Bases anatômicas e histomorfométricas para a compreensão das neuropatias dos nervos mediano e ulnar em crianças / Anatomical and histomorphometrical basis for the understanding of median and ulnar nerves neuropathies in children

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

10/05/2011

RESUMO

The anterior carpal region has two tunnels limited by fibrous tissue: the carpal tunnel and the ulnar tunnel. The clinical and surgical importance of this region is related to the carpal and ulnar tunnel syndromes, both able to impair motor and sensitive functions. The diagnosis and clinical approach to treat these syndromes are mainly based on anatomical features of the tunnels in adults. In children, little is known about the anatomy of these tunnels. In the present study, we describe the anatomy and histology of the carpal and ulnar tunnels in children. Thirty-three hands from children between ages 2 and 11 were studied. Seven samples were submitted to magnetic resonance and dissected; 14 samples were dissected and 12 processed to histology. The histomorphometric analysis in transversal sections showed 58.1% of the areas of the carpal tunnel are occupied by tendons of both superficial and deep flexor muscles of the fingers, by the tendon of the carpal radial flexor muscle and the tendon of the long flexor muscle of the thumb. The median nerve occupied 12.1% of the tunnel area. Magnetic resonance analysis showed that the median nerve was positioned either lateral (71,4%) or median (28,5%) in the carpal tunnel. The ulnar tunnel revealed a palmar location and 93.8% of the samples the inferior limit of the ulnar tunnel was made by the retinaculum of flexor muscles and of the hook of the hamate. In 16% of the samples, an accompanying artery of the median nerve persisted, occupying 1.1% of the area of the carpal tunnel. In 41,6% of the samples the density of the volume of the conjunctive tissue did not change in relation to the dimensions of the carpal tunnel or in relation to the space occupied by the tendons. According to these data, we concluded that the anatomy of the neurovascular components of carpal tunnel and ulnar tunnel in children have individual in relation to those described in adults and these differences may be of relevance to perform safer surgical approaches to the treatment of carpal and ulnar tunnel syndromes

ASSUNTO(S)

nervo mediano nervo ulnar anatomia median nerve ulnar nerve anatomy

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