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The Nerve of Henle: An Anatomic and Sympathetic Study of the Ulnar Innervation
Eduardo Pablo Zancolli, MD1; Diego Piazza, MD2; Carlos Lozano, MD3; Christina Kaufman, PhD3; Jim Kleinert, MD3; Luis Scheker3; Eduardo Zancolli, MD4
1Kleinert Kutz, Louisville, KY; 2Fundacion Favaloro, Buenos Aires, Argentina; 3Christine M. Kleinert Institute, Louisville, KY; 4Hospital Naval Pedro Mallo, Buenos Aires, Argentina

Introduction: Initially described by Bourgery, the Nerve of Henle(NH) is described as a branch of the ulnar nerve(UN) in the forearm. Studies on the NH are few. Balogh et al, reported the presence sympathetic nerve fibers, but only found the NH in less than 60% of cases. This study will present data on the presence of the nerve and frequency of sympathetic fibers in relation to the ulnar nerve and its branches in the forearm. The data will be analyzed to determine if the absence of the NH influences the number of the sympathetic fibers of the posterior interosseous nerve (PIN).

Materials and Methods: The UN was dissected in 15 fresh cadaveric forearms from the medial epicondyle to the pisiform under 3.5X magnification. The origin of the nerve of the NH was measured from the medial epicondyle and the pisiform. The NH was identified and dissected in its course with the ulnar artery(UA) through out the forearm. The ulnar innervation was divided in 3 segments. 2 cm nerve samples where obtained from each segment. An additional PIN sample was obtained in each specimen. The nerve samples were fixed in 10% formalin and paraffin embedded. The tissue was stained for sympathetic fibers using Tyrosine hydroxylase antibody (ABCAM catalog #ab62111) and anti-rabbit Ig-HRP (Life Technologies, cat# 65-6120). The number of sympathetic fibers per fascicle where quantified using Motic images Plus (www.motic.com).

Results: The NH was present in 100% of the cases. In 80% had a typical presentation (McCabe and Kleinert). In the typical presentation the NH divided from the UN on average 10.51 cm distal to the medial epicondyle and 15.88 proximal to the pisiform. In the atypical presentation the NH's origin was 17.6 cm distal to the medial epicondyle and 8.8 cm proximal to the pisiform. The dorsal sensory branch divided from the UN on average 7.78 cm proximal to the pisiform. Sympathetic nerve fibers were found in all nerve samples. However the NH had a higher number of sympathetic fibers per mm2 of fascicle area, compared to the UN and Dorsal Sensory Nerve.

Conclusion: Data collected to date on freshly embalmed specimens revealed the presence of the Nerve of Henle in all forearms. A higher concentration of sympathetic nerve fibers and migration of the nerve into the ulnar artery suggests the NH may be a good target in the treatment of vasospastic disorders in the hand.

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