The palmar cutaneous branch of the median nerve divides from the main median nerve in the distal forearm and passes superficial to the transverse carpal ligament (not through the carpal tunnel) to supply the central palm skin. Its superficial course makes it vulnerable to injury during carpal tunnel release surgery, producing persistent palmar scar tenderness (pillar pain) that can persist for months after otherwise successful decompression.
| Origin | Median nerve in the distal forearm 5 cm proximal to the wrist crease |
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Palmar cutaneous branch injury during carpal tunnel release produces pillar pain — persistent tenderness of the thenar and hypothenar eminence skin adjacent to the incision that is the most common post-operative complaint. Endoscopic carpal tunnel release reduces pillar pain incidence by avoiding the palmar skin incision but requires greater technical expertise. The branch is identified and protected during open release by staying ulnar to the thenar crease.
Palmar cutaneous nerve injury or hypersensitivity producing persistent palmar scar tenderness after carpal tunnel release, managed with desensitisation therapy.
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