Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound
Bilateral cleft hand syndrome is a rare congenital malformation with complex anatomy. Previous reports have mainly focused on the description of bone and soft tissue abnormalities, but information about innervation is scarce. Knowledge of the peripheral nerve anatomy is helpful for surgical treatmen...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.857363/full |
| _version_ | 1811251145821126656 |
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| author | Pietro Falco Steven Hovius Nens van Alfen |
| author_facet | Pietro Falco Steven Hovius Nens van Alfen |
| author_sort | Pietro Falco |
| collection | DOAJ |
| description | Bilateral cleft hand syndrome is a rare congenital malformation with complex anatomy. Previous reports have mainly focused on the description of bone and soft tissue abnormalities, but information about innervation is scarce. Knowledge of the peripheral nerve anatomy is helpful for surgical treatment, optimizing the reconstruction, and preventing iatrogenic damage. Following clinical assessment and conventional radiologic imaging, we used high-resolution ultrasound of both hands and forearms to image the peripheral nerves in a patient with severe bilateral cleft hand syndrome. The patient presented with two ulnar digits, a deformed thumb on the right, and a rudimentary thumb appendage on the left. In keeping with the tissue elements present and absent, we found a severe bilateral nerve size reduction of the median nerves, sparing the anterior interosseous nerve fascicles. The radial nerve and end branches were intact, and a slightly smaller ulnar nerve was found that ended in two digital branches to a single digit. Our study shows that in cleft hand syndrome the peripheral nervous system anatomy exactly reflects the presence and absence of the corresponding muscle and skin innervation areas. This information is helpful for planning a surgical-reconstructive approach and suggests a potential role for nerve ultrasound in the assessment of complex limb malformations. |
| first_indexed | 2024-04-12T16:16:17Z |
| format | Article |
| id | doaj.art-46d6580219d04504a8b40d3af6115cd6 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T16:16:17Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-46d6580219d04504a8b40d3af6115cd62022-12-22T03:25:43ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-05-011310.3389/fneur.2022.857363857363Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by UltrasoundPietro Falco0Steven Hovius1Nens van Alfen2Department of Human Neuroscience, Sapienza University, Rome, ItalyDepartment of Plastic Surgery, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, NetherlandsBilateral cleft hand syndrome is a rare congenital malformation with complex anatomy. Previous reports have mainly focused on the description of bone and soft tissue abnormalities, but information about innervation is scarce. Knowledge of the peripheral nerve anatomy is helpful for surgical treatment, optimizing the reconstruction, and preventing iatrogenic damage. Following clinical assessment and conventional radiologic imaging, we used high-resolution ultrasound of both hands and forearms to image the peripheral nerves in a patient with severe bilateral cleft hand syndrome. The patient presented with two ulnar digits, a deformed thumb on the right, and a rudimentary thumb appendage on the left. In keeping with the tissue elements present and absent, we found a severe bilateral nerve size reduction of the median nerves, sparing the anterior interosseous nerve fascicles. The radial nerve and end branches were intact, and a slightly smaller ulnar nerve was found that ended in two digital branches to a single digit. Our study shows that in cleft hand syndrome the peripheral nervous system anatomy exactly reflects the presence and absence of the corresponding muscle and skin innervation areas. This information is helpful for planning a surgical-reconstructive approach and suggests a potential role for nerve ultrasound in the assessment of complex limb malformations.https://www.frontiersin.org/articles/10.3389/fneur.2022.857363/fullcleft hand syndromeperipheral nerve anatomynerve ultrasoundreconstructive surgerycongenital malformations |
| spellingShingle | Pietro Falco Steven Hovius Nens van Alfen Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound Frontiers in Neurology cleft hand syndrome peripheral nerve anatomy nerve ultrasound reconstructive surgery congenital malformations |
| title | Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound |
| title_full | Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound |
| title_fullStr | Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound |
| title_full_unstemmed | Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound |
| title_short | Peripheral Nerve Innervation in Bilateral Cleft Hand Syndrome Elucidated by Ultrasound |
| title_sort | peripheral nerve innervation in bilateral cleft hand syndrome elucidated by ultrasound |
| topic | cleft hand syndrome peripheral nerve anatomy nerve ultrasound reconstructive surgery congenital malformations |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.857363/full |
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