Purpose
Targeted muscle reinnervation (TMR) transfers cut the nerve endings to the motor nerves
of the nearby muscles to reduce neuroma pain and/or enhance prosthetic function. To
guide surgeons, anatomic “roadmaps” describe nerve transfer options for TMR at various
locations. This study aimed to landmark and measure motor entry points (MEPs) to the
hand interossei muscles in the context of TMR for digital nerve neuroma management.
Methods
Ten fresh-frozen cadaveric hands were dissected to describe the innervation arising
from the deep branch of the ulnar nerve to the dorsal interossei (DIs) and palmar
interossei (PIs) muscles. The location of MEPs relative to the bone and soft tissue
landmarks and the size of the target nerves were measured.
Results
The MEPs for the DIs and PIs were found in the central third of the metacarpal. The
MEPs to the PIs averaged 23.3–24.7 mm from the median nerve. The length of nerve proximal
to the MEP was limited, ranging between 6.5 ± 2.6 mm for the first PI and 10.5 ± 2.7
mm for the second PI. Similarly, minimal nerve proximal to the MEP of the DI was available
for mobilization. Access to the first PI innervation required substantial release
of the thenar musculature. Motor nerve diameter averaged 0.85–0.97 mm.
Conclusions
In considering TMR for the management or prevention of digital nerve neuromas, the
motor branches to the second and third PIs are the most accessible and best approached
volarly, whereas motor branches to the DIs take more direct routes into the muscle,
making volar exposure difficult. Nerve length proximal to the MEP is short, requiring
that most of the nerve length for neurorrhaphy comes from the digital nerve. Size
mismatch at the neurorrhaphy site is favorable compared to more proximal TMR.
Clinical relevance
Targeted muscle reinnervation in the hand is technically feasible for a patient with
a symptomatic neuroma after digital amputation.
Key words
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Article info
Publication history
Published online: June 09, 2021
Accepted:
April 28,
2021
Received:
June 3,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
