RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE - II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. / NAME OF THE CANDIDATE &
ADDRESS / Dr. VIJAY KUMAR S.
POST GRADUATE STUDENT DEPARTMENT OF ANATOMY
BANGALORE MEDICAL COLLEGE & RESEARCH INSTITUTE
BANGALORE – 560002
2. / NAME OF THE INSTITUTION / BANGALORE MEDICAL COLLEGE & RESEARCH INSTITUTE
BANGALORE – 560002
3. / COURSE OF STUDY AND
SUBJECT / M. D. (ANATOMY)
4. / DATE OF ADMISSION TO
COURSE / 30th MAY 2011
5. / TITLE OF THE TOPIC:
“A STUDY OF ORIGIN, COURSE, DISTRIBUTION AND
VARIATIONS OF ULNAR NERVE”.
6.
7.
8.
9.
10.
11.
12. / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the Study:
The ulnar nerve is also known as musician’s nerve. It arises from the
medial cord of brachial plexus, from the ventral rami of C8 and T1 in the axilla.
Here it runs between axillary artery and vein. In arm, continues medial to the
brachial artery, pierces the medial intermuscular septum, inclining medially as it
descends anterior to the medial head of the triceps to the interval between medial
epicondyle and olecranon process of the humerus. It runs distally enters forearm
between the two heads of flexor carpi ulnaris and passes medial to ulnar artery to
enter Guyon’s canal. It divides here into superficial and deep branches. In its
course ulnar nerve supplies flexor carpi ulnaris, medial half of flexor digitorum
profundus, adductor pollicis, hypothenar muscles, medial two lumbricals,
interossei and skin of medial one and half digits of palmar and dorsal aspect of
hand.1,2,3
The course of ulnar nerve in the arm, forearm and hand is to be known by
all physicians, surgeons, orthopedicians and neurosurgeons. This helps in
preventing paraesthesia caused by prolonged inflation of cuff of
sphygmomanometer in the arm; damage due to fracture of medial epicondyle;
preventing damage to ulnar nerve branches at Guyon’s canal during surgical
release or endoscopic release of flexor retinaculum.
6.2 Review of Literature:
Jamuna in her case study described the variations in relation to origin of
ulnar nerve from medial cord. The ulnar nerve was present lateral to the axillary
artery and then it crossed the axillary artery from lateral to medial and further
coursed down medial to the brachial artery.4
Gupta, Goyal et al, in their case report found anomalous communicating
branches between medial root of median and ulnar nerve. Another
communicating branch from ulnar nerve to radial nerve was observed.5
Glabriel and Makar in their case report revealed anatomical variations in
the ulnar nerve which trifurcated just proximal to the pisiform bone. In some it
was in the Guyon’s canal. In this report third branch was a muscular branch
innervating the three heads of abductor digiti minimi. The communication
between dorsal branch of ulnar nerve and digital nerve of the fingers have been
referred to as Kaplan’s anastomoses.6
Olave and Sol described that ulnar nerve lies at the hook of hamate and
bifurcates in the middle portion of the tunnel. They found variations of ulnar
nerve at the level of ulnar tunnel namely anomalous branches emerging
from dorsal branch of nerve or trifurcating before entering tunnel.7
Lama, Petu et al, in their case report found ulnar nerve divides into three
branches on the dorsal aspect of the wrist, one medial, two lateral branches. It
supplies medial three digits that is radial and ulnar side of little, ring and middle
finger.8
6.3 Objectives of the study:
1. To study the origin, course and distribution of ulnar nerve in the arm,
forearm and hand.
2.  To observe any variations in origin, course and distribution of ulnar nerve
in the arm, forearm and hand.
MATERIALS AND METHOD:
7.1. Sources of data:
The study will be conducted on 50 upper limbs embalmed cadavers from the
Department of Anatomy, Bangalore Medical College and Research Institute,
Bangalore.
7.2. Method of collection of Materials:
A. Study Design: observational method.
B. Study Period: November 2011 – may 2013.
C. Place of Study: Dissection hall, Department of Anatomy, Bangalore
Medical College and Research Institute, Bangalore.
D. Sample Size: 50.
E. Inclusional Criteria: Cadavers of both the sexes which are in good condition
without any deformity will be included in the study.
F. Exclusional Criteria: Cadavers with congenital, acquired deformities and
fractures of the upper limb will be excluded from the study.
G. Methodology:
By dissection method, 10 percent formalin fixed cadavers will be used.
The dissection of upper limb will be done according to the practical
manual.9 Ulnar nerve will be traced from its origin at the axilla, its course in the arm, forearm and palm with its distribution, its relations with axillary artery, brachial artery, ulnar artery and median nerve will be observed. All upper limb
specimens will be photographed.
H. Statistical Analysis:
By chi square method.
7.5. Does this study require any investigations or interventions to be
conducted on patients or other human or animals? If so, please describe
briefly;
NO.
7.6. Has ethical clearance been obtained from your institution in case of 7.3?
YES.
LIST OF REFERENCS:
1. Standring S.: Gray’s Anatomy; Section 6; Pectoral girdle and Upper limb: 40th
Edition, The Anatomical basis of Clinical Practice; New York, Elsevier
Churchill Livingstone; 2008; 780-898.
2. Snell R.S.: Clinical Anatomy; Chapter 9; The Upper Limb; 8th edition,
Lippincott, William & Wilkins; 2004: 449-509.
3. Romanes G.J.; Cunningham’s Textbook of Anatomy; Chapter 11; The
Peripheral nervous system; 12th edition, Oxford, Oxford Publication;1981:
779-781.
4. Jamuna M.; Case report: Clinically significant variations of the cords of
the brachial plexus in relation to axillary artery; International Journal of
Anatomical variations; 2011; 4: 9-11.
5. Gupta M., Goyal N. and Harjeet; Anomalous communications in the
branches of brachial plexus, PGIMER; Chandigarh; The Journal of
Anatomical society of India; 2005; 54, 1: 01-03.
6. Ghabriel M.N. and Maker P.H.; Anatomical variations in the ulnar nerve and
hypothenar muscles: International journal of Anatomical variations; 2011; 4:
131-133.
7. Enrique Olave, Mariano Del Sol; Correspondance; The ulnar tunnel: a rare
disposition of its contents; Journal of Anatomy; 1997; 191: 615-616.
8. Lama P, Petu B.K. and Bhat K. M. R.; Case Report: High origin of dorsal
branch of ulnar nerve and variations in its branching pattern and distribution:
The Cases Journal; 2009; The Electronic Access;
http://www.casesjournal.com/2/1/9130
9. Romanes G. J. Cunningham’s manual of practical anatomy, 15th edition;
Oxford University Press: 1990; 35-103.
SIGNATURE OF THE CANDIDATE:
REMARKS OF THE GUIDE:
This study is important to know the variations in the origin ,course and
distribution of the ulnar nerve, which is very important for the surgeons to avoid
injury to the nerve during surgery and also helpful to the orthopedic surgeons in
the fracture of medial epicondyle. Hence it is approved and forwarded.
NAME & DESIGNATION :
11.1 Guide:
DR. IMTIAZUL HAQ
PROFESSOR AND HEAD
DEPARTMENT OF ANATOMY
BANGALORE MEDICAL COLLEGE
& RESEARCH INSTITUTE, BANGALORE
11.2 Signature:
11.3 Co – guide (If any):
NO
11.4 signature:
11.5 Head of the Department:
DR. IMTIAZUL HAQ
PROFESSOR AND HEAD
DEPARTMENT OF ANATOMY
BANGALORE MEDICAL COLLEGE
& RESEARCH INSTITUTE, BANGALORE
11.6 Signature:
12.1 REMARKS OF THE CHAIRMAN PRINCIPAL:
12.2 SIGNATURE: