CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(05): 564-571
DOI: 10.1016/j.rbo.2017.12.019
Artigo Original | Original Article
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

Riché-Cannieu Anastomosis: Structure, Function, and Clinical Significance[*]

Article in several languages: português | English
1  Faculdade de Ciências Médicas e da Saúde, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brasil
,
Luiz Angelo Vieira
1  Faculdade de Ciências Médicas e da Saúde, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brasil
,
João José Sabongi Neto
2  Serviço de Cirurgia da Mão, Conjunto Hospitalar de Sorocaba (CHS), Sorocaba, SP, Brasil
,
Maurício Ferreira Caetano
2  Serviço de Cirurgia da Mão, Conjunto Hospitalar de Sorocaba (CHS), Sorocaba, SP, Brasil
,
Rodrigo Guerra Sabongi
3  Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
› Author Affiliations
Further Information

Publication History

31 October 2017

22 December 2017

Publication Date:
29 October 2019 (online)

Abstract

Objective To define the anatomy pattern and the incidence of Riché-Cannieu anastomosis, that is, median and ulnar communication in the palmar aspect of the hand.

Materials Methods A total of 80 anatomical dissections were performed on 60 hands of 30 cadavers from 1979 to 1982, and on 20 hands from 2012 to 2015. All of these procedures were performed at the Department of Anatomy of our institution. The incidence of Riché-Cannieu anastomosis and the innervation of the thenar muscles were studied.

Results Riché-Cannieu anastomosis was identified in every dissected hand (100%). The extramuscular Riché-Cannieu anastomosis was recorded in 57 hands, and the intramuscular, in 19 hands. The association of extra- and intramuscular Riché-Cannieu anastomoses occurred in four hands. The ulnar component always originated from the deep branch. The anastomotic branch arising from the median nerve originated from the motor thenar branch (recurrent branch) of the median nerve in most of the observations. The median-ulnar double innervation only to the deep head of the flexor pollicis brevis was identified in 29 of 80 hands. The double innervation only of the superficial head of the flexor pollicis brevis was found in 13 hands. In 12 hands, the deep head of the flexor pollicis brevis was absent. The double innervation of the superficial and deep heads of the flexor pollicis brevis occurred in 14 hands. The oblique head of the adductor pollicis received double innervation in 12 hands. The deep head of the flexor pollicis brevis and the oblique head of adductor pollicis were doubly-innervated in nine hands. The transverse head of the adductor pollicis received double innervation in two hands. Double innervation of the deep head of the flexor pollicis brevis and the transverse head of the adductor pollicis were found in one hand.

Conclusion According to the present study, Riché-Cannieu anastomosis should be considered a normal anatomical neural connection, not an anatomical variation. Knowledge of this anastomosis is essential because the presence of such neural communication may result in confusing clinical, surgical, and electromyographic findings in cases of median or ulnar damage or entrapment.

* Study developed at Faculdade de Ciências Médicas e da Saúde, Pontifícia Universidade Católica de São Paulo, Sorocaba, SP, Brazil. Originally Published by Elsevier Editora Ltda.