Unexpected motor axons in the distal superficial radial and posterior interosseous nerves: a cadaver study

Variable innervation of the first dorsal interosseous muscle: an electrophysiological study

Background

The first dorsal interosseous muscle (FDI) is usually innervated by the deep branch of the ulnar nerve. However, as was first noted by Sunderland in 1946, some individuals have variable innervation of the FDI. This study investigated the incidence of variable innervation of the FDI by using electrophysiological examination and further evaluated the relevance of this variation in patients with cubital tunnel syndrome (CuTS).

Methods

This study included 211 patients who underwent peripheral nerve surgery in Huashan hospital, Fudan University, between October, 2012 and February, 2014. The patients were divided into three groups: the carpal tunnel syndrome (CTS) group, the CuTS group and the control group. During surgery, electromyography was used to determine FDI variation, and a hand function instrument was employed to estimate the pinch strength between the thumb and index finger in both hands of the CuTS patients.

Results

The electromyogram test showed that 22 of the patients enrolled had variable innervation of the FDI. Compared with the CTS group and the control group, the incidence of variable innervation of the FDI was much higher in the CuTS group (P<0.05). Patients under the age of 60 years old in the CuTS group were more likely to have the variation (P=0.043). A higher pinch strength ratio was significantly associated with variable innervation of the FDI in the CuTS patients (P=0.030).

Conclusions

Using electromyography, our study demonstrated that the variable innervation of the FDI could be innervated by the median nerve. In the CuTS patients, the higher incidence of FDI variation was possibly related to age. This variation might lead to a better prognosis for CuTS patients.

The Froment-Rauber nerve: a case report and review

INTRODUCTION

The Froment-Rauber nerve is a rarely described anomalous nerve arising from 1 of the terminal branches of the radial nerve that provides innervation to intrinsic hand muscles. We describe a 26-year-old man who had a traumatic radial nerve injury that resulted in first dorsal interosseous muscle wasting. He presented to our clinic 2.5 years post-injury, after having had unnecessarily undergone surgical exploration of the ulnar nerve.

METHODS

The patient's history, clinical examination, and multiple electrodiagnostic tests were reviewed.

RESULTS

All findings were consistent with a diagnosis of anomalous innervation via a Froment-Rauber nerve.

CONCLUSIONS

Understanding this rare phenomenon may aid in diagnosing confusing clinical cases and prevent unnecessary procedures.