Division of Anatomy, University of Toronto, Toronto, Ontario, Canada
Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada.
Reg Anesth Pain Med. 2024 Aug 5;49(8):565-572. doi: 10.1136/rapm-2023-105009.
Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint is a common disorder that negatively impacts hand function. Denervation of the thumb CMC joint has emerged as a viable treatment option. However, the innervation pattern of the thumb CMC joint is controversial. Therefore, the objective of this study was to identify the articular branches supplying the thumb CMC joint and to document their relationship to anatomical landmarks to provide the foundation for image-guided diagnostic block and denervation procedures.
In 10 formalin-embalmed upper limb specimens articular branches supplying the thumb CMC joint were dissected from their origin to termination. A frequency map documenting the number of articular branches was generated. The frequency map enabled visualization and comparison of the relative area of innervation of the thumb CMC joint by each articular branch.
The thumb CMC joint received innervation from six nerves. These were the deep branch of ulnar nerve (DBUN), dorsal articular nerve (DAN) of the first interosseus space, thenar branch of median nerve (TBMN), palmar cutaneous branch of median nerve (PCBMN), lateral antebrachial cutaneous nerve (LACN) and superficial branch of the radial nerve (SBRN) and/or their branches. Each nerve was found to innervate different aspects of the joint. The DBUN and DAN were found to innervate the posteromedial aspect of the thumb CMC joint, the TBMN and PCBMN anterior/anteromedial aspects, LACN posterolateral/lateral/anterior aspects and SBRN posterolateral/anterolateral aspects.
The thumb CMC joint was innervated by articular branches originating from the SBRN, DAN, LACN, PCBMN, TBMN and DBUN. The documented anatomical relationships provide the foundation to inform selective diagnostic block and denervation of the thumb CMC joint. Further investigations are needed to assess the clinical implications of the current study.
拇指腕掌（CMC）关节的骨关节炎（OA）是一种常见的手部疾病，会对手部功能产生负面影响。拇指 CMC 关节的去神经支配已成为一种可行的治疗选择。然而，拇指 CMC 关节的神经支配模式存在争议。因此，本研究的目的是确定供应拇指 CMC 关节的关节支，并记录其与解剖标志的关系，为影像引导下的诊断性阻滞和去神经支配提供基础。
在 10 例福尔马林固定的上肢标本中，从起源到终止处解剖供应拇指 CMC 关节的关节支。生成记录关节支数量的频率图。该频率图可可视化并比较每个关节支对拇指 CMC 关节的相对神经支配区域。
拇指 CMC 关节接受来自 6 条神经的支配。这些神经包括尺神经深支（DBUN）、第一骨间空间背侧关节支（DAN）、正中神经鱼际支（TBMN）、正中神经掌皮支（PCBMN）、前臂外侧皮神经（LACN）和桡神经浅支（SBRN）及其分支。每条神经支配关节的不同部位。DBUN 和 DAN 支配拇指 CMC 关节的后内侧部分，TBMN 和 PCBMN 支配前/前内侧部分，LACN 支配后外侧/外侧/前侧部分，SBRN 支配后外侧/前外侧部分。
拇指 CMC 关节由来自 SBRN、DAN、LACN、PCBMN、TBMN 和 DBUN 的关节支支配。所记录的解剖关系为选择性诊断性阻滞和拇指 CMC 关节去神经支配提供了基础。需要进一步研究来评估当前研究的临床意义。
