Flexor Carpi Ulnaris Research Articles

Evaluation of split flexor carpi ulnaris tendon transfer for fingers and thumb extension, pronator teres transfer for wrist extension in high radial nerve palsy

Background: The radial nerve is the largest terminal branch of the brachial plexus. Loss of radial nerve function creates a significant disability in the hand. The grip is severely impaired following loss of radial nerve function as a result of loss of extension of wrist, metacarpophalangeal joints of fingers and interphalangeal joints of the thumb. Methods: Prospective, quasi experimental study carried out for 3 years at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR). Forty-eight patients of high radial nerve palsy were selected for tendon transfer (split FCU tendon to EDC and EPL) and PT transferred to ECRB. Results: Mean age of the patients was 28.92 years (range 15-45 years), significantly higher in 26-35 years age group. There was preponderance of injury to the dominant right side (58.33%) than the none-dominant left side (41.67%). Motor vehicle accident (66.67%) was the common cause of injury followed by assault (33.33%). Out of 48 patients, 28 patients score 8-9 (excellent), 16 patients score 7 (good), 4 patients scores 5 (fair). So that, total 44 patients achieved satisfactory outcome (91.67%) and 4 patients achieved unsatisfactory outcome (8.33%). All patients can extend their wrist, fingers and thumb. Beyond this, all patients can flex their fingers up to mid palmar crease and thumb can be extended separately-independent of EDC function. Conclusions: Transfer of split FCU tendon to EDC and EPL for fingers and thumb extension in irreparable and neglected long standing high radial nerve palsy results significant functional outcome.

Upper limb movement control strategy of top-tier elite male badminton players when smashing for different distances

PurposeMastering the skill of smashing in a game can be quite challenging. Unfortunately, it’s not always easy to control the distance of the smash. The present study investigated the impact of different smashing distances on muscle activation patterns and kinematics of the upper limbs.Material and methodsTen collegiate athletes from a top-ranked team in Korea participated in the present study with a mean age, weight, and height of 21 ± 1 years, 71.9 ± 9.1 kg, and 1.78 ± 2.24 m, respectively. Three valid data points for each subject at three different distances were analyzed using a one-way analysis of variance (ANOVA).ResultsThe results demonstrated that with increasing smashing distance, the internal rotation angle of the elbow and wrist joints decreased, while the angular velocity of flexion and internal rotation of the shoulder, elbow, and wrist joints increased. Muscle activation increased for all muscles except the biceps brachii (BICLO) with increasing distance. The greatest changes in activation levels were observed in the anterior deltoid (DELTA), extensor carpi radialis (ECR), and flexor carpi ulnaris (FCU).ConclusionsDuring tasks with different smashing distances, muscle activation in the upper limbs (except the biceps) increased with increasing distances. Additionally, the internal rotation angle of the upper limbs decreased with increased distances, while the angular velocity of flexion and internal rotation of the shoulder, elbow, and wrist joints increased.

Effects of victim's body posture and attacker's gender on slashing attacks: a biomechanical study.

Sharp force injury has been and will remain to be a major cause of violent death; however, scientific evaluations on the impact of body posture of the victim and gender of the perpetrator on sharp force injury have been scarce. The purpose of this study was to evaluate the biomechanical characteristics found in individuals (male and female) when using a Chinese kitchen knife to slash the neck of a dummy while it was in the standing and supine positions. This work offers a solid basis for forensic identifications, criminal investigations, and court trials. A total of 12 male and 12 female college students participated in this study. Kinematic, kinetic, and surface electromyography (sEMG) data were evaluated when slashing the neck of a dummy while it was in the standing and supine positions using a Chinese kitchen knife. When slashing the neck of a standing dummy, participants showed shorter contact time (19.5%) and slower shoulder velocities (30.9%) as well as higher hip velocity (26.0%) and increased root mean square (RMS) and integral electromyography (iEMG) for the anterior deltoid (51.3% and 51.2%, respectively) compared to those while the dummy was in the supine position (all p < 0.05), regardless of gender. When slashing a dummy's neck while it was in standing and supine positions, male participants showed higher shoulder, elbow, and wrist velocities (22.6%, 22.7%, and 24.4%, respectively) and higher slashing velocity (19.8%), slashing force (24.2%), and energy (46.2%) than female participants (all p < 0.05). In addition, male participants showed shorter contact time (17.8%), and the values of RMS and iEMG of the anterior deltoid, biceps brachii, extensor carpi radialis longus, and flexor carpi ulnaris were less than those of female participants (98.9%, 47.3%, 65.6%, and 33.4% for RMS and 115.1%, 59.4%, 80.1%, and 47.8% for iEMG, respectively). There was no difference in slashing speed, slashing force, and energy when using a Chinese kitchen knife to slash the dummy's neck while it was in different body postures (standing and supine), suggesting a similar level of injury severity. However, there were significant differences in slashing action patterns between the two body postures, with longer contact time, smaller hip velocity, greater shoulder velocity, and less muscle activation level of the deltoid exertion when slashing the dummy's neck in the supine position. Gender may have a greater effect on the severity of slashing, and the gender difference may be partly related to the body weight difference. The findings from this study may provide quantitative indicators and references for analyzing the motive behind the crime, as well as for case reconstruction, and for the court's conviction and sentencing processes.

Nerve compression after opponensplasty: a cadaveric study

Background: We describe the differences in thumb opposition between different opponensplasty tendon transfers and determine the immediate pressure on the median and ulnar nerves incurred by each transfer. Methods: Using fresh frozen cadavers (8 specimens), opponensplasties were performed using extensor indicis proprius (EIP), flexor digitorum superficialis (FDS) with flexor carpi ulnaris (FCU) pulley, palmaris longus (PL, Camitz procedure), and PL utilizing the thenar fascia as a pulley (PLwP). Each tendon transfer was tensioned, and the thumb flexion, abduction and pronation were measured. The pressure on the median and ulnar nerves were measured for each tendon transfer at varying tensions. Results: There were no differences seen in flexion or pronation between any of the four tendon transfers. FDS, PL and PLwP demonstrated more abduction than the EIP transfer, however differences were less than 10°. EIP and FDS transfers caused significantly more pressure on the median nerve than PL or PLwP at high tendon tensions. Both EIP and FDS tendon transfers caused significantly more pressure on the ulnar nerve than PL or PLwP, and the pressure increased as tension on the transfer increased. No pressure differences were seen between PL and PLwP. Conclusions: No significant differences were seen in thumb flexion or pronation between the four tendon transfers. Differences were seen for abduction with EIP showing the least amount of abduction. EIP and FDS caused more median nerve compression than PL transfers at high tension. Both EIP and FDS tendon transfers cause more ulnar nerve compression than PL transfers at all tensions. Level of Evidence Level: V

Efficacy of Dry Needling in Enhancing Hand Function and Reducing Spasticity in MCA Stroke Patients: A Prospective Case Report

Stroke, particularly involving the middle cerebral artery (MCA), often leads to persistent disability, significantly impairing hand function and inducing severe spasticity in the forearm flexors due to complex motor pathway involvement. This case report evaluates the effectiveness of combining dry needling therapy (DNT) with task-oriented training (TOT) in reducing spasticity and improving hand function in a post-MCA stroke patient. A 61-year-old male with right-side hemiplegia following a left MCA stroke, compounded by a history of diabetes, hypertension, and recent kidney stone diagnosis, participated in this study. The patient experienced severe functional limitations due to spasticity (grade 3 on the Modified Ashworth Scale) and scored 31 on the CAHAI-13, indicating significant hand dysfunction. DNT was applied to key forearm muscles (flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, and pronator teres), followed by TOT targeting daily tasks. Post-intervention, the patient demonstrated significant improvements: spasticity was reduced (Modified Ashworth Scale score decreased from grade 3 to grade 2), and muscle hypertonicity, as measured by EMG, was reduced in all targeted muscles. Functional hand use improved markedly, with the CAHAI-13 score increasing from 31 to 45. These improvements led to enhanced independence in daily activities. This case report highlights the clinical relevance of integrating DNT with TOT in stroke rehabilitation. The combined intervention not only reduced spasticity and improved neuromuscular function but also led to meaningful gains in hand function, enhancing the patient’s ability to perform daily activities independently. Given the promising results, this combined approach could serve as a practical and effective strategy for improving motor recovery and functional independence in post-stroke patients. Further studies with larger sample sizes are necessary to confirm these findings and explore the broader application of this approach in clinical practice.

An Ergonomic Golf Grip Leads to Lower Forearm Muscle Activity - A Prospective Case Series of 30 Right-Handed Amateur and Professional Golfers

BackgroundThe elbow is a common site for overuse injuries in golfers. Tendinopathies, such as medial and lateral epicondylitis, are frequently diagnosed in amateur and professional golfers. The aim of our study was to determine the effect of an ergonomic golf grip on forearm muscle activity during the five phases of the golf swing.MethodsThirty right-handed golfers with a mean age of 32 years (range, 18–70 years) and a mean handicap of 15 (range, 0–43) performed 10 golf swings with a standard and ergonomic golf grip respectively. The mean and maximum muscle activity of the Musculus (M.) extensor carpi radialis brevis (ECRB), M. flexor carpi ulnaris (FCU), M. pronator teres (PT) and M. biceps brachii (BB) of the lead and trail arms were assessed during the five phases of the golf swing using surface electromyography (EMG). Subgroup analyses were performed regarding sex, playing ability (handicap < 10 vs. ≥10), weekly playing time (≤ 5 h, 5–20 h, > 20 h) and preexisting elbow pain during golfing (VAS < 2 vs. VAS ≥ 2). Significance was set at p < 0.05.ResultsAn ergonomic golf grip resulted in a reduction in muscle activity in at least one but up to three consecutive phases of the golf swing for the ECRB, FCU and PT of the lead arm and for the PT of the trail arm. Amateurs, a playing time < 20 h per week and golfers without preexisting elbow pain were factors that were associated with greater reductions in muscle activity.ConclusionForearm muscle activity can be decreased using an ergonomic golf grip, indicating the possible role of an ergonomic golf grip as a preventive measure against overuse syndromes such as medial and lateral epicondylitis.Trial registration numberThis study was retrospectively registered at the German Clinical Trials Register DRKS-ID: DRKS00033732 (01/03/2024).

Evaluation of a palmar approach to the carpal flexor tendon sheath

SummaryBackgroundA palmar approach for centesis of the carpal flexor tendon sheath has not been reported.ObjectiveTo determine the feasibility and accuracy of a palmar approach to an undistended carpal flexor tendon sheath.Study designIn vivo and experimental.MethodsBoth forelimbs of six horses were used. A 20‐gauge, 8.9‐ or 7.62‐cm spinal needle was inserted 3–4 cm proximal to the dorsal border of the accessory carpal bone in the space between the ulnaris lateralis and flexor carpi ulnaris muscles and directed sagittally and perpendicular to the long axis of the limb until the needle contacted the radius. The needle was retracted slightly, contrast medium was injected, and a laterally projected radiograph of the carpus and distal aspect of the radius was obtained and examined.ResultsThe technique, when performed on 12 limbs of six horses, was 92% accurate. For one limb, the needle was inadvertently directed slightly ventrally, rather than perpendicular to the long axis of the limb, causing it to contact the radius near its physeal remnant, resulting in centesis of the antebrachiocarpal joint.ConclusionsThe palmar approach to the carpal flexor tendon sheath appears to be highly accurate.

Stroke-induced excess in capillarization relative to oxidative capacity in rats is muscle specific.

Stroke is not only associated with muscle weakness, but also associated with reduced muscle fatigue resistance and reduced desaturation during exercise that may be caused by a reduced oxidative capacity and/or microvasculature. Therefore, the objective of the present study was to determine the effects of stroke on muscle mass, fiber size and shape, capillarization and oxidative capacity of the rat m. extensor carpi radialis (ECR) and m. flexor carpi ulnaris (FCU) after a photothrombotic stroke in the forelimb region of the primary sensorimotor cortex. The main observation of the present study was that 4 weeks after induction of stroke there were no significant changes in muscle fiber size and shape. Although there was no significant capillary rarefaction, there was some evidence for remodeling of the capillary bed as reflected by a reduced heterogeneity of capillary spacing (p = 0.006) that may result in improved muscle oxygenation. In the ECR, but not in the FCU, this was accompanied by reduction in muscle fiber oxidative capacity as reflected by reduced optical density of sections stained for succinate dehydrogenase (p = 0.013). The reduced oxidative capacity and absence of significant capillary rarefaction resulted in a capillary to fiber ratio per unit of oxidative capacity that was higher after stroke in the ECR (p = 0.01), but not in the FCU. This suggests that at least during the early stages, stroke is not necessarily accompanied by muscle fiber atrophy, and that stroke-induced reductions in oxidative capacity resulting in relative excess of capillarization are muscle specific.

Relationship between the elasticity of the forearm flexor-pronator muscles and elbow valgus torque in young baseball pitchers: a descriptive laboratory study

BackgroundThe forearm flexor-pronator muscles act as a dynamic elbow stabilizer against elbow valgus load during baseball pitching. The elasticity of these muscles increases with pitching. However, it is unclear whether increased muscle elasticity is associated with greater elbow valgus torque during pitching. This study aimed to determine the relationship between the elasticity of the forearm flexor-pronator muscles and elbow valgus torque during pitching in young baseball pitchers. MethodsWe recruited 124 young baseball pitchers aged 9 to 12 years. The exclusion criteria included current pain with pitching, history of surgery on the tested extremity, or injuries on the tested extremity within the past 12 months. Before the examination, participants completed a questionnaire about their age, height, weight, dominant arm and practice time per week. The strain ratios of flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), and pronator teres as the index of muscle elasticity were measured using ultrasound strain elastography. Participants pitched three fastballs at a distance of 52 ft 6 in (16 m) with maximum effort while wearing a sensor sleeve that recorded the elbow valgus torque. A multiple linear regression analysis was conducted to examine the association between muscle elasticity and elbow valgus torque, adjusting for age, height, weight, and practice time. ResultsThe final analysis included 107 pitchers. After adjusting for covariates, increased strain ratio of the FCU was significantly associated with greater elbow valgus torque (coefficients = 0.038, 95% confidence interval [CI], 0.016–0.059, P<.001). Similarly, increased strain ratio of the FDS was significantly associated with greater elbow valgus torque (coefficients = 0.027, 95% CI, 0.013–0.042, P<.001). ConclusionThe high elasticities of the FCU and FDS were associated with greater elbow valgus torque during pitching in young baseball pitchers. The high elasticity of these muscles is a protective response and may be necessary for young baseball pitchers with greater elbow valgus torque during pitching. Among young baseball pitchers with greater elbow valgus torque, those who are unable to produce the higher elasticities of these muscles could have greater elbow valgus load during pitching and be at a higher risk for elbow injuries. The measurement of the elasticities of the FCU and FDS may be useful for identifying young baseball pitchers at risk of sustaining elbow injuries.

A novel case of ulnar nerve compression neuropathy with co-existing accessory flexor carpi ulnaris and accessory abductor digiti minimi

A novel case of ulnar nerve compression neuropathy with co-existing accessory flexor carpi ulnaris and accessory abductor digiti minimi

Identification of physically demanding work tasks among cleaners: field study using electromyography.

While chronic forearm pain is a common and debilitating condition among cleaners, the most physically demanding tasks remain unidentified. The present field study examines forearm muscle activity during 9 common cleaning tasks in a real working environment. Seven healthy cleaners participated in this study (age: 35.17 ± 9.62 yr; height: 168.17 ± 8.06 cm; weight: 77.14 ± 13.78 kg; experience: 5.60 ± 3.29 yr). Surface wireless electromyography (EMG) was recorded from 2 muscles on both sides of the upper limb, flexor carpi ulnaris (FCU), and extensor carpi radialis (ECR), and normalized to maximal voluntary isometric contractions (MVIC). Top-3 demanding high-force tasks (90th percentile EMG) were the rough floor, dirty rough floor, and office floor mopping for the FCU, and mopping high walls, ceiling mopping, and baize cleaning for the ECR. Top-3 static work tasks (10th percentile EMG) were mopping low walls, ceiling mopping, and dirty rough floors mopping for the FCU and mopping of high walls, low walls, and ceiling for the ECR. The study identified the forearm muscles' most physically demanding work tasks during cleaning tasks. The development of better working tools is recommended to avoid high-force overload as well as prolonged static overload of these muscles in cleaners.

Electromyographic Analysis of Upper- and Lower-extremity Muscles in Adults during Agro-healing Activities

This study investigated the activity of upper- and lower-extremity muscles for 15 agricultural tasks of agro-healing. For the development of an agro-healing program using farm resource types, 15 selected agro-healing activities (namely, digging, raking, fertilizing, planting transplants, tying plants to stakes, watering, harvesting, washing, cutting, cooking, collecting natural objects, decorating natural objects, interacting with dogs, walking dogs, and feeding fish) were extracted and performed in a total of 21 adults (average age: 42.29 ± 14.76 years) at D Care Farm in Cheongju, Korea, from June to July 2022. Before these activities, informed consent was obtained from participants and muscle activity of the upper and lower extremities was measured. Muscle activation during activity performance was measured using electromyography (EMG), and the rating of perceived exertion for each activity was investigated. Bipolar surface EMG electrodes were attached at 16 locations on the left and right upper-extremity muscles (anterior deltoid, biceps brachialis, brachioradialis, and flexor carpi ulnaris) and lower-extremity muscles (vastus lateralis, vastus medialis, biceps femoris, and gastrocnemius). The results indicated that the activity of the lower-extremity muscles was higher than that of the upper-extremity muscles during 15 agricultural activities. During plant-mediated activity and animal-assisted activities, the rate of right muscle use was higher than that of left muscle use among the upper-extremity muscles, whereas the rate of right and left muscle use showed a similar tendency among the lower-extremity muscles. During plant-mediated activities, agricultural activities involving the use of heavy tools highly activated the right forearm muscle (flexor carpi ulnaris), whereas holding and interacting with animals highly activated the left forearm muscles (biceps brachialis, brachioradialis, and flexor carpi ulnaris). It is expected that the EMG data obtained in this study can be used as basic biomechanical data when designing an agro-healing program to improve physical function.

The effect of baseball grips on the hardness of the flexor digitorum superficialis.

In baseball pitches, the forkball requires a special grip, pinching the ball between the second and third fingers to achieve the resulting breaking ball trajectory. We hypothesized that the forkball grip would have a substantial impact on the hardness of the flexor digitorum superficialis. The aim was to quantify and clarify the change in the hardness of the flexor digitorum superficialis due to the forkball grip. Twenty-one adult male subjects were recruited and instructed to perform two baseball grips with the ball: fast and forkball, and the rest without the ball. The shear wave speeds of the pronator teres, flexor carpi radialis, flexor digitorum superficialis, and flexor carpi ulnaris were measured using shear wave elastography. In the forkball grip, compared with the fastball grip and the rest without the ball, the shear wave speed of the flexor digitorum superficialis was significantly higher than those of the pronator teres, flexor carpi radialis, and flexor carpi ulnaris (P<0.001), indicating that muscle hardness increased due to the forkball grip. In contrast, no significant differences were found between the conditions for the other forearm flexor-pronator muscles. Quantification of muscle hardness using shear wave elastography showed that gripping a forked ball increased muscle hardness in the flexor digitorum superficialis.

Mapping Origins of Tendons on the Medial Epicondyle to Improve Treatment of Medial Epicondylitis: Anatomical Study

Medial epicondylitis is a tendinosis found commonly in throwing and golfing athletes. Although there are choices for nonsurgical treatments, when these fail, surgical intervention can be considered. When surgical treatment is performed, the objective is to debride the diseased tissue from the epicondyle. The purpose of this study was to clarify the locations and size of the common flexor tendons and medial collateral ligament (MCL) relative to each other and to the posterior ridge of the medial epicondyle. The common flexor tendons and MCL were dissected and reflected their origin on the medial epicondyle in six cadaver elbows. Measurements were taken from the posterior and distal ridges of the medial epicondyle with respect to the humerus. Each origin was also measured for its height and width. The flexor carpi ulnaris origin starts at a mean of 4.2 mm from the posterior ridge of the medial epicondyle and extends anteriorly an average of 4.8 mm. The flexor carpi radialis starts at a mean of 4.2 mm from the posterior ridge and extends anteriorly an average of 7.4 mm. The pronator teres begins at a mean of 4.6 mm from the posterior ridge and extends an average of 5.7 mm anteriorly. The MCL starts at an average of 10.4 mm from the posterior ridge and extends 5.2 mm anteriorly. The measurements found have allowed the creation of a map of the specific common flexor tendon origins and their sizes on the medial epicondyle, as well as their position relative to the MCL. A surgeon may debride 1 cm anteriorly from the posterior ridge of the medial epicondyle to safely address the affected tissues and ensure the safety and integrity of the MCL.

Subcutaneous Anterior Transposition With Modified Procedures to Prevent Recurrence Associated With the Transposed Ulnar Nerve.

Subcutaneous anterior transposition of the ulnar nerve is a common surgical treatment for cubital tunnel syndrome. However, there are surgical failures associated with the new compressive sites at the edge of flexor carpi ulnaris (FCU) and resubluxation posterior to the medial epicondyle of the transposed nerve. To reduce the muscle volume at the edge of FCU, we approach the ulnar nerve by dividing the muscle belly of the FCU humeral heads. This procedure can reduce repeated traction forces on the transposed nerve at the edge of the FCU. To keep the transposed ulnar nerve anteriorly, we use a fat flap including the membranous superficial fascia. This flap can softly stabilize the ulnar nerve and act as a pliable cover to prevent perineural scarring or further constriction around the flap. Ninety-three elbows in 90 patients who had undergone this procedure for cubital tunnel syndrome were evaluated. According to Messina's criteria, the numbers of patients showing excellent, good, fair, and poor recovery were 41 (44%), 47 (51%), 5 (5%), and 0 (0%), respectively. Most patients experience resolution of symptoms and good functional outcomes. None of the patients suffered recurrence, infection, or nerve injury.

Upper Extremity Nerve Transfers for Treatment of Nerve Injury After Cervical Spine Surgery: A Single-Center Retrospective Review.

Nerve transfers to restore or augment function after spinal cord injury is an expanding field. There is a paucity of information, however, on the use of nerve transfers for patients having undergone spine surgery. The incidence of neurologic deficit after spine surgery is rare but extremely debilitating. The purpose of this study was to describe the functional benefit after upper extremity nerve transfers in the setting of nerve injury after cervical spine surgery. A single-center retrospective review of all patients who underwent nerve transfers after cervical spine surgery was completed. Patient demographics, injury features, spine surgery procedure, nerve conduction and electromyography study results, time to referral to nerve surgeon, time to surgery, surgical technique and number of nerve transfers performed, complications, postoperative muscle testing, and subjective outcomes were reviewed. Fourteen nerve transfers were performed in 6 patients after cervical spine surgery. Nerve transfer procedures consisted of a transfer between a median nerve branch of flexor digitorum superficialis into a biceps nerve branch, an ulnar nerve branch of flexor carpi ulnaris into a brachialis nerve branch, a radial nerve branch of triceps muscle into the axillary nerve, and the anterior interosseous nerve into the ulnar motor nerve. Average patient age was 55 years; all patients were male and underwent surgery on their left upper extremity. Average referral time was 7 months, average time to nerve transfer was 9 months, and average follow-up was 21 months. Average preoperative muscle grading was 0.9 of 5, and average postoperative muscle grading was 4.1 of 5 ( P < 0.00001). Upper extremity peripheral nerve transfers can significantly help patients regain muscle function from deficits secondary to cervical spine procedures. The morbidity of the nerve transfers is minimal with measurable improvements in muscle function.

Cubital Tunnel Syndrome Due to Intraneural Ganglion Cysts of the Ulnar Nerve With Joint-Cyst Connection at the Elbow

BACKGROUND AND OBJECTIVES: The unifying articular theory suggests that intraneural ganglion cysts in the cubital tunnel arise from the elbow joint and are connected to the ulnar nerve through an articular branch. This study aimed to report our clinical experience with these cysts and our surgical findings and outcomes. METHODS: We retrospectively analyzed 13 patients who underwent surgery for cubital tunnel syndrome caused by an intraneural ganglion cyst of the ulnar nerve. Clinical symptoms, physical examination findings, nerve conduction testing electromyography, plain radiography, and ultrasonography were evaluated before and after surgery. MRI was performed in 2 patients. Cyst decompression, disconnection of the articular branch, and ulnar nerve transposition were performed in all. RESULTS: The mean follow-up was 29 months. After surgery, local elbow pain and Tinel sign disappeared in all patients, and the average Numerical Rating Scale dropped from 3.7 (2-5) to 0 (0-0). Two-point discrimination testing was normal (&lt;5.0 mm) in 12 patients. Wartenberg sign and “claw hand” deformity became negative, and muscle function and motor nerve conduction velocity were improved in 12 patients. The Medical Research Council muscle strength grade was M4 or M5 in the flexor carpi ulnaris, flexor digitorum profundus of the 4th and 5th digits, and first dorsal interosseous muscle in 12 patients. Postoperative spontaneous potentials including fibrillation and sharp waves, and motor unit recruitment in the first dorsal interosseous muscle were obviously improved. A cystic articular branch was confirmed during surgery in all patients. No cyst recurred clinically or on follow-up ultrasonography. CONCLUSION: The unifying articular theory of intraneural ganglion cysts applies to those located in the ulnar nerve at the elbow. Surgical disconnection of the articular nerve branch from the ulnar nerve eliminated the pathway for cyst recurrence and achieved good long-term outcomes.

Anatomic study of flexor carpi ulnaris and brachioradialis muscles and their implication in reconstructive surgeries

Management of soft tissue loss around the posterior aspect of the elbow region is most challenging for clinicians, as it may require reconstructive methods for the better healing of wounds. One of the options for reconstructive surgery is local muscle rotational flaps by the flexor carpi ulnaris (FCU) and brachioradialis (BR). This study aimed to explore the morphometry and vascular anatomy of FCU and BR. Thirty formalin-embalmed cadaveric upper extremities (16 right and 14 left) were utilized for this study. The average length of the FCU muscle belly was 28.96 ±2.16 cm within a range of 24.3 to 32.5 cm, and the average length of the tendon was 10.05 ± 2.2 cm, with a range of 6.9 to 14.3 cm. The number of vascular pedicles for FCU was one in 5, two in 21, and three and four in 2 specimens respectively. All the pedicles arose from the ulnar artery. The average length of the BR muscle was 28.2 ±3.58 cm, with a range of 22.8 to 36.8 cm, and the average length of its tendon was 8.2 cm, with a range of 5.7 to 13.5 cm. In 90% of specimens, BR had only one vascular pedicle and in 10% there were two pedicles. These pedicles arose from the radial recurrent artery and the radial artery. Detailed morphometric and topographic anatomy of the vascular pedicles of FCU and BR are provided in this study, which can be considered the morphological database for the South Indian population.

Fractional Lengthening of Forearm Flexor Tendons: A Cadaveric Biomechanical Analysis

Multiple procedures have been described for wrist and finger flexion contractures and spasticity. Fractional lengthening of forearm flexor tendons involves making parallel transverse tenotomies at the musculotendinous junction to elongate the muscle. Currently, there is limited literature to define the biomechanical consequences of this lengthening technique. Forty-eight flexor tendons were harvested from eight paired upper limbs including flexor carpi radialis, flexor carpi ulnaris, flexor pollicis longus, and flexor digitorum superficialis tendons. Each tendon that was lengthened was paired with the contralateral tendon as a control. A pair of transverse tenotomies were completed for the fractional lengthening. The first tenotomy was performed at the musculotendinous junction where the tendon narrowed to 75% of its maximal width. The second tenotomy was made 1 cm distal to the first. Tendon length was measured before and after fractional lengthening at a constant resting tension of 1 N. The maximum load at failure of each tendon and the mechanism of failure were each measured and compared with the contralateral side. After fractional lengthening, the mean increase in resting tendon length was 4 mm. When loaded to failure, the mean maximum load of fractionally lengthened tendons was 42% of the mean maximum load of intact tendons. All lengthened tendons failed at the distal tenotomy site. Fractional lengthening resulted in an increase of 3-6 mm (mean: 4 mm) in tendon length at resting tension. There was a significant loss in tensile strength and load to failure following fractional lengthening compared with an intact musculotendinous unit. The reduction in tensile strength following fractional lengthening results in loads at failure that are, in some cases, lower than the estimated forces required to perform basic tasks. Caution during the healing and rehabilitation period is warranted.

Single tendon transfer of the flexor carpi ulnaris for high radial nerve palsy

Complete radial nerve palsy results in a lack of extrinsic extensors of the wrist, fingers and thumb. The optimal treatment of persistent hight radial nerve palsy is tendon transfer, which leads generally to acceptable results with better extension of the fingers and ability to grasp large objects. There are a multiple techniques of tendon transfers from a single to multiple one generally three tendons, however a single flexor carpi ulnaris tendon (FCU) transfer has some advantages, including simplicity, shorter operation time, less morbidity and less surgical scars, which can be important in some patients, particularly women. We present a case report of single tendon transfer of the FCU to the digital extensors for high radial nerve palsy secondary to closed diaphyseal humeral fracture.