Illustrated Encyclopedia of Human Anatomic Variation: Opus III: Nervous System: Plexuses

Median Nerve

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

Either the outer (lateral) or the inner (medial) branch (from the lateral and medial cords) of the nerve may consist of two nerve bundles.

The site of union between the lateral and medial branches is quite variable and has been found as far down as the elbow.

The two branches may enclose the axillary vein as well as the axillary artery.

The median nerve or either of its branches may pass behind the axillary artery instead of in front of it; the nerve may also pass behind the brachial artery.

The lateral branch of the nerve sometimes arises in the middle of the arm, behind the axillary artery, and joins the medial branch.

The median nerve usually passes between the two heads of pronator teres. It may also pass superficial or deep to the two heads or may pierce the humeral head. The nerve may lie on the superficial surface of flexor digitorum superficialis instead of deep to it. In some cases, the median splits, forming a cleft in the forearm and allowing the passage of the ulnar artery or one of its branches, the superficial long head of the flexor pollicis, or an extra palmaris longus muscle to pass through. The divided nerve may pass through the carpal tunnel in separate compartments.

Communications have been described between the median and ulnar nerves in the arm, forearm, or hand. Up to 90% of all subjects studied are reported to have median-ulnar nerve anastomoses, 10% of which are bilateral. In other studies (e.g., Thomson, J. Anat. 69:159-164) 15% (63 of 406 arms) is a commonly given value. In the Thomson study, communications between the anterior interosseous ocurred in 8% (33 cases); between the median and ulnar trunks in 3% (12 cases); between the muscular branches of median and ulnar in 4% (16 cases) and by a superficial branch between the median and ulnar in 0.5% (2 cases). They are more frequently reported on the right side. These median-ulnar anastomoses may carry nerve fibers to muscles of the hand that are commonly supplied by the ulnar nerve. Opponens pollicis may be supplied by both the ulnar and median nerves (30% of cases). The superficial head of the short flexor of the thumb (flexor pollicis brevis) is very frequently (83% of cases) supplied by both the median and ulnar nerves, and in about 25% of cases by the ulnar alone.

Martin-Gruber anastomoses occur in cases where motor axons usually destined for the ulnar nerve continue from the medial cord into the median nerve. These anastomoses were mentioned by Verchère as the work of Rolando Martin, in De nerv. corp. hum., Holmiae et Lipsiae, 1781, secto secunda, p. 216; by Gruber, in Arch. für Anat., 1870, p. 501; by Letiévant, in Soc. chir., Paris, 1867 et in Traité des sections nerveuses., Paris, 1873, p. 45, by Frantz Glénard, by Audibert et Savy, in the Bull. de la Soc. des conf. anat. de Lyon, and by Henle, in his classic treatise Handb. der Nervenlehre, 1879, p. 549.

The anterior interosseous branch of the median nerve to m. abductor indicis and to the first dorsal interosseous muscles (3% of individuals) have been described. The third, fourth, and fifth common digital branches of the median may arise in the proximal forearm and enter the hand independently. The anterior and posterior interosseous nerves may communicate at the lower end of the interosseous space.

The median may communicate with the musculocutaneous nerve. In 50% of individuals, the part of flexor digitorum profundus to the index and middle fingers is supplied by the median nerve while the part to the ring and little finger is supplied by the ulnar. The median nerve may encroach on the part of the muscle supplied by the ulnar nerve. Only rarely does the ulnar nerve encroach to supply the middle finger (medial distal edge) part of flexor digitorum profundus.

The median nerve may innervate, in part, biceps brachii and brachialis muscles.

Occasionally, the median nerve (and brachial artery) passes through a channel formed by a supracondylar process and ligament, where it (they) may become compressed, producing clinical symptoms.

A median nerve was found entering the belly of flexor digitorum superficialis, on its lateral side, and emerging from its tendon (to the index finger) about 25 mm above the wrist joint.

The median nerve may pass into the hand within the flexor retinaculum, where it may also give rise to the motor recurrent branch. The recurrent branch may also arise above or pass through the retinaculum to reach the thenar muscles.

Classification of Median Nerve Anomalies in the Carpal Tunnel (from the wrist flexor crease to the superficial palmar arch.) (from Amadio)

The median nerve may be perforated by the median artery, when present.

Riche-Cannieu anastomoses (between the median and ulnar nerves in the palm of the hand) may exist in 70% of individuals. Martin-Gruber (median-ulnar nerves) anastomoses in the forearm have a reported frequency of 15%. It should be remembered that the "anastomoses" occur between the median, ulnar, radial, and musculocutaneous nerves, as well as between other nerves. These are errors in the pathway (course) of some, inappropriately placed nerve fibers. In order for these nerve fibers to get to their proper end-point, the bundle of nerves fibers leave the inappropriate trunk and join the proper nerve trunk. Both Martin-Gruber and Riche-Cannieu "anastomoses" are examples of nature's correction of nerve fibers located in inappropriate nerve pathways. Certainly a mystery, these "anastomoses". On a broader and larger scale, the brachial plexus and sacral plexuses are other examples of neuronal sorting.

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References

Ahn, D.S., Yoon, E.S., Koo, S.H., and S.H. Park. (2000) A prospective study of the anatomic variatiosn of them edian nerve in the carpul tunnel in Asians. Ann. Plast. Surg. 44(3):282-287.

Ajmani, M.L. (1996) Variations in the motor nerve supply of the thenar and hypothenar muscles of the hand. J. Anat. (189, pt.1):145-150.

Amadio,P.C. (1987) Bifid median nerve with a double compartment within the transverse carpal canal. J. Hand Surg. (Am.) 12:366-368.

Amadio, P.C. (1988) Anatomic variations of the median nerve within the carpal tunnel. Clinical Anatomy 1:23-31.

Anson, B.J., Ed. (1966) Morris' Human Anatomy, 12th ed., The Blakiston Divison, McGraw-Hill Book Company, New York.

Artico, M., DeSantis, S., Cavallotti, D., and C. Cavallotti. (2000). Anatomical Variations of the ulnar and median nerves in the upper limb. J. Anat. Embryol. 105(3): 189-200.

Backhouse, K.M. (1975) Innervation of the hand. Hand 7:107-114.

Barfred, T., Hojlund, A.P. and K. Bertheussen. (1985) Median artery in carpal tunnel syndrome. J. Hand Surg. (Am.) 10:864-867.

Barta, E. and L. Petrovits. (1927) Das Ligamentum supracondyloideum. Anat. Anz. 63:177-184.

Baruch, A. and A. Hass. (1977) Anomaly of the median nerve. J. Hand. Surg. (Am.) 2:331-332.

Bas, H. and J.M. Kleinert. (1999) Anatomic variations in sensory innervation of the hand and digits. J. Hand Surg. (Am) 24(6):1171-1184.

Beaton, L.E. and B.J. Anson. (1939) The relation of the median nerve to the pronator teres muscle. Anat. Rec. 75:23-26.

Behiery, E.E. (2004) Anatomical variations of the median nerve distribution and communication in the arm. Folia Morphol. (Warsaw) 53(3):313-318.

Bennett, J.B. and C.C. Couch. (1982) Compression syndrome of the recurrent motor branch of the median nerve. J. Hand Surg., (Am.) 7:407-409.

Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation. Munich and Baltimore.

Blain des Cormiers, -. (1848) Exemple d'anomalie du nerf médian. Bulletins et Mem. de la Société Anatomique de Paris XXII(5,6):129.

Blair, W.F. and K. Joos. (1982) The innervation of flexor carpi radialis. An interfasicular dissection. Arch. Neurol. 39:647-649.

Broca, A. (1888) Innervation collaterale et plaies des nerfs. Gazette Hebdomadaire de Médecine et de Chirurgie. S.2., 25(9):129-132.

Borchardt, M. and -. Wjasmenski. (1917) Der Nervus medianus. Beitr. Klin. Chir. 107:553-582.

Botman, Y.A. and J. W. Mulder. (2001). Misinterpretation of nerve damage to the hand and forearm due to variations in the motor inservation. Ned. Tydschr. Geneeskd. 145(27):1316-1320. In Dutch.

Broca, -. (1850) Tendon du petit palmaire perforant le nerf médian. Bulletins et Mem. de la Société Anatomique de Paris XXV(1):5-6.

Brooks, H. St. J. (1887) Variations in the nerve supply of the lumbrical muscles in the hand and foot, with some observations on the innervation of the perforating flexors. J. Anat. Physiol. 21:575-585.

Buch, C. (1964) Zur Variation der Innervationweise des M. Biceps brachii unter Beachtung der Astagabe vom N. musculocutaneous und vom N. medianus. Anat. Anz. 114:131-140.

Buch-Hansen, K. (1955-56) über Varietaten des Nervus medianius und des Nervus musculocutaneous und deren Beziehungen. Anat. Anz. 102:187-203

Calori, L. (1868) Delle anomalie più importanti di ossa, vasi, nervi, e muscoli occorse nell'ultimo biennio fascendo anatomia del corpo umano. Mem. R. Accad. Sci. Istituto di Bologna S. 2., 8:417-482.

Calori, L. (1877) Sul variato rapporto vascolare delle due radici del nervo mediano e sulle condizioni atte a produrlo. Mem. R. Accad. Sci Istituto di Bologna S3., 8:443-456.

Calori, L. (1880) Intorno al canale sopracondiloideo dell'omero nell'umano. Mem. R. Accad. Sci. Istituto di Bologna S. 4., 2:37-46.

Cannieu, A. (1887) Note sur une anastomose entre le branche profunde de cubital et le median. Bull. Soc. Physiol. Norm. Pathol. (Bordeaux) 17:339-342.

Carroll, R.E. and D.P. Green. (1972) The significance of the palmar cutaneous nerve at the wrist. Clin. Orthop. 83:24-28.

Cavalio, A.V., Slattery, P.G., and R.J. Barton. (2003) Endoscopic carpal tunnel release and congenital anomolies of the median nerve. Hand Surg. 8(2):265-270.

Chaise, F. and J. Witvoet (1983) Les anomalies de division du nerf median. Une observation. Revue de la literature. J. Chir. (Paris) 120:335-336.

Chabaud,B., Flocard,F., Dasse,Y, Ribot, C., Bady, B., and M. Sindou. (1993) Surgical applications of anatomical variations of the median nerve at the corist. Neurochirurgie 39(2): 92-100. In French.

Chaput, -. (1886) Note sur deux variétés d'anastomoses nerveuses de l'avant-bras. Bulletins et Memoires de la Société Anatomique de Paris. 1886(6):427-429.

Cheung, J.W. Shyu, J.F., Teng, C.C., Chen, T.H., Su, C.H., Shyr, Y.M., Wang, J.J., Wu, C.W., Liu, W.Y. and J.C. Liu. The anatomical variations of the palmar cutaneous branch of the median nerve in Chinese adults. J. Chin. Med. Assoc. 67(1):27-31.

Crandall, R.C. and A.L. Hamel. (1979) Bipartite median nerve at the wrist. J. Bone Joint Surg. (Am) 61:311.

Curtis, F. (1886) L'anastomose du médian et du cubital. International Monatschrift für Anat. u. Hist. (Leipzig) 3:309-324.

Dankmeijer, J. and J.M. Waltman. (1950) Sur l'innervation de la face dorsale des doights humains. Acta Anat. 10:377-384.

Darlin, L.B., Aulicino, P.L., and T.L. Bergfield. (1992) Anatomical variations of the median nerve and the corist. Orthop. Rev. 21(8): 955-959.

Deville, -. (1843) Anastomose du nerf musculo-cutané avec le nerf median. Bulletins et Mem. de la Société Anatomique de Paris XVIII(10):293.

DiDio, L.J.A. and J.G. Angelo (1963) Nervus medianus piercing the caput humerale of the m. pronator teres. Anat. Anz. 112:385-388.

Don Griot, J.P., Van Kooten, E.O., Zuidan, J.H., Prose, L.P., and J.J. Hage. (2002). Internal anatomy of the communicating branch between the ulnar and the median nerves in the hand and it's relevance to volar digital sensibility. J. Hand Surg (Am) 27(1): 143-146.

Durox, P.E., Barry, P. and P. LaCoste. (1952) Le rameau thenarien du médian. Assoc. Anatomistes Comptes Rendus 39:146-150.

Duroux, -., Dujol, -., Gabrielle, C. and -. Garde. (1952) Le anomalies du nerf médian. Assoc. Anatomistes Comptes Rendus 39:153-154.

Eiken, O., Carstam, N. and A. Eddeland (1971) Anomalous distal branching of the median nerve. Case Reports. Scand. J. Plast. Reconstr. Surg. 5:149-152.

Falconer, D. and M. Spinner. (1985) Anatomic variations in the motor and sensory supply of the thumb. Clin. Orthop. 195:83-96.

Ferner, H. (1937) Ein abnormer Verlauf des Nervus medianus vor der dem M. pronator teres. Anat. Anz. 84:151-156.

Fetrow, K.O. (1970) Practical and important variations in sensory nerve supply to the hand. Hand 2(2):178-184.

Forrest, W.J. (1967) Motor innervation of human thenar and hypothenar muscles in 25 hands: A study combining electromyography and percutaneous nerve stimulation. Can. J. Surg. 10:196-199.

Graham III, W.P. (1973). Variations of the motor branch of the median nerve at the wrist. Case Report. Plast Reconstr. Surg. 51(1):90-92.

Gruber, W. (1867) Anomaler Verlauf des Nervus medianus vor dem Musculus pronator teres, bei Durchbohrung des letzteren durch die hoch am Oberarme von der Arteria brachialis entsprungene Arteria interossea. Arch. Anat. Physiol. Wissen Med. 1867:552-559.

Gruber, W. (1870) über die Verbindung des Nervus medianus mit dem Nervus ulnaris am Unterarme des Menschen und der Saugethiere. Arch. Anat. Physiol. Klin. Med. (Leipzig) 37:501-522.

Gruber, W. (1881) über eine durch den Theilungswinkel der Arteria brachialis treende Ansa Recurrens zwischen dem Nervus musculocutaneous brachii und dem Nervus medianus beim Menschen. Arch. Pathol. Anat. Physiol. Klin. Med. 86:29-33.

Gruber, W. (1881) Abgang des Ramus volaris digitorum communis III des Nervus medianus in verschiedener Höhe am Unterarme. Arch. Pathol. Anat. Physiol. Klin. Med. 86:33-35.

Gunther, S.F., DiPasquale, D., and R. Martin. (1993) Struthers' ligament and associated median nerve variations in a cadaveric specimen. Yale, J.Bio.Med. 66(3):203-208.

Gutmann, L. (1977) Median-ulnar nerve communications and carpal tunnel syndrome. J. Neurol. Neurosurg. Psychiatry 40:982-986.

Gutmann, L. (1993) Important anomalous innervations of the extremities. Muscle & Nerve 16:339-347.

Gutmann, L. (1993) AAEM minimonograph #2: Important anomolous innerrations of the extremities. Muscle Nerve 16(4):339-347.

Harness, D. and E. Sekeles. (1971) The double anastomotic innervation of thenar muscles. J. Anat. 109:461-466.

Hartmann, -. (1887) Note sur l'anatomie des nerfs de la paume de main. Bull. et Mém. Soc. Anatomique de Paris 1887(5):860-864.

Hartmann, -. (1888) Anastomoses elliptiques des nerfs du membre supérieur. Bull. et Mem. Soc. Anatomique de Paris 1888:151.

Henle, J. (1868) Handbuch der Systematischen Anatomy des Menschen, von Friedrich Vieweg und Sohn, Braunschweig.

Highet, W.B. (1943) Innervation and function of the thenar muscles. Lancet 1:227-230.

Hopf, H.C. (1990) Forearm ulnar to median nerve anastomosis of sensory axons. Muscle & Nerve 13:654-656.

Hurwitz, P.J. (1996) Variations in the course of the thenar motor branch of the median nerve. J. Hand Surg. (Br) 21(3): 344-346.

Jabaley, M.E., Wallace, W.H. and F.R. Heckler. (1980) Internal topography of major nerves of the forearm and hand: A current view. (1980) J. Hand Surg. 5:1-18.

Jamieson, R.W. and B.J. Anson. (1952) The relation of the median nerve to the heads of origin of the pronator teres muscle. A study of 300 specimens. Q. Bull. Northwestern University Medical School 26:34-35.

Johnson, R.K. and M.M. Shrewsbury. (1970) Anatomical course of the thenar branch of the median nerve. J. Bone Joint Surg. (Am) 52:269-273.

Kessler, I. (1969) Unusual distribution of the median nerve at the wrist. Clin. Orthop. 67:124-126.

Kitayama, Y., Tsukada, S. and M. Kurokawa. (1985) High division of the median nerve: Unusual anatomical variation. Ann. Plast. Surg. 14:74-76.

Komar, J., Szegvari, M., Gloviczky, Z. and A. Szantao. (1978) Traumatischer Durchschnitt des N. medianus ohne komplette motorische Parese: Martin-Grubersche Anastomose. Nervenarzt 49:697-699.

Kopsch, F. (1908) Rauber's Lehrbuch der Anatomie des Menschen. Georg Thieme, Leipzig.

Kornberg, M., Aulicino, P.L. and T.E. DuPuy. (1983) Bifid median nerve with three thenar branches-case report. J. Hand Surg. (Am) 8:583-584.

Lanz, U. (1975). Variations of the median nerve at the carpal tunnel. Handchirurgie 7(4):163-164. In German.

Lanz, U. (1977) Anatomical variations of the median nerve in the carpal tunnel. J. Hand Surg. (Am) 2(1):44-53.

Latarjet, A. (1948) Testut's Traite d'Anatomie Humaine, 9th ed. G.Doin & Cie., Paris.

Leinberry, C.F. and M.A. Wehbe. (2004) Brachial plexus anatomy. Hand clin. 20(1):1-5.

LeMinor, J.M. (1990) A rare variation of the median and musculotaneous nerves in man. Arch. Anat. Histol. Embryol. 73:33-42. In French.

Lindley, S.G. and J.M. Kleinert. (2003) Prevalence of anatomic variations encountered in elective carpal tunnel release. J. Hand Surg. (A) 28(5):849-855.

Linell, E.A. (1921) The distribution of nerves in the upper limb, with reference to variabilities and their clinical significance. J. Anat. 55:79-112.

Lorey, -. (1874) Note sur la distribution des nerfs colletéraux des doigts et sur les sections nerveuses du member supérieur. Bulletins et Mem. de la Société Anatomique de Paris XLIX(7):574-575.

Luna, E. (1910) Frequente anastomosi tra il nervo ed il ramo volare profondo del nervo cubitale. Anat. Anz. 36:383-384.

Luna, E. (1911) Frequente anastomose entre le nerf median et le rameau profund du nerf cubital. Arch. Ital. Biol. 55:141.

Martin, R. (1763) Tal om Nervers allmanna Egenskaper i Manniskans Kropp. L. Salvius, Stockholm.

Matejcik, V. (2003) Anatomic deviations in the origin of the median nerve. Rozhl. Chir. 10:526-528. In Slovak.

Matini, K. (1983) Abnormal distribution of the median nerve at the wrist and forearm. Plast. Reconstr. Surg. 71:711-713.

May, J.W., Jr., and H. Rosen (1981) Division of the sensory ramus communicans between the ulnar and median nerves: A complication following carpal tunnel release. A case report. J. Bone Joint Surg. (Am). 63:836-838.

Meals, R.A. and M Shaner (1983) Variations in digital sensory patterns: A study of the ulnar nerve-median nerve palmar communicating branch. J. Hand Surg. (Am). 8:411-414.

Miller, M.R., Ralston, H.J. III., and M. Kasahara. (1958) The pattern of cutaneous innervation of the human heart. Am. J. Anat. 102:183-217.

Murphey, F., Kirklin, J.W. and A.J. Finlayson. (1946) Anomalous innervation of the intrinsic muscles of the hand. Surg., Gynecol. Obstet. 83:15-23.

Nakano, K.K. (1978) The entrapment myopathies. Muscle Nerve 1:264-279.

Ogden, J.A. (1972) An unusual branch of the median nerve. J. Bone Joint Surg. (Am) 54:1779-1781.

Omer, G.E., Jr. and M. Spinner. (1980) Management of Peripheral Nerve Problems. W.B. Saunders Company, Philadelphia.

Papathanassiou, B.T. (1968) A variant of the motor branch of the median nerve in the hand. J. Bone Joint Surg. (Br) 50:156-157.

Phalen, G.S. (1966) The carpal tunnel syndrome. Seventeen year's experience in diagnosis and treatment of six hundred fifty-four hands. J. Bone Joint Surg. (Am) 48:211-228.

Ranschburg, P. (1917) über die Anastomosen der Nerven der oberen Extremität des Menschen mit Rücksicht auf ihren neurologische und nervenchirurgische Bedeutung. Neurol. Centralblatt 36:521-534.

Rey, R.C., Sanz, O.P., and R.E. Sica. (1984) Electrophsiological study of the variations of the innervations of the hand muscles. Arq. Neuropsiquiatr. 42(1):14-19. In Spanish.

Richelot, L.G. (1883) Note sur l'innervation collatérale a propos d'une résection du nerf médian. Bull. et Mém. de la Soc. de Chirurgie de Paris 1883(23Mai):438-466.

Robbins, H. (1963) Anatomical study of the median nerve in the carpal tunnel and etiologies of the carpal tunnel syndrome. J. Bone Joint Surg. (Am) 45:953-966.

Rowntree, T. (1949) Anomalous innervation of the hand muscles. J. Bone joint Surg. (Br) 31:505-510.

Sadr, A.R. (1946) Cross nerve anastomosis in man. Ann. Surg. 124:599-603.

Sargou, M.F., Uslu, S.S., Celik, H.H., and D. Aksit. (1995) A variation of the median nerve at the level of brachial plexus. Bull. Assoc. Anat (Nancy) 79(246):25-26.

Schaefer, E.A., Symington, J. and T.H. Bryce., Eds. Quain's Anatomy, 11th ed., Longmans, Green, and Co., London.

Schultz, R.J., Endler, P.M. and H.D. Huddleston. (1973) Anomalous median nerve and an anomalous muscle belly of the first lumbrical associated with carpal-tunnel syndrome. Case Report. J. Bone Joint Surg. (Am) 55:1744-1746.

Seradge, H. and E. Seradge. (1990) Median innervated hypothenar muscle: anomalous branch of median nerve in carpal tunnel. J. Hand Surg. (Am) 15:356-359.

Siegel, J.L., Daulin, L.B., and P.L. Aulicino. (1993) An anatomical variation of the palmar cutaneous branch of the median nerve. J. Hand Surg. (Br) 18(3):182-183.

Siverhus, S.W., Kremchek, T.E., Smith, W.R., Basch, T.M. and R.L. Drake. (1989) A cadaveric study of anatomic variations of the recurrent motor branch of the median nerve. Orthop. Rev. 18(3):315-320.

Sokolow, P.A. (1929-30) Abweichungen in dem Verlaufe der Gefässe und Nerven im Zusammenhang mit dem Vorhandensein des Proc. supracondyloideus am Oberarmbein. Anat. Anz. 68:156-163.

Spinner, M. (1970) The anterior interosseous nerve syndrome with special attention to its variation. J. Bone Joint Surg. (am) 52:84-94.

Stilwell, D.L., Jr. (1957) The innervation of deep structures of the hand. Am. J. Anat. 101:75-99.

Stopford, J.S.B. (1919) The variations in distribution of the cutaneous nerves of the hand and digits. J. Anat. 53:14-25.

Sunderland, S. (1945) The innervation of the flexor digitorum profundus and lumbrical muscles. Anat. Rec. 93:317-321.

Sunderland, S. (1945) The intraneural topography of the radial, median and ulnar nerves. Brain 68:243-298.

Sunderland, S. (1946) The innervation of the first dorsal interosseous muscle of the hand. Anat. Rec. 95:7-10.

Sunderland, S. and L.J. Ray. (1946) Metrical and non-metrical features of the muscular branches of the median nerve. J. Comp. Neurol. 85:191-203.

Taleisnik, J. (1973) The palmar cutaneous branch of the median nerve and the approach to the carpal tunnel. An anatomical study. J. Bone Joint Surg. (Am) 55:1212-1217.

Tanzer, R.C. (1959) The carpal-tunnel syndrome. A clinical and anatomical study. J. Bone Joint Surg. (Am) 41:626-634.

Thompson, I.M. (1922) Anomaly of the median nerve and flexor digitorum sublimis muscle. Anat. Rec. 23:375-379.

Thompson, I.M. (1934-35) The diagnostic application of our knowledge of the normal variability of cutaneous nerve areas, exemplified by the median and ulnar nerves. J. Anat. 69:159-164.

Tountas, C.P., MacDonald, C.J., Meyerhof, J.D. and D.H. Bihrle. (1983) Carpal tunnel syndrome. A review of 507 patients. Minn. Med. 66:479-482.

Tountas, C.P., Bihrle, D.M., MacDonald, C.J. and R.A. Bergman (1987) Variations of the median nerve in the carpal canal. J. Hand Surg. (Am.) 12:708-712.

Tountas, C.P. and R.A. Bergman. (1992) Anatomic Variations of the Upper Extremity. Churchill-Livingstone, New York.

Valls-Sole, J. (1991) Martin-Gruber anastomosis and unusual sensory innervation of the fingers: report of a case. Muscle and Nerve 14:1099-1102.

Verchère, F. (1883) Anastomoses du nerf médian et du nerf cubital à la partie supérieure de l'avant-bras. - Innervation des fléchisseurs. Bulletins et Memoires de la Société Anatomique de Paris. 1883(1):49-52.

Verdan, C. (1981) Anomalies of muscles and tendons in the hand and wrist. Rev. Chir. Orthop Repartrice Appar. Mot. 67(3):221-230. In French.

Villar, F. (1887) Anastomose du musculo-cutané et du médian. - Anastomose du médian et du cubital. Bulletins et Memoires de la Société Anatomique de Paris. 1887(4):192-194.

Villar, F. (1888) Quelques recherches sur les anastomoses des nerfs du membre supérieur. 1) Anastomoses du musculo-cutanéet du médian; 2) Anastomoses du médian et du cubital.; 3) Anastomoses du radial et du cubital. - De leur importance au point de vue du rétablissement des fonctions à la suite des sections nerveuses. Bull. et Mém. de la Soc. Anatomique de Paris 2:607-615.

Wallace, W.A. and P.A.M. Weston. (1974) The arrangement of the digital nerves within the human thumb and index fingers. J. Anat. 118:381-382.

Wallace, W.A., and R.E.Coupland. (1975) Variations in the nerves of the thumb and index finger. J.Bone Joint Surg. (Br) 57(4):491-494.

Wilbourn, A.J. and E.H. Lambert. (1976) The forearm median to ulnar nerve communications: electrodiagnostic aspects. Neurology 26:368.

Wilson, J.T. (1890) Two cases of variation in the nerve supply of the first lumbrical muscle in the hand. J. Anat. Physiol. 24:22-26.

Wood, V.E. and G. K. Frykman. (1978) Unusual branching of the median nerve at the wrist: A case Report. J. Bone Joint Surg. (Am) 60:267-268.

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