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Dr. Ebraheim's animated educational video describing Anastomosis Between the Median & Ulnar Nerves In The Forarm and Hand. There are four categories of anomalous interconnections that may occur between the median and ulnar nerve. Two of this anastomosis are found in the forearm termed Martin Gruber (MGA) and Marinacci (MA). 1-Martin Gruber (MGA) 2-Marinacci (MA) ( reverse of Martin Gruber (MGA)) 3-Riche-Cannieu Anastomosis (RCA): connection between the deep branch of the ulnar nerve and the recurrent branch of the median nerve. 4-Berrettini Anastomosis: communication between the digital nerves (sensory nerves) arising from the ulnar and median nerves in the hand. Most common nerve anastomosis pattern. Awareness of each of these is important due to their clinical implications. MGA stems from the median nerve proximally, most often from the anterior interosseous nerve branch to join the ulnar nerve distally. It is commonly found unilaterally and on the right side, running an oblique course and connecting posterior to the ulnar artery. MGA nerve fibers are most often of an efferent nature, contributing to the motor innervation of the hand via the ulnar nerve. Muscles supplied include the first dorsal interosseous, the hypothenar group, and/or the thenar group. Beneficially, partial or total sparing of thenar muscles can occur with median nerve damage at the wrist, and motor function typically ulnar-supplied hand muscles may be preserved with lesions to the ulnar nerve at the elbow. However median nerve injury at the elbow or ulnar nerve injury at the wrist may have more destructive results. Consequently, MGA may complicate the diagnosis of carpal tunnel syndrome, cubital tunnel syndrome, peripheral lesions and neuropathies. It is also important to note that iatrogenic damage of MGA is possible in the management of cases such as ulnar artery reconstruction and ulnar nerve transposition. The least common of the anastomosis is MA, which is also known as reverse MGA. Ulnar to median anastomosis in the forearm-reverse of Martin-Gruber. It arises from the ulnar nerve proximally in the forearm to unite with the median nerve distally. Nerve fibers are mostly motor and enter the median nerve to supply typically median innervated muscles of the hand. Therefore, median nerve injuries at the elbow may not result in noticeable effects on thenar muscles, whereas ulnar nerve injuries at the elbow may be accompanied by denervation changes over thenar muscles. Riche-Cannieu Anastomosis (RCA) occurs between the recurrent branch of the median nerve and the deep branch of the ulnar nerve in the hand. There are several presentations: •A hand may be entirely supplied by the ulnar nerve. •Have a motor function supplied solely by the ulnar nerve. •Or have a partial ulnar innervation of normally median-innervated muscles. As a result, misdiagnosis and/or mismanagement may be possible in cases of complete or severe median nerve lesion, carpal tunnel syndrome and neuropathies. Berrettini Anastomosis (BA) is the most common of the four neural connections, often considered a normal anatomical structure. It exits as a junction between the common digital nerves of the ulnar and median nerves, most often from the fourth to the third common digital nerve. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundati...