The palmar cutaneous branch of the ulnar nerve arises from the ulnar nerve approximately 5-6 cm above the wrist and descends superficial to the flexor retinaculum to supply the skin over the hypothenar eminence, the medial palm, and the proximal little finger. It passes superficial to Guyon canal and is therefore spared in Guyon canal ulnar nerve entrapment.
| Origin | Ulnar nerve in the distal half of the forearm |
|---|---|
| Course | Descends on the ulnar artery and pierces the deep fascia above the wrist, passing superficial to the flexor retinaculum |
| Sensory |
|
Preservation of palmar cutaneous branch sensation (hypothenar eminence) in ulnar nerve compression at the wrist distinguishes Guyon canal entrapment (preserved) from more proximal ulnar nerve pathology at the cubital tunnel (involved) where all ulnar cutaneous territories are affected. During FCU resection or ulnar bone procedures at the wrist, this branch must be protected to avoid painful neuroma in the medial palm. FCU incisions for distal ulnar surgery should be placed to avoid the palmar cutaneous territory.
Incisions on the ulnar aspect of the wrist for FCU tendon surgery, pisiform excision, or ulnar styloid procedures may injure the palmar cutaneous branch producing a painful neuroma in the medial palm, managed by proximal neuroma relocation away from the scar or targeted neurectomy.
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