Anastomosis between Median and Ulnar Nerve in The Forearm and Hand

1. A D E W I J A Y A , M D – N O V E M B E R 2 0 2 1
Anastomosis between
Median and Ulnar Nerve
in The Forearm and Hand

2. 4 Major Classifications
Forearm
Martin-Gruber
anastomosis
(MGA)
Marinacci
anastomosis
(MA)
Hand
Riche-Cannieu
anastomosis
(RCA),
Berrettini
anastomosis (BA)
Smith, J. L., Siddiqui, S. A., & Ebraheim, N. A. (2019). Comprehensive summary of anastomoses between the median and ulnar nerves in the forearm and hand. Journal of hand and
microsurgery, 11(01), 001-005.

3. Clinical Importance
 Presentation of musculoskeletal disorders
 Surgical outcomes
 Surgical approaches
Smith, J. L., Siddiqui, S. A., & Ebraheim, N. A. (2019). Comprehensive summary of anastomoses between the median and ulnar nerves in the forearm and hand. Journal of hand and
microsurgery, 11(01), 001-005.

4. Martin-Gruber Anastomosis (MGA)
 Prevalence: 19.5 – 27 %
 More common: unilateral; right side
 Autosomal dominant
 Bilateral presentation: Trisomy 21
 Proximal extension of the median nerve or its
branches to the ulnar nerve distally mainly motor
fibers
Smith, J. L., Siddiqui, S. A., & Ebraheim, N. A. (2019). Comprehensive summary of anastomoses between the median and ulnar nerves in the forearm and hand. Journal of hand and
microsurgery, 11(01), 001-005.

5. MN: median nerve, UN: ulnar NERVE, FDP: Flexor digitorum profundus, FDS: Flexor digitorum superficialis, AIN: anterior interosseous nerve, CB: communicating branch.
E Herrera et al. Salud UIS.,2009, 41, 157-168

6. Electrophysiology
Sur A, Sinha MM, Ughade JM. Prevalence of Martin-Gruber Anastomosis in Healthy Subjects: An Electrophysiological Study from Raigarh, Chhattisgarh. Neurol India
2021;69:950-5

7. Marinacci Anastomosis
 0.7 - 4 %
 Reverse MGA, with the ulnar nerve branching
proximally to join the median nerve distally
 Mainly motor fibers
Meenakshi-Sundaram S, Sundar B, Arunkumar M J. Marinacci communication: an electrophysiological study. Clin Neurophysiol. 2003;114(12):2334–2337.
Hopf H C. Forearm ulnar-to-median nerve anastomosis of sensory axons. Muscle Nerve. 1990;13(07):654–656.

8. Riche–Cannieu Anastomosis
 55.5 – 100 %
 Autosomal dominant
 An interconnection between the recurrent branch of
the median nerve and the deep branch of the ulnar
nerve
 Both motor and sensory fibers may be involved
Smith, J. L., Siddiqui, S. A., & Ebraheim, N. A. (2019). Comprehensive summary of anastomoses between the median and ulnar nerves in the forearm and hand. Journal of hand and
microsurgery, 11(01), 001-005.

9. Riche–Cannieu Anastomosis
 Three possible
presentations exist:
- A hand may be completely
supplied by the ulnar nerve
- A hand with all motor
innervation via the ulnar
nerve
- A hand with normally
median-innervated
muscles partially supplied
by the ulnar nerve
Smith, J. L., Siddiqui, S. A., & Ebraheim, N. A. (2019). Comprehensive summary of anastomoses between the median and ulnar nerves in the forearm and hand. Journal of hand and
microsurgery, 11(01), 001-005.

10. Berretini Anastomosis
 60.9 – 80 %
 Neural connection between common digital nerves of
the ulnar and median nerves
 Pure sensory
Unver Dogan N, Uysal I, Seker M. The communications between the ulnar and median nerves in upper limb. Neuroanatomy. 2009;8:15–19.
Roy J, Henry B M, PĘkala P A et al.Median and ulnar nerve anastomoses in the upper limb: A meta-analysis. Muscle Nerve. 2016;54(01):36–47.

11. Smith, J. L., Siddiqui, S. A., & Ebraheim, N. A. (2019). Comprehensive summary of anastomoses between the median and ulnar nerves in the forearm and hand. Journal of hand and
microsurgery, 11(01), 001-005.

12. Wakode, S. L., Ravi, N., & Agrawal, A. (2020). Electrodiagnostic description of a rare variant of Berrettini anastomois: A case report. International Journal of Surgery Case Reports, 76, 404-408.

13. THANK YOU