Anterior Compartment Of The Forearm Research Articles

An accessory muscle belly or an accessory muscle head? An unusual arrangement of muscles in the anterior compartment of the forearm

PurposeKnowledge of the unusual arrangement of the flexor pollicis longus (FPL) muscle is important as the variable tendon may be a rare cause of carpal tunnel syndrome.MethodsDuring a routine dissection at the Department of Anatomy, an unusual formation of the FPL muscle was observed in a formalin embalmed Central European cadaver.ResultsThis report presents a variation of the FPL muscle, where the muscle split and formed a separate accessory head inserting into the first lumbrical muscle. Moreover, a tendinous interconnection was present between the FPL muscle tendon and the tendon of the aberrant muscle head.ConclusionThe cases described by previous literature, concerning the Linburg–Comstock variation or the accessory head of the first lumbrical muscle originating from the FPL muscle, are closest to the present case. Such variation has a clinical significance ranging from the functional limitation of the thumb and index finger movement to the potential median nerve compression.

Surgical resection of venous malformations of the forearm.

We retrospectively reviewed 35 patients with venous malformations located in the forearm and treated by surgery in a single institution during the period 2010-19. The common complaints were pain and swelling (34 patients) and impaired function with contractures of fingers (15 patients). Twenty-four had complete resection and 11 had an incomplete resection. Associated procedures were reconstruction or lengthening of tendons in 17 patients. At the last follow-up (mean 61months), 32 of the 35 had no residual pain and 27 had no functional sequelae. On MRI follow-up exams, 27 had no residual venous malformations. Venous malformations in the anterior compartment of the forearm can impair the function of the hand. They are developed almost exclusively in the connective tissue around tendons and muscles, deforming the musculotendinous structures and involving nerves. Surgery seems an appropriate option for the condition in this area.Level of evidence: IV.

Prevalence of agenesis of palmaris longus in male and female genders on clinical examination - a review.

Palmaris longus is a muscle that is located in the anterior compartment of the forearm. Among the muscles belonging to the flexor compartment of forearm, palmaris longus is located at the most superficial position and that is why it is easy to access. It exhibits high variability and its prevalence ranges between 1.5% and 63.9%. The knowledge of prevalence of agenesis of palmaris longus is essential both in terms of updating anatomical information and also for physicians, radiologists, physiotherapists and surgeons. The surgeons must know about the variability as it may be beneficial while they plan surgeries involving the palmaris muscle as a graft. The current narrative review was planned to highlight the variability pattern of palmaris longus muscle in terms of prevalence, gender and laterality. Palmaris longus agenesis is more common in females and on the left side. Besides, unilateral agenesis is more common compared to bilateral agenesis.

Ultrasonographic evaluation of the median nerve: normal and variant anatomy and appearance.

The median nerve is a mixed sensory and motor nerve that innervates part of the flexor muscles in the anterior compartment of the forearm and muscles in the lateral part of the hand; palmar cutaneous and digital cutaneous nerves branch from the median nerve, which provides sensory innervation to the skin on the radial side of the palm. Also, the median nerve is an object of interest because neuropathy of the median nerve at the level of the carpal tunnel is the most common entrapment neuropathy which increases dramatically in patients with diabetes. Neuromuscular ultrasound provides extensive diagnostic information and has proved itself as a useful complementary test to electrodiagnostic examinations in cases involving median nerve neuropathy. It often happens that the cause of nerve entrapment and neuropathy are variants of several anatomical structures along the course of the median nerve. It is important to be aware and report such anatomical variations of the median nerve in order to avoid damaging the nerve during surgical treatment. Despite the frequently documented abnormalities in the pathway of the brachial plexus and the median nerve, the anatomical variations are unusual to see and are rarely reported. Moreover, there are variations that do not fit under any of the classifications described in the literature.

Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure?

The flexor pollicis longus (FPL) is located in the anterior compartment of the forearm. It is morphologically variable in both point of origin and insertion. An additional head of the FPL can lead to anterior interosseous syndrome. This report presents a morphological variation of the FPL (additional head in proximal attachment and bifurcated tendinous insertion in distal attachment) and an unrecognized structure that has not so far been described in the literature. This structure originates in six heads (attached to the FPL or interosseous membrane) that merge together, and inserts on to the FPL. All the variations noted have clinical significance, ranging from potential nerve compression to prevention of tendon rupture.

Surgical management of the proximal injury to the nerves of the upper extremity: strategy at overcoming multiple critical gaps

Aim of the study — to evaluate the outcomes of reconstruction procedures at complete injuries of brachial plexus in subclavicular region. The retrospective analysis of the reconstruction procedures in 3 men and one woman (mean age 36,4 years) with complete injury of brachial plexus in subclavicular region was conducted. Injury to musculocutaneuos, median, ulnar and radial nerves was accompanied by axillary (2 cases) or brachial (2 cases) artery injury. One patient had no injury to musculocutaneous nerve within the injury’s structure. All patients underwent surgical reconstruction of the neural structures 4,8 months (mean term) post initial vascular surgery. The autografting was the main reconstruction procedure of the long nerves of the upper extremity at their critical gap (mean gap 10,5cm) with donor-nerves of the small (sural nerve) and large (ulnar nerve) cross sectional diameter. Both motor and sensory components of recovery were evaluated with MRC Scale and Seddon Scale respectively. Each patient evaluated the recovered median nerve mediated functions with Brief Michigan Hand Questionnaire. It was revealed that one patients showed poor recovery of the entire complex of the muscles of the upper and lower arm (MRSC 2 points or lower). Two patients showed good recovery of the biceps brachii muscle (MRCS score 5 points) on 14th and 13th month respectively. Mean MRC Scale score among three patients for the muscles of the anterior compartment of the forearm was: 3,3 points for m. flexor pollicis longus, 3,6 points for mm. flexores digitorum and 4 points for m. flexor carpi radialis respectively. Mean MRC Scale score among three patients for the muscles of the posterior compartment of the forearm was: 2,6 points for m. extensor pollicis longus, 3,3 points for m. extensor digitorum sublimis and 4 points for radial wrist extensors respectively. The median nerve mediated sensation recovered to 2,3 points on Seddon scale. Only one patient showed effective recovery of the thumb opposition. Loss of ulnar nerve mediated functions was expectable among all 4 enrolled patients, thereafter we observed no recovery of key pinch and diagonal volar grip. Three patients showed recovery of transversal volar grip only. Mean Brief MHQ score was 55,55 points – unsatisfactory recovery. The reconstruction of the ulnar nerve, thereafter recovery of the “intrinsics”, should be the priority in terms of reanimation of the basic grips and pinches of the upper extremity – one should avoid harvesting of the ulnar nerve at multiple nerve injury cases; the expectable loss of functions at the utililization of the radial nerve as a donor nerve, could be easily recompensed with the tendon transfer procedures in later terms.

Morphological Study Of Palmaris Longus Muscle

Background: The palmaris longus is one of the most variable muscle in the human body, this variations are important not only for the anatomist but also radiologist, orthopaedic, plastic surgeons, clinicians, therapists. In view of this significance is performed this study with the purpose to determine the morphological variations of palmaris longus muscle.
 Methods and Findings: A total of 17 cadavers with different age groups were used for this study. The upper limbs region (34 sides) were dissected carefully and photographed in the Morphology Laboratory at the University of Pamplona. Of the 34 limbs studied, 30 showed normal morphology of the Palmaris longus muscle (PL) (88,2%); PL was absent in 3 subjects (8,85% of all examined forearm). Unilateral absence was found in 1 male subject (2,95% of all examined forearm); bilateral agenesis was found in 2 female subjects (5,9% of all examined forearm). Duplicated PL muscle was found in 1 male subject (2,95 % of all examined forearm). The palmaris longus muscle was innervated by branches of the median nerve .The accessory palmaris longus muscle was supplied by the deep branch of the ulnar nerve. Palmaris longus muscle is a muscle located in the superficial layer of the anterior compartment of the forearm. It has a small belly arising from the medial epicondyle of the humerus, and its long thin tendon inserts into the palmar aponeurosis in the hand, the muscle has importance in medical clinic, surgery, radiological analysis, in studies about high-performance athletes, in genetics and anthropologic studies.
 Conclusions: The anatomical variations of the palmaris longus muscle must be documented of their clinical significance and their potential use in orthopaedic and reconstructive surgery.

English

Introduction:Flexor carpi radialis is a muscle of the superficial group of muscles, in the anterior compartment of the forearm. Normally, it takes origin from the medial epicondyle of humerus and is inserted into the palmar aspect of the base of second metacarpal bone and gives off a slip to the third metacarpal in the same aspect. Case report:Here we present a case with most of FCR (except for few muscle fibres close to the origin) being replaced with tendinous portion. Discussion:The action of FCR is in combination with the other muscles acting at the wrist joint. Some of the actions include flexion, abduction and circumduction that involve FCR. Any change in the normal anatomy of the muscle would affect the normal actions at the wrist. The knowledge regarding the variations in this muscle would prove beneficial to physiotherapists and also clinicians. Other main clinical implications of FCR is in grafts. The clinical and applied aspects have been discussed in the report.

A Comparative Analysis of Sonographic Interpretation of Peripheral Nerves in the Anterior Compartment of the Forearm Between an Experienced and Novice Interpreter

This article describes a pilot study that compares the ability of a novice interpreter and an experienced interpreter to interpret ultrasound images of peripheral nerves in the anterior compartment of the forearm. Twenty subjects between 18 and 50 years of age were included. A student was taken through tutorials in which she was guided through identification of the peripheral nerves of the anterior forearm. After the tutorials, the experienced interpreter traced the subjects' ulnar nerve and artery neurovascular bundle proximally in the anterior compartment of the forearm until just before it separated into the artery and nerve. Here the distance between the median and ulnar nerve was measured by the investigators. The Bland and Altman design and paired t tests were used to compare the agreement between the results of the two investigators. The Bland and Altman analysis reveals that the difference between two sets of measurements (experienced investigator vs. student) is calculated to be 0.08 mm ± 0.22 mm for the left arm and 0.16 mm ± 0.43 mm for the right arm. A paired t test revealed that there is no significant difference in the measurements obtained by the two investigators (left arm: p = .12; right arm: p = .10). These results suggest that the measurements of the two investigators may be interchangeable. This pilot study shows that after tutorials combining dissection and sonographic interpretation, the ability of a novice interpreter to identify ultrasonographic images of peripheral nerves in the anterior compartment of the forearm is comparable to that of an experienced interpreter.

Comment éviter les lésions iatrogènes du rameau communicant médio-ulnaire de Martin-Grüber dans la voie d’abord transmusculaire médiale du coude ?

The incidence of Martin-Grüber medio-ulnar communicating branch (MUCB), from median nerve to ulnar nerve, is about 20%. To avoid operative injury to MUCB, the authors suggest some modifications to the medial approach of the elbow. They suggest medial aponeurotomy of the anterior compartment of the forearm, disinsertion of the medial epicondylar muscles with dissection between the flexor carpi ulnaris (FCU) and the other medial epicondylar muscles, not exceeding 3 cm distally. This allows a valuable exposure of the elbow joint through a medial approach, with FCU disinsertion and ulnar nerve transposition preserving the ulnar nerve vascularization, without injury to the MUCB.

Les hémangiomes intramusculaires de l’avant-bras : sept cas

The authors reexamined the files of seven patients dealt with for intramuscular hemangioma of forearm. It concerns five women and two men, between 16 and 39years old. The average time of consultation was 13months. The clinical signs were dominated by the development of a generally painless soft mass over the anterior compartment of the forearm and/or the elbow. Two patients presented nervous lesions signs of the ulnar or median nerves. The feeder pedicle was the ulnar artery in five cases and radial artery in two cases. The excision was incomplete in two cases because of the invasion of the ulnar nerve by the hemangioma. With four years average follow-up, the five patients having undergone a complete excision do not present a recurrence and the hand function is excellent. The authors insist on the interest of a preoperative diagnosis with the IRM, which permits to envisage surgical difficulties due to the proximity of vascular and nervous pedicles.

Abnormal muscle in the anterior compartment of the forearm: a case report

During routine dissection for the undergraduate medical students, we encountered an unusual, additional muscle in the anterior compartment of the forearm. This muscle took origin from the anterior surface of the radius in common with the flexor digitorum superficialis muscle. It had a tendon of origin and a tendon of insertion. Its fleshy radial belly and the tendon of insertion, crossed superficial to the median nerve. The muscle was inserted partly to the flexor retinaculum and partly to the undersurface of palmar aponeurosis. The observations made by us in the present case will supplement our knowledge of variations of the muscles in this region which could be useful for hand surgeons as it could possibly compress the median nerve because of its close relationship to it.

Le syndrome de loge antérieure de lˈavant-bras provoqué par lˈexercice : une cause rare dˈépisodes récidivant de rhabdomyolyse aiguë dˈeffort

Introduction. – An effort-related compartmental syndrome is well known in the leg, but may be present infrequently, acutely or chronically in the anterior compartment of the forearm. Exegesis. – We report a case of a 32-year-old man who presented four times after climbing exercices a bilateral compartment of the forearm, unusual because of the observation of rhabdomyolysis, but without irreversible damage. Clinical information and follow-up on two acute and 14 chronic cases were reexamined, showing a homogenous presentation. He refused fasciotomy because he stopped athletic activities. Measurement of intramuscular pressure after exertion was useful for diagnosis. Conclusion. – A local effort-related pain must call to mind a chronic compartment syndrome of the forearm, which may risk incurring the acute form, with irreversible lesions of muscle and nerve, and possibly renal failure because of rhabdomyolsis.

ACUTE CARPAL TUNNEL SYNDROME. MEDIAN ARTERY THROMBOSIS AS CAUSE.

Anatomy The carpal canal or tunnel conducts the long flexor tendons and the median nerve from the anterior compartment of the forearm into the central compartment of the palm. It is bounded by the volar transverse carpal ligament (flexor retinaculum) anteriorly and an arch formed by the carpal bone on the other three sides. On the radial side the ligament is attached to the tubercle of the navicular and the ridge on the greater multangular and, on the ulnar side, to the pisiform and the hook of the hamate. The ligament is continuous along its proximal margin with the deep fascia of the forearm, and it merges distally with the palmar fascia. This tunnel is, therefore, bounded by inelastic ligamentous tissue and bone. The close mechanical tolerance in this tunnel gives rise to increased pressure upon its contents when enlargement of any of the enclosed tissue by edema of trauma