Flat Tendon Research Articles

A Rare Variation of Palmaris Longus Muscle and Flexor Carpi Ulnaris Muscle with Clinical Significance: Case Report

Not so many variations of the muscles belonging to the flexor muscle group of the forearm are described in comparison to the tendons of extensor muscle group of the forearm. During routine dissection in the section hall of the Department of Anatomy, Histology and Embryology in Medical University of Sofia we came across a very interesting variation of palmaris longus muscle and the tendons of flexor carpi ulnaris muscle. We observed the division of the tendon of palmaris longus into two wide and flat tendon bellies called lateral and medial. These bellies formed a Y-shaped figure. The lateral tendon belly passed over the upper part of the flexor retinaculum and inserted into the palmar aponeurosis. The medial tendon however ran deeper than the lateral one and the beginning of the palmar aponeurosis and finally reached the flexor retinaculum where it was inserted. We also came across the presence of additional tendon belly belonging to the flexor carpi ulnaris muscle. That additional belly arose from the pisiform like the pisohamate and pisometacarpal ligaments, then ran deeper than usual and finally joined the fourth metacarpal bone.

A Clinico-epidemiological Study to Evaluate the Outcomes of Extensor Tendon Injury Repair of the Hand

Introduction: Extensor tendon injuries of the hand are more common in presentation than flexor tendon injuries. These wounds may leave the patient with significant, long-lasting damage if they are not appropriately treated when they first show. The result of extensor tendon injuries needing surgical repair at a tertiary health-care facility in Western India is being reported in the present research. Materials and Methods: Data were gathered prospectively for patients who presented to our hospital in a sequence without being randomly assigned from October 2019 to February 2022. The research comprised 38 individuals who had extensor tendon injuries in total. We are the only ones who can repair peripheral vessels (such as the radial and ulnar arteries), and we only accomplish this while using prolene 8-0/7-0 and under loupe magnification. Ethilon 4-0 is used as the core, while 5-0 is used for epitendinous repair in tendon repairs (interrupted). Most of the time, the modified Kassler approach is employed as a procedure. The figure-eight or mattress sutures were used on flat tendons. Plaster of Paris was used to apply the post-operative splint. A follow-up was conducted after 3 weeks, 6 weeks and finally after 3 months. Results: A total of 38 cases of tendon injuries were registered in the study over a period of 29 months, from October 2019 to February 2022. Most hand injuries were in Zone VI (15.8%) followed closely by Zones IV, VII and VIII. Zone I and II injuries were not encountered. The primary outcome was calculated using the total active range of movement, which was documented compared to a contralateral normal finger. Grade percentage range was poor, fair, good and excellent (0%–24%, 25%–49%, 50%–74% and 75%–100%, respectively). It was seen that Zones V, VI and VIII had better outcomes compared to Zone VII injuries. Conclusion: Although the incidences of extensor tendon injuries are more often encountered than flexor tendon injuries, more protocols and further studies are needed to achieve a complete range of motion in such cases.

MCL Reconstruction Using a Flat Tendon Graft for Anteromedial and Posteromedial Instability

The main principles of the present medial collateral ligament (MCL) reconstruction techniques are (1) to approximate the natural anatomy and (2) to restore the main passive restraining structures in anteromedial and posteromedial knee instability. Therefore, we describe a technique using a flat tendon graft instead of tubular grafts with point-to-point bone fixation. Moreover, we address the deep MCL, a relevant restraint to anteromedial instability.

A sciaenid swim bladder with long skinny fingers produces sound with an unusual frequency spectrum

Swim bladders in sciaenid fishes function in hearing in some and sound production in almost all species. Sciaenid swim bladders vary from simple carrot-shaped to two-chambered to possessing various diverticula. Diverticula that terminate close to the ears improve hearing. Other unusual diverticula heading in a caudal direction have not been studied. The fresh-water Asian species Boesemania microlepis has an unusual swim bladder with a slightly restricted anterior region and 6 long-slender caudally-directed diverticula bilaterally. We hypothesized that these diverticula modify sound spectra. Evening advertisement calls consist of a series of multicycle tonal pulses, but the fundamental frequency and first several harmonics are missing or attenuated, and peak frequencies are high, varying between < 1–2 kHz. The fundamental frequency is reflected in the pulse repetition rate and in ripples on the frequency spectrum but not in the number of cycles within a pulse. We suggest that diverticula function as Helmholz absorbers turning the swim bladder into a high-pass filter responsible for the absence of low frequencies typically present in sciaenid calls. Further, we hypothesize that the multicycle pulses are driven by the stretched aponeuroses (flat tendons that connect the sonic muscles to the swim bladder) in this and other sciaenids.

Improved Friction Joint With Self-Locking Grips

Flexible risers are used in the oil industry to transport liquids and gas from the seafloor to extraction and production equipment at the sea surface. Ongoing research aims at using composite materials instead of steel, in order to reduce weight and increase stiffness. Ensuring an optimal load transfer between the composite and metal components is very important. This paper presents an improved method for anchoring a flat fiber-reinforced tendon using a double grip system with self-locking grips. The novelty is the combination of new experimental results and finite element (FE) analysis to develop a superior dry friction grip. Experimental results are carried using a dedicated test setup, through which the test parameters can be accurately controlled. The efficiency of the grip system during pullout is superior to results obtained with flat grips. Numerical results offer an in-depth understanding of the influence between friction, geometrical parameters, and performance, making it possible to optimize the design. Results show that this grip system offers immediate technical applications, in a variety of conditions.

Medial patellofemoral ligament reconstruction using quadriceps tendon

Stabilization of the patella by medial patellofemoral ligament (MPFL) reconstruction. Recurrent lateral patella instability with chronic weakening of the MPFL. Femoropatellar cartilage defects ICRS grade 3° or higher. Tuberositas Tibiae Trochlear Groove Index (TTTG) >20 mm. Lateral hypercompression of the patella without instability. A 3 cm transverse skin incision at the superomedial edge of the patella in 90° of flexion. Longitudinal incision of the prepatellar bursa and exposure of the quadriceps tendon. Preparation of a flat tendon strip with a length of 8 cm, a width of 10 mm, and a thickness of 3 mm, leaving the attachment at the patella intact. Flipping of the tendon strip and passing of the graft through a tunnel underneath the prepatellar tissue at the medial edge of the patella. Passing of the graft in layer two of the medial joint capsule just below the fascia (layer 1) and the vastus medialis. Fixation of the graft in a bone tunnel, drilled in the femoral insertion site of the native MPFL using a biodegradable interference screw. Patella centralizing brace for 4 weeks with range of motion (ROM) 0/0/90°, 20 kg of partial weight bearing for 3 weeks. Full weight-bearing according to pain starting from week 4 postoperatively. ROM up to 90° of flexion directly postoperatively. Free ROM starting from week 6 postoperatively. Stationary cycling 6 weeks postoperatively. Swimming and running after 10 months. Return to pivoting sports after 4-5 months. A total of 17 patients (7 men and 10 women; average age 21.5 years ±3.9 years, average BMI 22.6 ±3.9) were treated using this technique between March 2011 and November 2012. Only patients with at least one recurrent patella dislocation following conservative treatment were included. Patient satisfaction 12 months postoperatively was very high. Overall, 94.1 % would undergo the procedure again and 94.1 % were very satisfied with the cosmetic result. Significant improvement in Lysholm score 6, 12, and 24 months postoperatively (p < 0.05). Free ROM in 94.1 % of cases 12 months postoperatively. The Kujala score was reported to be 89 (±7.1) 12 months following surgery. No redislocation occurred during the 24 months following surgery.

Converting round tendons to flat tendon constructs: Does the preparation process have an influence on the structural properties?

The structural properties of hamstring tendon grafts were evaluated in a porcine model, after processing it to a flat shape, to better replace or augment anatomic flat structures (e.g. ACL, MPFL or MCL). In this biomechanical study, porcine flexor tendons were used which have a comparable shape to semitendinosus and gracilis tendons. One part of the tendon was prepared to a flat tendon construct by splitting the tendon longitudinally with a knife to half of the diameter of the tendon. The semi-split tendon was scratched out to a flat shape. The other matched part was tested in its original round shape. The tendons (n=40) have been fixed in a uniaxial testing machine (Zwick/Roell) by cryo-clamps after preparing the fixed ends by 2-0 polyester sutures (2-0 Ethibond® EXCEL, Ethicon, Somerville, NJ). In every specimen, there was a free 60-mm tendon part between both clamps. The tendons have been loaded to failure to evaluate typical biomechanical parameters such as stiffness, yield load and maximum load. No statistically significant differences (n.s.) regarding stiffness, yield load and maximum load between natively round and processed flat tendons could be detected. A prepared flat-shaped tendon does not show any different structural properties compared with an original round tendon. Therefore, a flat tendon seems to be a biomechanical stable graft option for anatomic reconstruction or augmentation of injured natively flat-shaped structures such as MCL, MPFL or ACL.

Traumatic Rupture of the Coracobrachialis Muscle: A Case Report.

Rupture of the coracobrachialis muscle is extremely rare; to the best of our knowledge, rupture of this muscle from indirect, nonpenetrating trauma has yet to be reported1,2. This case report describes a distal coracobrachialis rupture that was caused by indirect trauma. Because of the progression of the injury and its clinical presentation, along with the rarity of a coracobrachialis rupture, the patient was initially diagnosed with a distal biceps tendon rupture at an outside institution, which delayed treatment. The coracobrachialis muscle functions as a flexor of the shoulder. Additionally, it serves as an adductor and internal rotator of the shoulder and stabilizes the shoulder joint when the arm is at the side. It inserts via a flat tendon in the middle third of the humerus, between the origins of the brachialis and triceps muscles3. It is important to be aware of the rare rupture of the coracobrachialis muscle because it may be misdiagnosed as a distal biceps tendon rupture. We aim to emphasize the importance of recognizing this unusual injury and to present a surgical treatment option. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-one-year-old oil rig worker was lifting a heavy piece of equipment by elevating his arm and flexing his elbow when the machine suddenly jerked. He felt a tearing sensation and had substantial pain and deformity in the right arm. Initially, he was seen by an emergency physician, who diagnosed a distal biceps tendon rupture because of the bulging deformity at the medial aspect of the upper arm, as well as weakness and pain during elbow flexion. He did poorly with nonoperative treatment and was referred to an orthopaedic surgeon for consultation. Magnetic resonance imaging (MRI) of the right …

Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications

During the routine dissection of upper limbs of a Caucasian male cadaver, variations were observed in the brachial plexus. In the right extremity, the lateral cord was piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited the passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of humerus. A variation in the course and branching of the nerve might lead to variant or dual innervation of a muscle and, if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both clinical diagnosis and surgical practice.

Bilateral variations of the brachial plexus involving the lateral cord and median nerve: an anatomical case study with clinical implications (915.8)

In the course of routine dissection of the upper limbs of a Caucasian male cadaver, bilateral variations were observed in the brachial plexus. In the right extremity, the lateral cord was found to be piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of the humerus. A variation in the course and branching of a nerve might lead to variant or dual innervation of a muscle and if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both the clinical diagnosis of musculoskeletal pathology and surgical practice.

Morphometric analysis of the palmaris longus muscle: a fetal study

Objectives:The palmaris longus muscle is absent in 10-15% of forearms. Its long, flat tendon broadens as it passes in frontof flexor retinaculum, to which it is partly adherent. In the palm it splits to attach the longitudinally directed fibres of thepalmar aponeurosis. This fetus study is made to evaluate morphometric and topographic differences of adult and fetal palmaris longus muscle. Methods: The present study is carried out on 24 human fetuses aged 17-40 weeks of gestation. All upper limbs were carefully dissected with the aid of a stereomicroscope at 1.6x magnification. Digital calliper was used for all the measurements.Results: The palmaris longus muscles were absent in both forearms in 7 fetuses and in a unilateral forearm in 5 fetuses.Reversed palmaris longus muscle was found in 2 forearms. Most fetuses had a typical palmaris longus muscle and tendonshape. The mean length and width of the tendons were 18.42±9.55 and 0.66±0.37 mm, respectively, in second trimesterand, 25.9±13.90 and 1.71±0.95 mm in third trimester, respectively. The mean length and width of the muscular belly were13.33±7.05 and 2.03±1.04 mm, respectively, in second trimester and, 30.42±16.81 and 3.77±2.07 mm in third trimester,respectively. Conclusion:The results of our study show to more pronounced loss of the muscle on the left side. This detailed fetal studyin relationship to the palmaris longus muscle would be useful for educational anatomy dissections and surgical interventionsfor relevant clinical procedures

GASTROCNEMIUS - ACHILLES TENDON - AXIS: A HUMAN ANATOMICAL VARIATION

Gastrocnemius muscle forms the belly of the calf. It arises by two heads. Each head is attached to either condyles of the femur by strong flat tendons and to the subjacent part of the capsule of the knee joint. Normally the upper third and part of the middle third is fleshy and then it becomes tendinous, uniting with the tendon of soleus, to form the tendo-achilles. The tendo-achilles is the thickest and strongest tendon in the human body measuring 15cm in length. It begins near the middle of the leg and gets attached to the posterior, mid level of the calcaneum. We are reporting new anatomical variations in this case apart from the previously documented ones. 1. Lateral and medial heads of Gastrocnemius are fleshy in its entire length. 2. Fleshy fibres of the lateral and medial heads are discrete and attach directly to the posterior aspect of the calcaneum. 3. Total absence of the achilles tendon. At the outset these findings have clinical relevance because it has been suggested that the absence of a well developed achilles tendon in the African apes would preclude them from effective running, both at high speeds and over extended distances. Bilateral achilles tendon vibration in the absence of vision has a major impact on postural orientation. Secondly the routine procedure of flap cover for the middle third soft tissue defects of the leg is the usage of soleus muscle flap. To add to the armamentarium of flap cover for middle third defects of the leg, gastrocnemius muscle flap is used as it was found to be fleshy throughout.

Sound production and pectoral spine locking in a Neotropical catfish (Iheringichthys labrosus, Pimelodidae)

Catfishes may have two sonic organs: pectoral spines for stridulation and swimbladder drumming muscles. The aim of this study was to characterize the sound production of the catfish Iheringichthys labrosus. The I. labrosus male and female emits two different types of sounds: stridulatory sounds (655.8 + 230 Hz) consisting of a train of pulses, and drumming sounds (220 + 46 Hz), which are composed of single-pulse harmonic signals. Stridulatory sounds are emitted during abduction of the pectoral spine. At the base of the spine there is a dorsal process that bears a series of ridges on its latero-ventral surface, and by pressing the ridges against the groove (with an unspecialized rough surface) during a fin sweep, the animal produce a series of short pulses. Drumming sound is produced by an extrinsic sonic muscle, originated on a flat tendon of the transverse process of the fourth vertebra and inserted on the rostral and ventral surface of the swimbladder. The sounds emitted by both mechanisms are emitted in distress situation. Distress was induced by manipulating fish in a laboratory tank while sounds were recorded. Our results indicate that the catfish initially emits a stridulatory sound, which is followed by a drumming sound. Simultaneous production of stridulatory and drumming sounds was also observed. The catfish drumming sounds were lower in dominant frequency than stridulatory sounds, and also exhibited a small degree of dominant frequency modulation. Another behaviour observed in this catfish was the pectoral spine locking. This reaction was always observed before the distress sound production. Like other authors outline, our results suggest that in the catfish I. labrosus stridulatory and drumming sounds may function primarily as a distress call.

3D reconstruction of the crural and thoracolumbar fasciae

To create computerized three-dimensional models of the crural fascia and of the superficial layer of the thoracolumbar fascia. Serial sections of these two fasciae, stained with Azan-Mallory, van Gieson and anti-S100 antibody stains, were recorded. The resulting images were merged (Image Zone 5.0 software) and aligned (MatLab Image Processing Toolkit). Color thresholding was applied to identify the structures of interest. 3D models were obtained with Tcl/Tk scripts and Paraview 3.2.1 software. From these models, the morphometric features of these fasciae were evaluated with ImageJ. In the crural fascia, collagen fibers represent less than 20% of the total volume, arranged in three distinct sub-layers (mean thickness, 115 μm), separated by a layer of loose connective tissue (mean thickness, 43 μm). Inside a single sub-layer, all the fibers are parallel, whereas the angle between the fibers of adjacent layers is about 78°. Elastic fibers are less than 1%. Nervous fibers are mostly concentrated in the middle layer. The superficial layer of the thoracolumbar fascia is also formed of three thinner sub-layers, but only the superficial one is similar to the crural fascia sub-layers, the intermediate one is similar to a flat tendon, and the deep one is formed of loose connective tissue. Only the superficial sub-layer has rich innervation and a few elastic fibers. Computerized three-dimensional models provide a detailed representation of the fascial structure, for better understanding of the interactions among the different components. This is a fundamental step in understanding the mechanical behavior of the fasciae and their role in pathology.

Morphology of Psoas Minor and Psoas Accessorius

Psoas minor muscle is considered to be a vestigial muscle like palmaris longus and plantaris. It lies anterior to the psoas major muscle. It has a small fleshy belly and a long flat tendon. This small muscle is the representative in man of a relatively large muscle which in most mammals plays an important part of flexing the lumbar part of vertebral column. In some lower mammals it is larger than psoas major and acts as a flexor of pelvis; this being utilized in running by the rabbit and the apes in brachiating. It begins to disappear in those primates which assume the erect posture. The presence of this muscle varies from person to person and on the two sides. It is present in about 40 to 60% of the population. In the majority it is inserted on the iliopubic eminence but may also be attached to the arcuate line of ilium and the iliac fascia. While going through the literature we did not come across any detailed study of the muscle in the population of this region. Hence, we have conducted a detailed study of psoas minor muscle in 30 cadavers bilaterally. In the present series this muscle was absent in 70%. Average length of fleshy belly was 8.23 cm and that of the tendon 15.48 cm. In some cases an unusual interesting feature observed was the origin of some fibers of psoas major from the deep surface of flattened tendon of Psoas minor muscle, which we have named as Psoas accessorius.

Technique Tip: Tubularizing Flat Tendons in Foot and Ankle Surgery

We describe a novel technique of tubularizing flat tendons in tendon transfer procedures, including Jones procedure and Chrisman-Snook reconstruction. The technique strengthens the tendon, facilitates passage and fixation through bony tunnels, and helps protect it from fraying.

In Vitro Comparison of the Krackow and Locking Loop Suture Patterns for Tenorrhaphy of Flat Tendons

SummaryTenorrhaphy of 20 pairs of canine patellar tendons, was by a modification of the Krackow suture pattern on one of the pair and a single locking loop suture pattern on the contralateral tendon. The tenorrhaphies were pulled apart at a rate of 127 cm/min. The mode of failure for all tendons was disruption of the tendon and the suture material pulling out of the tendon. The mean maximum load for the locking loop suture pattern was 67.2 N (S.D. 7.8), compared to 61.3 N (S.D. 9.3) for the modified Krackow suture pattern. The mean energy absorbed to maximum load was 0.54 Joules (J) (S.D. 0.168) for the locking loop and 0.37 J (S.D. 0.12) for the modified Krackow. The mean stiffness was 4846 N/m (S.D. 803) for the locking loop and 5573 N/m (S.D. 921) for the modified Krackow.This study indicated the locking loop suture pattern was significantly better than the modified Krackow suture pattern in maximum strength (p = 0.03), total energy absorbed to failure (p = 0.0004) and stiffness (p = 0.004). Both suture patterns are suitable for use in flat tendons or ligaments based on their maximum strength. However, the effect of the modified Krackow suture pattern on vascularity and healing has not been evaluated.The locking loop suture pattern proved to be significantly better than the modified Krackow suture pattern in maximum strength, total energy absorbed to failure and stiffness.

The subscapularis muscle and its glenohumeral ligament-like bands. A histomorphologic study.

The subscapularis muscle and the distribution of its tendinous bands is of significance in the surgical management of the shoulder joint. This distribution pattern has not been previously described in detail. We feel that, in any anterior approach to the glenohumeral joint for fracture fixation, joint replacement, and soft tissue reconstruction, a thorough understanding of the distribution pattern of the subscapularis bands is essential. We examined the subscapularis muscles from five cadavers. Four sections from the lateral one-half of each muscle were custom-mounted and stained with Masson's trichrome. We found a consistent pattern in which the tendinous bands were evenly interspersed in the midportion of the muscle and condensed laterally into a single large, flat tendon in the superior two-thirds of the muscle. The inferior one-third remained muscular. Understanding this pattern should help the surgeon have confidence that he/she has obtained a more secure repair in procedures involving the subscapularis muscle.

Anatomic and Electromyographic Studies of the Costo-Pulmonary Muscles in the Cock

INTRODUCTIONTHE gross anatomy of the avian pulmonary diaphragm, with some speculation as to its function, has been described by a large number of investigators. Since a recent review of the literature concerning this structure has not been published and in view of the possible importance of this structure in the normal respiratory function in the bird, it is desirable to initiate this communication with a discussion of the observations of previous workers.The broad connective tissue sheet and the associated bundles of skeletal muscle which cover the ventral surface of the lungs of the bird have been termed the diaphragme pulmonaire by Sappey (1847), the diaphragmite anterieur by Milne-Edwards (quoted by Huxley, 1882), the pulmonary aponeurosis by Huxley (1882), and the pulmonary diaphragm by Müller (1907–08). Since the term “aponeurosis” is generally used to refer to a broad flat tendon and does not include any muscular elements, the…