Carpal tunnel release: Safe and simple identification of the flexor retinaculum based on superficial anatomical landmarks.

The aim of our study was to project the borders of the flexor retinaculum (FR) onto superficial landmarks since its insufficient splitting is the most common reason for persistence of symptoms after carpal tunnel release. In 60 hands the radial and ulnar styloid processes were linked by a horizontal line and a longitudinal line was laid through the ring finger's radial side. These were intersected resulting in the reference point "A" on the forearm. As the second basing point "B", the radial margin of the ring finger at the palmar digital crease was chosen. Measurement of the FR was carried out with regard to the reference points. The proximal margin of the FR was located at 4% of the reference line A-B starting from point A and extended up to 52% of this total length. Results indicate that splitting alongside the proximal half of line A-B divides the FR completely. Clin. Anat. 30:512-516, 2017. © 2017 Wiley Periodicals, Inc.

Sensory nerve supply of the distal radio-ulnar joint with regard to wrist denervation.

The objective of this study was to determine the precise departure points of the articular branches innervating the distal radio-ulnar joint from the anterior and posterior interosseous nerves. The study sample consisted of 116 upper limbs from adult human cadavers. The articular branches were prepared under the dissection microscope to take measurements using the radial styloid process as point of reference. The articular branch departed from the anterior interosseous nerve at a mean distance of 2.9 cm proximal to the styloid for a radius length of 20.5 cm, and 3.7 cm for a radius length of 26.5 cm, respectively. For the posterior interosseous nerve, the departure point was at a mean distance of 3.1 cm (radius length of 20.5 cm) and at 4.0 cm (radius length of 26.5 cm). Apart from a single branch from the posterior interosseous nerve, all articular branches were located distal to the proximal border of the pronator quadratus. Results indicate that wrist denervation from the volar approach, if performed at the proximal border of the pronator quadratus, or from the dorsal approach at a distance of 4.8 cm (for a radius length of 20.5 cm) or 6.2 cm (for a radius length of 26.5 cm) proximal to the radial styloid process, will eliminate the nerve supply to the distal radio-ulnar joint in the majority of cases.

Minimally invasive approach to the radial nerve--A new technique.

PURPOSE: To describe a minimally invasive approach to find the radial nerve (RN) simply and safely by tracing the posterior antebrachial cutaneous nerve (PACN) without damaging muscles, using only the surgeon's hand to define a window for the skin incision. BACKGROUND: Although it is absolutely necessary to locate the radial nerve during osteosynthesis of the humerus, the literature lacks guidelines on how to do so. METHODS: We have dissected the upper extremities of 54 adult human cadavers, embalmed using Thiel's method. After the PACN was identified in a defined space, its course was traced proximally by incising the lateral intermuscular septum (LIS) of the upper arm and thereby reaching the radial nerve (RN). Subsequently, using the lateral epicondyle (LE) of the humerus as a reference point, the distances to the points where the PACN perforated the LIS, and where the RN was identified, were measured. These individual data were related to the total length of the humerus. RESULTS: The results indicate that with this approach and without harming musculature, the RN can be reached by tracing the PACN at a height of 11.1-13.0 cm (females) and 11.9-14.0 cm (males) starting from the LE. CONCLUSION: Our examination shows the PACN to be a convenient guide to the RN.

Promoting parenting by keeping new families together from birth through dismissal.

Many new parents enter parenting ill-prepared to care for their newborn. Nurses promote optimal parenting by facilitating parent-newborn contact immediately after birth and sustaining continual contact during the brief hospitalization. By serving as positive role models, continually assessing, teaching, and reevaluating the parental knowledge base and care, nurses prepare parents for the challenging role of parenting.