The Nerve of Henle. An Anatomic and Sympathetic Study of the Ulnar Artery Innervation
Eduardo Pablo Zancolli, MD; Hand Surgery, Fundacion Favaloro, Buenos Aires, Argentina; Diego Piazza, MD; Christine M. Kleinert Institute, Louisville, KY; Christina Kaufman, PhD; Christine Marie Kleinert Institute for Hand and Microsurgery, Louisville, KY; Luis R. Scheker, MD; Kleinert Kutz Hand Care Center, Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY; Eduardo Alfredo Zancolli, MD; Hospital naval Pedro Mallo, Buenos Aires, Argentina
Background: The Nerve of Henle (NH) is described as a branch of the ulnar nerve (UN) in the forearm. Studies of the NH are few. Kleinert and Mc Cabe suggested the presence of sympathetic fibers in the NH. Balogh et al confirmed that the NH carried sympathetic fibers. Both studies only reported the presence of the NH in less than 60% of the dissections performed. Zancolli et al had shown the presence of the NH in all the specimens dissected (100%), and described a strong anatomic relation between the NH and the ulnar artery. Purpose: The purpose of this study is to evaluate and quantify the presence of sympathetic fibers in the ulnar artery (UA) before and after is being reach by the nerve of Henle in the forearm.
Material and Methods: The UN was dissected in 7 fresh cadaveric forearms from the medial epicondyle to the pisiform under 3.5X magnification. The NH was identified and dissected in its course with the UA throughout the forearm. A 1 cm ulnar artery sample was obtained in each specimen before and after the NH contact the artery. The nerve and artery samples were stained for sympathetic fibers using Tyrosine hydroxylase antibody (ABCAM catalog no. ab62111) and anti-rabbit Ig-HRP (Life Technologies, catalog no. 65-6120). Sympathetic fibers in the UA samples were studied under microscope magnification.
Results: The NH was present in 100% of the specimens. Sympathetic nerve fibers were found in all the NH studied. In all the specimens the NH travel a short distance in the forearm to join the ulnar artery. The UA appear to present more sympathetic fibers between the media and adventitia after the NH reaches the artery in 6 of the 7 arteries studied.
Conclusion: The NH was observed in all the forearms studied (100%). Previous studies described the presence of NH up to 58% of the specimens. We think that the main difference in the presence of NH is because we only used fresh cadaveric forearms. In all the cases, the NH joined the UA in the forearm after exiting the UN, showing a strong anatomic relation between these 2 structures. Immunochemistry confirmed the presence of sympathetic fibers in all the NH studied. 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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