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First Dorsal Digital Nerve of the Thumb

nervus digitalis dorsalis pollicis radialis

The first dorsal digital nerve of the thumb is a branch of the superficial radial nerve that supplies the dorsal skin of the radial (lateral) surface of the thumb from the MCP joint to the IP joint level. It runs with the first dorsal digital artery along the radial dorsal thumb. It is distinct from the palmar digital nerves of the thumb which are branches of the median nerve.

Region: Hand & Wrist

Clinical Relevance

Clinical Notes

The first dorsal digital nerve is at risk during de Quervain tenosynovitis release and First CMC joint arthroscopy and arthroplasty. The nerve runs immediately superficial to the first extensor compartment fibrous sheath, and longitudinal incision must be made carefully to avoid nerve injury producing painful numbness on the dorsal thumb. Scar neuroma of this nerve after de Quervain release produces chronic dorsal radial thumb pain that can be more disabling than the original tenosynovitis. Targeted nerve block at the radial styloid anaesthetises this nerve for dorsal thumb procedures.

Pathology

Common Injuries & Conditions

First Dorsal Digital Nerve Injury in De Quervain Release

Longitudinal incision directly over the first extensor compartment for de Quervain tenosynovitis release risks the first dorsal digital nerve of the thumb crossing the operative field; nerve division produces dorsal thumb numbness and painful neuroma that may require neuroma excision and nerve end relocation proximal to the scar zone.