Annals of Rehabilitation Medicine

Branching Patterns and Anatomical Course of the Common Fibular Nerve: Goo Young Kim, Chae Hyeon Ryou, Ki Hoon Kim, Dasom Kim, Im Joo Rhyu, Dong Hwee Kim; Ann Rehabil Med 2019;43(6):700-706. Published online December 31, 2019; DOI: https://doi.org/10.5535/arm.2019.43.6.700

Abstract
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Objective
To present the branching patterns and anatomical course of the common fibular nerve (CFN) and its relationship with fibular head (FH).
Methods
A total of 21 limbs from 12 fresh cadavers were dissected. The FH width (FH_width), distance between the FH and CFN (FH_CFN), and thickness of the nerve were measured. The ratio of the FH_CFN to FH_width was calculated as follows: <1, cross type and ≥1, posterior type. Angle between the CFN and vertical line of the lower limb 5 cm proximal to the tip of the FH was measured. Branching patterns of the lateral cutaneous nerve of the calf (LCNC) were classified into four types according to its origin and direction as follows: type 1a, lateral margin of the CFN; type 1b, medial margin of the CFN; type 2, lateral sural cutaneous nerve (LSCN); and type 3, CFN and LSCN.
Results
In the cross type (15 cases, 71.4%), the ratio of FH_CFN/FH_width was 0.83 and the angle was 13.0°. In the posterior type (6 cases, 28.6%), the ratio was 1.04 and the angle was 11.0°. In the branching patterns of LCNC, type 2 was the most common (10 cases), followed by types 1a and 1b (both, 5 cases).
Conclusion
Location of the CFN around the FH might be related to the development of its neuropathy, especially in the cross type of CFN. The LCNC showed various branching patterns and direction, which could be associated with difficulties of electrophysiologic testing.

Citations

Citations to this article as recorded by

Axonal profiling of the common fibular nerve and its branches: Their functional composition and clinical implications
Taeyeon Kim, Tae‐Hyeon Cho, Shin Hyung Kim, Hun‐Mu Yang
Clinical Anatomy.2024;[Epub] CrossRef
Intraneural Topography and Branching Patterns of the Common Peroneal Nerve: Studying the Feasibility of Distal Nerve Transfers
Elliot L.H. Le, Taylor H. Allenby, Marlie Fisher, Ryan S. Constantine, Colin T. McNamara, Caleb Barnhill, Anne Engemann, Orlando Merced-O’Neill, Matthew L. Iorio
Plastic and Reconstructive Surgery - Global Open.2024; 12(10): e6258. CrossRef
Fluoroscopically-guided therapeutic injection of the proximal tibiofibular joint in a patient with lateral knee pain
Cooper Dean, Ivan Davis, David Alvarez
Radiology Case Reports.2020; 15(12): 2510. CrossRef

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Branching Patterns of Medial and Inferior Calcaneal Nerves Around the Tarsal Tunnel: Beom Suk Kim, Phil Woo Choung, Soon Wook Kwon, Im Joo Rhyu, Dong Hwee Kim; Ann Rehabil Med 2015;39(1):52-55. Published online February 28, 2015; DOI: https://doi.org/10.5535/arm.2015.39.1.52

Abstract
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Objective

To demonstrate the bifurcation pattern of the tibial nerve and its branches.

Methods

Eleven legs of seven fresh cadavers were dissected. The reference line for the bifurcation point of tibial nerve branches was an imaginary horizontal line passing the tip of the medial malleolus. The distances between the reference line and the bifurcation points were measured. The bifurcation branching patterns were categorized as type I, the pattern in which the medial calcaneal nerve (MCN) branched most proximally; type II, the pattern in which the three branches occurred at the same point; and type III, in which MCN branched most distally.

Results

There were seven cases (64%) of type I, three cases (27%) of type III, and one case (9%) of type II. The median MCN branching point was 0.2 cm (range, -1 to 3 cm). The median bifurcation points of the lateral plantar nerves and inferior calcaneal nerves was -0.6 cm (range, -1.5 to 1 cm) and -2.5 cm (range, -3.5 to -1 cm), respectively.

Conclusion

MCN originated from the tibial nerve in most cases, and plantar nerves were bifurcated below the medial malleolus. In all cases, inferior calcaneal nerves originated from the lateral plantar nerve. These anatomical findings could be useful for performing procedures, such as nerve block or electrophysiologic studies.

Citations

Citations to this article as recorded by

Morphometric assessment of tibial nerve and its branches around the ankle
Jeha Kwon, Hong Bum Park, Soonwook Kwon, Im Joo Rhyu, Dong Hwee Kim
Medicine.2024; 103(15): e37745. CrossRef
Clinical Results Following Conservative Management of Tarsal Tunnel Syndrome Compared With Surgical Treatment: A Systematic Review
Neeraj Vij, Heather N. Kaley, Christopher L. Robinson, Peter P. Issa, Alan D. Kaye, Omar Viswanath, Ivan Urits
Orthopedic Reviews.2022;[Epub] CrossRef
An MRI study of the tibial nerve in the ankle canal and its branches: a method of multiplanar reformation with 3D-FIESTA-C sequences
Yan Zhang, Xucheng He, Juan Li, Ju Ye, Wenjuan Han, Shanshan Zhou, Jianzhong Zhu, Guisheng Wang, Xiaoxia Chen
BMC Medical Imaging.2021;[Epub] CrossRef
The Study of Anatomy of Tarsal Tunnel in Human Fetuses by Dissection Method
B. R. Chaithra Rao, Sucharitha Annam, Sreepadma Sunkeswari, Sandeep Patil
National Journal of Clinical Anatomy.2021; 10(2): 66. CrossRef
Tibial Nerve Block: Supramalleolar or Retromalleolar Approach? A Randomized Trial in 110 Participants
María Benimeli-Fenollar, José M. Montiel-Company, José M. Almerich-Silla, Rosa Cibrián, Cecili Macián-Romero
International Journal of Environmental Research and Public Health.2020; 17(11): 3860. CrossRef
Anatomical study and branching point of neurovascular structures at the medial side of the ankle
Chanatporn Inthasan, Tanawat Vaseenon, Pasuk Mahakkanukrauh
Anatomy & Cell Biology.2020; 53(4): 422. CrossRef
Cryoanalgesia. Review
Dmitrii A. Svirskii, E. E. Antipin, N. A. Bochkareva, A. T. Ibragimov, M. P. Yakovenko, E. V. Nedashkovskii
Annals of Critical Care.2020; (4): 58. CrossRef
Fine dissection of the tarsal tunnel in 60 cases
Y. Yang, M. L. Du, Y. S. Fu, W. Liu, Q. Xu, X. Chen, Y. J. Hao, Z. Liu, M. J. Gao
Scientific Reports.2017;[Epub] CrossRef
MR Imaging Findings in Heel Pain
Ching-Di Chang, Jim S. Wu
Magnetic Resonance Imaging Clinics of North America.2017; 25(1): 79. CrossRef
Nervenengpasssyndrome des Ramus calcanearis lateralis (Baxter-Nerv) und Nervus plantaris medialis (Jogger-Nerv)
Andreas Elsner, Timm Filler, Alexej Barg, Jonas Andermahr
Fuß & Sprunggelenk.2015; 13(4): 237. CrossRef

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Anatomical Relation of Ulnar Nerve and Flexor Carpi Ulnaris Muscle at the Wrist.: Choi, Chung Hwan , Jeong, Jeom Sun , Kim, Jeong Man , Lee, Ju Kang; J Korean Acad Rehabil Med 2009;33(3):344-347.

Abstract
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Objective
To verify proper stimulation point of ulnar nerve at the wrist by investigating anatomical relation of ulnar nerve and flexor carpi ulnaris (FCU) muscle. Method: Cadaver dissection of 9 wrists was done to identify gross anatomical relation of ulnar nerve and FCU muscle. Ultrasonography of 17 healthy volunteers was done for the measurement of distance from lateral border of FCU muscle to ulnar nerve at three sites. Ratios of these distances to total width of FCU muscle and FCU tendon were calculated. Results: FCU muscle was composed of lateral tendinous and medial muscular portion, and all ulnar nerves were located under the tendinous portion of FCU muscle on cadaver dissection. Ultrasonographic distances from lateral border of FCU muscle to ulnar nerve were 4.6±3.3 mm, 4.8±4.0 mm and 5.9±3.1 mm from distal to proximal sites. The ratios to total width of FCU muscle were 31.02± 23.31%, 24.30±26.12% and 24.48±13.01%, which showed that the ulnar nerve was closer to the lateral border than the medial border. The ratios to total width of FCU tendon were 49.63±41.35%, 51.30±50.46% and 64.59±36.79%, which showed progressive increment from distal to proximal sites. Conclusion: Proper stimulation point of ulnar nerve at the wrist is the lateral border of FCU muscle than the medial border. However, the proximity of ulnar nerve to the medial or lateral border was not conclusive, because the ratio to FCU tendon was not consistent in three sites of the wrist. Further electrophysiologic study is necessary for the comparison of proper stimulation point based on FCU tendon. (J Korean Acad Rehab Med 2009; 33: 344-347)

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Anatomical Landmark Analysis of Medial Plantar Proper Digital Nerve:a Cadaver Dissection Study.: Park, Geun Young , Im, Sun , Kim, Yun Hee , Kim, Young Kook; J Korean Acad Rehabil Med 2009;33(1):98-102.

Abstract
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Objective
To analyze the bifurcating points of medial plantar proper digital (MPPD) nerve by using anatomical landmarks on plane coordinates and thus determine the ideal stimulation site for MPPD sensory nerve conduction studies. Method: We dissected 10 feet from five adult cadavers and identified the bifurcation points of the MPPD nerve. Two reference lines in relation to anatomical landmarks were defined. A vertical line connecting the mid-point of heel (H) and tip of great toe (G) was defined as the HG line. A transverse line connecting the navicular tuberosity (N) and tuberosity of 5th metatarsal bone (M) was defined as the NM line. The bifurcation points of the 10 MPPD nerves were expressed in X, Y coordinates in relation to these two axis. Results: The bifurcation points were located at approximately 40% (40.0±2.4; mean±SD) of the HG line from the mid-point of heel (H) and at approximately 37% (36.5±3.6) of the NM line from the navicular tuberosity (N). The majority of these points were found to be clustered close to the HG line. Conclusion: The data on the MPPD nerve bifurcation points may be useful to localize the appropriate stimulation site that could be used in MPPD nerve conduction studies. (J Korean Acad Rehab Med 2009; 33: 98-102)

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Anatomical Considerations of Lateral and Medial Antebrachial Cutaneous Nerves.: Sin, Joo Yong , Kim, Dong Hwee , Bun, Hye Ryoung , Hwang, Mi Ryoung , Kang, Yoon Kyoo , Kwon, Hee Kyu , Lee, Hang Jae; J Korean Acad Rehabil Med 2007;31(3):329-332.

Abstract
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Objective
To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. Method: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. Results: BT_L and L12 were 1.4±3.7 mm and 4.4±3.7 mm respectively. ME_M, M8 and M10 were 28.6±6.9 mm, 18.9±8.9 mm and 18.3±8.2 mm respectively. The thickness of LABCN and MABCN was 19.1±4.9 mm and 13.2±4.2 mm respectively. Conclusion: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm. (J Korean Acad Rehab Med 2007; 31: 329-332)

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Suggestion of Safer and Easier Technique of Suprascapular Nerve Block based on Cadaver Study.: Hong, Hyun taek , Lee, Jong In , Lee, Won Il , Kim, Joon Sung , Sung, Nam Suk , Choi, Hang Joon , Won, Sun Jae , Ko, Young Jin; J Korean Acad Rehabil Med 2005;29(6):630-634.

Abstract
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Objective
To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. Method: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. Results: The length of the spine was 11.45⁑0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89⁑0.2：1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69⁑0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18⁑0.1 cm. Conclusion: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study. (J Korean Acad Rehab Med 2005; 29: 630-634)

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Positioning of Lumbar Facet Joints by Analysis of Surface Anatomy in Korean Adults.: Kim, Jong Moon , Lee, Jeong Mo , Kim, Jong Hoon , Chung, Jin Sang , Choi, Young Chil; J Korean Acad Rehabil Med 2004;28(6):601-605.

Abstract
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Objective
To determine the Korean adult standard of mean length and depth from spinous process which is palpable landmark of back to each facet joint. Method: The horizontal line was made between the posterior end of each facet joint, and the rectangular line was made on the horizontal line at the level of spinous process, respectively. We measured the length from the point of intersection to the posterior end of each facet joint (SFL), and the depth from the tip of spinous process to the point of intersection (SFD). All parameters were measured in 30 volunteers (Exp. 1) using computed tomography and in 30 cadavers (Exp. 2). Results: The lower lumbar spine revealed the longer SFL (p＜0.01). SFD was significantly increased from L1-L2 to L3-L4 facet joints, but significantly decreased in L5-S1 facet joint compared to L4-L5 facet joint (p＜0.01). There was no significant difference in laterality, gender, and viability (Exp. 1 and Exp. 2)(p＞0.05). There was no correlation with height and weight, either (r＜0.04). Conclusion: We measured the standard for SFL and SFD in Korean. We suggest that these results will be useful in clinical practice including blind approach of spinal intervention to the facet joints. (J Korean Acad Rehab Med 2004; 28: 601-605)

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The Emotional Problem and Its Relation to Lesion Location in Stroke Patient.: Park, Gi Young , Hwang, Sung Eun , Chang, Eun Jin , Jung, Chul Ho; J Korean Acad Rehabil Med 2001;25(5):751-757.

Abstract
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Objective: This study is aimed at the pathoanatomic correlates of emotional problem in the patients with stroke.

Method: Thirty patients with single, unilateral hemispheric lesion and no predisposing factors for psychiatric disorder were selected. Several neuropsychological assessments such as Mini- mental status examination-Korean (MMSE-K), Minnesota multiphasic personality inventory (MMPI), Symptom checklist-90-Revision (SCL-90-R) and Functional independence measure (FIM) were performed on all patients by a clinical psychologist and an occupational therapist.

Results: There were statistically significant differences between right and left hemisphere lesion group in emotional problems. Right hemispheric lesion group showed significantly higher scores of psychasthenia (MMPI), Obsessive-compulsive (SCL-90-R) and self care (FIM) than left hemispheric lesion group did. But there were no statistically significant differences between cortical and subcortical lesion group. Groups of left cortical lesion, right cortical lesion, left subcortical lesion and right subcortical lesion were not significantly different in their neuropsychological assessments and FIM except self care.

Conclusion: Obsessive-compulsive and anxious emotional problems are more closely related with right hemispheric lesion. Therefore patients with right hemispheric lesion need more careful psychological and psychiatric evaluation. However, because of the small numbers of subjects involved in the study, the role of lesion location remains unclear so that consecutive follow-up studies are needed.

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Superficial Peroneal Nerve Conduction Study.: Lee, Zee Ihn , Lee, Yang Soo , Kim, Poong Taek; J Korean Acad Rehabil Med 1997;21(2):330-334.

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Sixteen legs in eight cadavera were dissected to observe the anatomic course of the superficial peroneal nerve around the ankle and the superficial peroneal sensory conduction study was performed in twenty-eight normal subjects. The anatomic course of the superficial peroneal nerve around the ankle was in two types, type I and type II. Type I was 13 cases(81%) and type II was 3 cases(19%). In type I, the nerve penetrated the crural fascia and became subcutaneous at 8.8⁑1.1 cm proximal to the ankle joint and divided into two major branches at 2.6⁑1.1 cm proximal to the ankle. Medial and intermediate dorsal cutaneous nerves were located at 47%(⁑3.4%) and 35%(⁑4.9%) of the intermalleolar distance from lateral malleolus, respectively. In type II, the medial and intermediate dorsal cutaneous nerve arose seperately from the superficial peroneal nerve at 8.0⁑0.9 cm proximal to the ankle joint. Medial and intermediate dorsal cutaneous nerves were located at 49%(⁑5.6%) and 33%(⁑4.0%) of the intermalleolar distance from the lateral malleolus, respectively. Superficial peroneal sensory conduction study was performed based on the findings of type I. The mean distal latencies and amplitudes were 3.21⁑0.35 msec, 12.1⁑3.37 ㄍV and 3.17⁑0.37msec, 14.54⁑4.60 ㄍV in medial and intermediate dorsal cutaneous nerves, respectively.