon interposition. Denervation of the thumb CMC joint is not currently used to treat arthritis in this joint due to the failure of the procedure to yield significant symptomatic relief. The failure of denervation is puzzling, given that past anatomic studies show the radial nerve is the major innervation of the thumb CMC joint with the lateral antebrachial nerve and the median nerve also innervating this joint. Although no anatomic study has ever shown that the ulnar nerve innervates the CMC joint, due to both the failure of denervation and the success of arthroscopic thermal ablation, we suspect that previous anatomic studies may have overlooked innervation of the thumb CMC joint via the ulnar nerve.
We dissected 19 formalin-preserved cadaveric hand-to-mid-forearm specimens. The radial, median and ulnar nerves were identified in the proximal forearm and then followed distally. Any branch heading toward the radial side of the hand were followed to see if they innervated the thumb CMC joint.
Eleven specimens (58%) had superficial radial nerve innervation to the thumb CMC joint. Nine specimens (47%) had median nerve innervation from the motor branch. Nine specimens (47%) had ulnar nerve innervation from the motor branch.
We believe this is the first study to demonstrate that the ulnar nerve innervates the thumb CMC joint This finding may explain the poor results seen in earlier attempts at denervation of the thumb CMC, but the more favorable results with techniques such as arthroscopy with thermal ablation.
拇指腕掌（CMC）关节关节炎是手外科医生处理的最常见问题之一。拇指CMC关节关节炎的金标准治疗方法是大多角骨切除术、韧带重建和肌腱间置术。由于该手术未能显著缓解症状，目前拇指CMC关节去神经支配术并不用于治疗该关节的关节炎。去神经支配术的失败令人费解，因为过去的解剖学研究表明桡神经是拇指CMC关节的主要神经支配，前臂外侧神经和正中神经也支配该关节。尽管尚无解剖学研究表明尺神经支配CMC关节，但鉴于去神经支配术的失败和关节镜下热消融术的成功，我们怀疑先前的解剖学研究可能忽略了尺神经对拇指CMC关节的神经支配。
我们解剖了19个用福尔马林保存的尸体手部至前臂中部标本。在前臂近端识别桡神经、正中神经和尺神经，然后向远端追踪。追踪任何朝向手部桡侧的分支，以查看它们是否支配拇指CMC关节。
11个标本（58%）有桡神经浅支支配拇指CMC关节。9个标本（47%）有来自运动支的正中神经支配。9个标本（47%）有来自运动支的尺神经支配。
我们认为这是第一项证明尺神经支配拇指CMC关节的研究。这一发现可能解释了早期拇指CMC去神经支配术效果不佳的原因，但关节镜下热消融等技术的效果更好。
