3 years ago

Anastomose de Riché‐Cannieu: estrutura, função e significância clínica

Edie Benedito Caetano, Luiz Angelo Vieira, João José Sabongi Neto, Maurício Ferreira Caetano, Rodrigo Guerra Sabongi

Publication date: Available online 25 February 2018

Source: Revista Brasileira de Ortopedia

Author(s): Edie Benedito Caetano, Luiz Angelo Vieira, João José Sabongi Neto, Maurício Ferreira Caetano, Rodrigo Guerra Sabongi

Resumo
Objetivo

Definir a anatomia e a incidência da anastomose de Riché‐Cannieu, ou seja, comunicação entre os nervos medianos e ulnar na palma da mão.

Métodos

Foram dissecadas 60 mãos de 30 cadáveres frescos de adultos, entre 1979 a 1982, e 20 mãos entre 2011 e 2015, total de 80 mãos, no Departamento de Anatomia desta instituição. A incidência da anastomose de Riché‐Cannieu e a inervação dos músculos da região tenar foram estudadas.

Resultados

A anastomose de Riché‐Cannieu foi identificada em todas as mãos dissecadas (100%). A anastomose de Riché‐Cannieu extramuscular foi registrada em 57 mãos, a anastomose de Riché‐Cannieu intramuscular em 19 e a associação das anastomoses extra e intramuscular em quatro. O componente ulnar da anastomose de Riché‐Cannieu foi sempre do seu ramo profundo. O ramo anastomótico oriundo do nervo originava‐se do ramo recorrente do nervo mediano na maioria das observações. A dupla inervação mediano‐ulnar apenas da cabeça profunda do músculo flexor curto do polegar foi identificada em 29 de 80 mãos. Observou‐se dupla inervação apenas da cabeça superficial do músculo flexor curto do polegar em 13 mãos. Foi observada dupla inervação das cabeças superficial e profunda do flexor curto do polegar na mesma mão em 14 mãos. A cabeça oblíqua do adutor do polegar recebeu dupla inervação em 12 mãos. As cabeça profunda do musculo flexor curto do polegar e a cabeça oblíqua do adutor do polegar na mesma mão foram duplamente inervadas em nove mãos. A cabeça transversa do adutor do polegar recebeu dupla inervação em duas mãos. A dupla inervação da cabeça profunda do flexor curto do polegar e do cabeça transversa do adutor do polegar foi observada em uma mão.

Conclusão

De acordo com o presente estudo, a anastomose de Riché‐Cannieu deve ser considerada como uma conexão nervosa normal, e não uma variação anatômica. O conhecimento dessa anastomose é essencial, pois a presença dessa comunicação neural pode causar achados clínicos, cirúrgicos e eletromiográficos confusos em casos de lesões ou síndromes compressivas dos nervos mediano ou ulnar.

Abstract
Objective

Define the anatomy pattern and the incidence of Riché‐Cannieu anastomosis (RCA), i.e., median and ulnar communication in palmar aspect of the hand.

Methods

A total of 80 anatomical dissections were performed on 60 limbs of 30 cadavers from 1979 to 1982, and on 20 limbs from 2012 to 2015. All procedures were realized at the Department of Anatomy of this institution. The incidence of Riché‐Cannieu anastomosis and innervation of the thenar muscles were studied.

Results

The Riché‐Cannieu anastomosis was identified in all dissected hands (100%). Extramuscular Riché‐Cannieu anastomosis was recorded in 57 hands and intramuscular in 19 hands. The association of extra‐ and intramuscular Riché‐Cannieu anastomosis occurred in four. 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 the majority of the observations. The median‐ulnar double innervation to the deep head of the flexor pollicis brevis alone was identified in 29 of 80 hands. In 12 limbs, the deep head of the flexor pollicis brevis was absent. The double innervation of the superficial head of the flexor pollicis brevis was found alone in 13 hands. The double innervation of the superficial and deep heads of the flexor pollicis brevis in the same hand 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 in the same hand were doubly innervated in nine hands. The transverse head of adductor pollicis received double innervation in two hands. The double innervation of the deep head of the flexor pollicis brevis and the transverse head of the adductor pollicis was found in one limb.

Conclusion

According to this study, the Riché‐Cannieu anastomosis should be labeled as a normal anatomical neural connection and not as an anatomical variation. Knowledge of this anastomosis is essential because the presence of such neural communication can cause confusing clinical, surgical, and electromyographic findings in cases of median or ulnar damage or entrapment.

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