Prevalence and Major Patterns of the Berrettini Anastomosis of the Median and Ulnar Nerves- A Cadaveric Pilot Study

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Co-authors:

Albert Sarpong - Tilman J. Fertitta Family College of Medicine; Madeline Ayala - Tilman J. Fertitta Family College of Medicine; Dallas Bennett - Tilman J. Fertitta Family College of Medicine

Abstract Body : INTRODUCTION & OBJECTIVES:

The median and ulnar nerves provide significant motor and sensory functions for the upper extremity. Anastomoses between the median and ulnar nerve have been identified at four points, two of which reside within the hand as the Riche–Cannieu and Berrettini anastomoses (BA). Previous studies on the BA reported its prevalence, patterns, and function, as its preservation is salient in preventing iatrogenic injury. Since it is known a great amount of variation in the anastomosis exists, there is a need for further evaluation. The present study’s aim was to bring more clarity to the prevalence and major patterns of the BA within the hand.



MATERIALS & METHODS:

The twenty-four hands were dissected with a specific palmar dissection technique at Tilman J. Fertitta Family College of Medicine to ensure the preservation and identification of the BA. The specific patterns of the BA were documented, photographed, and stored. Said patterns were compared with previous studies to distinguish between prevalence and archetypes.



RESULTS:

The BA was found within twenty hands, yielding an 83% prevalence. Six hands (30%) presented with a Type 1 communication pattern and four (20%) hands presented with a Type 2 communication pattern. Other minor variations accounted for ten hands (50%). The Type 1 anastomosis arises from one point on the third common digital nerve (CDN) and connects to the second CDN at two points. Type 2 displays a simple oblique anastomosis arising from one point on the third CDN and attaching to one point on the second CDN.



CONCLUSION:

The BA was identified in 83% of the hands examined with two major communication patterns. The pattern of the Type 1 anastomosis is similar to communications observed in previous studies but differs in prevalence. However, the Type 2 anastomosis observed is consistent with the existing literature in both pattern description and prevalence. Additional samples will be collected to determine the statistical significance of this pilot study.



SIGNIFICANCE/ IMPLICATIONS:

The BA presents significant clinical implications, particularly concerning carpal tunnel syndrome. Compression at specific points in the median nerve’s distribution, distinctly at median and ulnar nerve anastomosis locations, presents various sensory implications critical for surgical praxis and preventing iatrogenic injury.