- Original article
- Open access
- Published:
Electrophysiological study of Martin—Gruber anastomosis in a sample of Egyptians
Egyptian Rheumatology and Rehabilitation volume 44, pages 153–158 (2017)
Abstract
Introduction
Martin–Gruber anastomosis (MGA) is one of the most common anomalous innervations present in the body. Missing these anomalous innervations may easily be mistaken for technical pitfalls or even for actual pathology.
Aim
The aim of the current study was to determine the presence and the frequency of MGA by electrophysiological examination in a sample of Egyptian subjects.
Subjects and methods
It is a cross-sectional study of consecutive apparently healthy volunteers. The study included 200 forearms from 100 apparently healthy Egyptian volunteers in a single-center public-hospital-based electromyography laboratory. Electrophysiological studies in the form of motor conduction study for the median and ulnar nerves were performed by recording the hypothenar, first dorsal inerosseous, and thenar muscles. Qualitative data were analyzed using Pearson’s Chi-square test and Fisher’s exact test.
Results
The present study included 69 (69%) women. MGA was found in 39 (19.5%) forearms of 26 (26%) subjects electrophysiologically. There was no statistical significant difference between the occurrence of MGA in men versus women (P=0.127). The most common form was MGA to the first dorsal interosseous muscle. It was present in 30 (15%) forearms of 24 (24%) subjects. MGA to thenar muscles was present in 13 (6.5%) forearms of 12 (12%) subjects. MGA to the abductor digiti minimi muscle was present in five (2.5%) forearms of five (5%) subjects.
Conclusion
Martin–Gruber anastomosis is present in Egyptians. The frequency of occurrence of MGA in a sample of Egyptian subjects was found to be 26% in electrophysiological examination.
References
Sarikcioglu L, Sindel S, Ozkaynak S, Aydin H. Median and ulnar nerve communication in the forearm: an anatomical and electrophysiological study. Med Sci Monit 2003; 9:BR351–BR356.
Pawar S, Gathe B, Jain AP, Singh R. Electrophysiologic study of Martin-Gruber anastomosis in central Indian subjects. Int J Biol Med Res 2011; 2:1165–1167.
Preston DC, Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrophysiologic correlations. 3rd ed. London, UK: Elsevier; 2013.
Van Dijk JG, Bouma PAD. Recognition of the Martin-Gruber anastomosis. Muscle Nerve 1997; 20:887–889.
Budak F, Gonenc Z. Innervation anomalies in upper and lower extremities (an electrophysiological study). Electromyogr Clin Neurophysiol 1999; 39:231–234.
Lee KS, Oh CS, Chung IH, Sunwoo IN. An anatomic study of the Martin-Gruber anastomosis: electrodiagnostic implications. Muscle Nerve 2005; 31:95–97.
Amoiridis G. Median-ulnar nerve communications and anomalous innervation of the intrinsic hand muscles: an electrophysiological study. Muscle Nerve 1992; 15:576–579.
Crutchfield CA, Gutmann L. Hereditary aspects of median-ulnar nerve communications. J Neurol Neurosurg Psychiatry 1980; 43:53–55.
Lee SA, Kim WK, Lee MC, Sunwoo IN, Kim KW. The electrodiagnostic findings in Martin-Gruber anastomosis. J Korean Neurol Assoc 1994; 12:87–91.
Leibovic SJ, Hastings H. Martin-Gruber revisited. J Hand Surg 1992; 17:47–53.
Rodriguez-Niedenführ M, Vazquez T, Parkin I, Logan B, Saudo JR. Martin-Gruber anastomosis revisited. Clin Anat 2002; 15:129–134.
Taams KO. Martin-Gruber connections in South Africa. An anatomical study. J Hand Surg Br 1997; 22:328–330.
Iyer V, Fenichel GM. Normal median nerve proximal latency in carpal tunnel syndrome: a clue to coexisting Martin-Gruber anastomosis. J Neurol Neurosurg Psychiatry 1976; 39:449–452.
Gutmann L. Median ulnar nerve communication and carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 1977; 40:982–986.
Saba EK. Median versus ulnar medial thenar motor recording in diagnosis of carpal tunnel syndrome. Egypt Rheumatol 2015; 37:139–146.
Hasegawa O, Matsumoto S, Iino M, Kirigaya N, Mimura E, Wada N, Gondo G. Prevalence of Martin-Gruber anastomosis on motor nerve conduction studies. Brain Nerve 2001; 53:161–164.
University of Cambridge Computing Service. Statistical Package of Social Science, version 17. Documentation. London, UK: University of Cambridge Computing Service; 2007.
Davis DL, Johnson EW. Anatomy for the electromyographer. In: Pease WS, Lew HL, Johnson EW, editors. Johnson’s practical electromyography. 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2007. pp. 3–20.
Rodriguez-Niedenführ M, Vazquez T, Ferreira B, Parkin I, Nearn L, Sañudo JR. Intramuscular Martin-Gruber anastomosis. Clin Anat 2002; 15: 135–138.
Prates LC, de Carvalho VC, Prates JC, Langone F, Esquisatto MAM. The Martin-Gruber anastomosis in Brazilians: an anatomical study. Braz J Morphol Sci 2003; 20:177–180.
Kayamori R. Electrodiagnosis in Martin-Gruber anastomosis. J Jpn Orthop Assoc 1987; 61:1367–1372.
Gutmann L. AAEM mini-monograph #2: important anomalous innervations of the extremities. Muscle Nerve 1993; 16:339–347.
Erdem HR, Ergun S, Erturk C, Ozel S. Electrophysiological evaluation of the incidence of Martin-Gruber anastomosis in healthy subjects. Yousei Med J 2002; 43:291–295.
Kimura J, Murphy MJ, Varda DJ. Electrophysiological study of anomalous innervation of intrinsic hand muscles. Arch Neurol 1976; 33:842–844.
Ballesteros LE, Forero PL, Quintero ID. Median ulnar nerves communication in the forearm: a study with autopsy material. Ital J Anat Embryol 2014; 3:232–240.
Hodzic R, Piric N, Hodzic M, Kojic B. Electrophysiological evaluation of the incidence of Martin-Gruber anastomosis in healthy Bosnian population. Macedonin J Med Sci 2011; 4:376–379.
Felippe MM, Telles FL, Soares ACL, Felippe FM. Anastomosis between median nerve and ulnar nerve in the forearm. J Morphol Sci 2012; 1:23–26.
Ayramlou H, Najmi S, Yazdchi M, Naeimi M, Pourabolghasem S. Study of prevalence of Martin-Gruber anomaly in patients with carpal tunnel syndrome. Int J Chronic Dis Ther 2015; 1:5–8.
Valls-Sole J. Martin-Gruber anastomosis and unusual sensory innervation of the fingers: report of a case. Muscle Nerve, 1991; 14: 1099–1102.
Uchida Y, Sugioka Y. Electrodiagnosis of Martin-Gruber connection and its clinical importance in peripheral nerve surgery. J Hand Surg Am 1992; 17:54–59.
Robinson LP. Entrapment neuropathies and other focal neuropathies. In: Pease WS, Lew HL, Johnson EW, editors. Johnson’s practical electromyography. 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2007. pp. 259–295.
Van Tieghem J, Vandendriessche G, Vanhecke J. Martin-Gruber anastomosis: the explanation for late diagnosis of severe ulnar nerve lesions at the elbow. Electromyogr Clin Neurophysiol 1987; 27:13–18.
Brandsma JW, Birke JA, Sims DS. The Martin-Gruber innervated hand. J Hand Surg 1986; 11A:536–539.
Kimura I, Ayyar DR, Lippmann SM. Electrophysiological verification of the ulnar to median nerve communications in the hand and forearm. Tohoku J Exp Med 1983; 141:269–274.
Rosen AD. Innervation of the hand: an electromyographic study. Electromyogr Clin Neurophysiol 1973; 13:175–178.
Golovchinsky V. Ulnar-to-median anastomosis and its role in the diagnosis of lesions of the median nerve at the elbow and the wrist. Electromyogr Clin Neurophysiol 1990; 30:31–34.
Stancic MF, Burgic N, Micovic V. Marinacci communication. Case report. J Neurosurg 2000; 92:860–862.
Santoro L, Rosato R, Caruso G. Median-ulnar nerve communications: electrophysiological demonstration of motor and sensory fiber crossover. J Neurol 1983; 229:227–235.
Simonetti S. Electrophysiological study of forearm sensory fiber crossover in Martin–Gruber anastomosis. Muscle Nerve 2001; 24: 380–386.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Aziz Saba, E.K. Electrophysiological study of Martin—Gruber anastomosis in a sample of Egyptians. Egypt Rheumatol Rehabil 44, 153–158 (2017). https://doi.org/10.4103/err.err_12_17
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/err.err_12_17