Flexor Compartment Of Forearm Research Articles

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.

Forearm compartment pressures and grip strength in elite motorbike racers with chronic exertional compartment syndrome

BackgroundRemarkably little research has been published on chronic exertional compartment syndrome (CECS) of the forearm. This study investigated forearm flexor compartment pressure pre- and post-exercise in elite motorbike racers clinically diagnosed with CECS and assessed their grip strength before and after arm pump exercise.MethodsElite motorbike riders with a clinical diagnosis of CECS of the right forearm when racing were recruited during the opening rounds of a British Superbike season. Their grip strength and forearm flexor compartment pressures were measured before and after a set exercise programme.ResultsOf the 11 riders recruited to the study, 10 completed the full testing regime. The mean pre-exercise forearm compartment pressures [11.7 mmHg (range 7–17 mmHg)] significantly increased post-exercise [30.5 mmHg (range 15–45 mmHg)], with a mean increase of 18.80 mmHg (P < 0.0001). The mean pre-exercise grip strength [50.61 mmHg (range 37–66.7 mmHg)] decreased post-exercise to [35.62 mmHg (range 17.1–52.5 mmHg)], a mean decrease of 14.99 mmHg (P < 0.0001).ConclusionThere is a statistically significant increase in the forearm flexor compartment pressures in elite motorbike racers with CECS, but with marked variability of these values. Grip strength decreases statistically significantly following onset of symptoms of CECS of the forearm.

Relation of Palmaris Longus agenesis with laterality of hand

Palmaris longus is a small vestigial muscle present in the flexor compartment of forearm and shows greater variability. Palmaris longus tendon graft has a growing interest in constructive surgeries. However, Palmaris longus agenesis is seen among different ethnic groups in different countries and the prevalence of absence varies from 4% to 63.9%. It shows variation with laterality of the hand as well.

Pronator teres accessorius: A new variant in flexor antebrachial musculature

Muscles of flexor compartment of forearm have a common origin from medial epicondyle of humerus. Additional bellies of flexor muscles are commonly reported but presence of supernumerary muscles is an infrequent phenomenon. The present study describes an unusual muscle mass in flexor compartment of forearm simulating pronator teres. During routine dissection the upper limb of a 50 years old male cadaver, a supernumerary muscle was found on left side of the upper limb in the flexor compartment. The origin of the muscle was 2cm wide and aponeurotic in nature and attached to an oblique line extending from the inferior surface of the medial epicondyle and the medial surface of the trochlea. It was inserted on an oblique line 2.5cm wide on the radius in area between supinator superiorly and flexor digitorum profundus inferiorly. Existence of accessory muscles, which connect flexor muscles, could be explained embryologically by incomplete cleavage of flexor mass during development. The flexor muscles of the forearm develop from the flexor mass which subsequently divides into two layers: superficial and deep. The deep layer gives rise to flexor digitorum superficialis, flexor digitorum profundus and flexor pollicis longus. These supernumerary muscles are extremely rare entities and probably represent deranged embryological development or the process of atavism in which the anomalous part persist for a longer time in the tree of evolution.

Supernumerary muscle in the flexor compartment of forearm – Case report

Supernumerary muscle in the flexor compartment of forearm – Case report

Double Gantzer's Muscles by Four Muscle Bellies and Its Clinical Significance: A Case Report

The Gantzer’s muscle (GM) is an additional muscle in the forearm as the accessory head of the flexor pollicis longus (FPL) and accessory head of the flexor digitorum profundus (FDP). We reported a rare case of double GM formed by four muscle bellies. From the dorsal part of flexor digitorum superficialis, small four bellies formed two muscles merging to FDP and FPL, as GMs. These accessory heads of FDP and FPL crossed the ulnar artery and the median nerve, respectively. These additional muscles in the forearm flexor compartment are rare and its clinical and embryological significances should be considered.

Osteofascial compartment pressure measurement in closed limb injuries - Whitesides' technique revisited.

Regular monitoring of tissue compartmental pressures and hence a timely intervention in patients with impending compartment syndrome has been shown to prevent morbidity and permanent disability. Intra-compartmental pressure in flexor compartment of forearm and various compartments of legs following recent trauma presenting within 6h of injury was carried out in 30 subjects using Whitesides' technique and patients were classified into 3 categories for treatment purposes i.e., Category I: pressure <30mmHg, Category II: pressure 30-40mmHg and Category III: pressure >40mmHg. Category I had 17 subjects, Category II had 6 subjects whereas 7 subjects fell into Category III. 6 patients out of the 30 studied needed fasciotomy, out of which 5 had fair or good result. Whitesides' technique, though not much widely favoured, is a safe, inexpensive, easily assembled and reliable method for measurement of intra-compartmental pressure as a guide for decompression.

Prevalence of the absence of Palmaris longus muscle in the students of Kathmandu University

Background: Palmaris longus muscle is one of the superficial muscles of flexor compartment of forearm. Its main function is to anchor the skin and fascia of the hand. It is a weak flexor of the hand at wrist and tenses the palmar aponeurosis. It is one of the most variable muscles and is phylogenetically classified as a retrogressive muscle. The agenesis of Palmaris longus ranges from 0% to 63% with an overall 16% unilateral and 9% bilateral. It is very useful in orthopedics, cosmetic, plastic and reconstructive surgery. Objective: To determine the occurrence of unilateral and bilateral agenesis of Palmaris longus muscle in right and left forearms in the students of Kathmandu University. Materials and methods: The study was carried out on 1020 randomly selected normal students (570 male and 450 female) with an age ranging from 18 to 25 years. The volar aspect of the wrist was inspected to find out the presence or absence of Palmaris longus tendon in its usual anatomical position by performing different tests. Result: The present study showed overall agenesis of Palmaris longus in 27.65% cases. Overall agenesis in male and female was 28.42% and 26.67% respectively. Unilateral and bilateral agenesis were 77.16% and 22.84% respectively in male whereas 67.50% and 32.50% respectively in female. Left sided and right sided agenesis were 55.20% and 44.80% respectively in male whereas 53.09% and 46.91% respectively in female. Conclusion: Palmaris longus is absent unilaterally in 20.20% and bilaterally in 7.45% of its population with an overall absence of 27.65%.

A study on morphology of palmaris longus

Palmaris longus muscle is one of the highly variable muscles of flexor compartment of forearm. In man, due to loss of prehension, the muscle became an almost vestigial structure, more tendinous than muscular and started becoming unilaterally or bilaterally agenetic. This muscle has got an evolutionary interest along with a high degree of importance in tendon graft surgeries. In this study the morphology of palmaris longus muscle was studied using routine dissection procedure in a total of 50 upper limbs, out of which 45 (90%) upper limbs showed normal anatomy. Two upper limbs (4%) showed reverse palmaris longus, one upper limb (2%) showed proximal and distal tendinous portion with a long middle belly, (here the muscle belly was much longer when compared to the combined length of the proximal and distal tendons). These variations in their morphology were noted and their clinical significance was discussed.

Unilateral variant motor innervations of flexor compartment of arm (915.10)

Variations in the nerves of the upper limb are very important in routine surgeries, where these nerves are more prone for injuries; these variations may also help in interpretation of a nervous compression having unexplained clinical symptoms. The musculocutaneous nerve usually branches out from the lateral cord of brachial plexus. It innervates the coracobrachialis, biceps brachii and brachialis muscles and continues as the lateral cutaneous nerve of forearm without exhibiting any communication with the median nerve or any other nerve. We report a unilateral variation in motor innervations of the right arm in a 72‐year‐old Female cadaver. The musculocutaneous nerve was found to be piercing coracobrachialis muscle, supplying it and later continue as lateral cutaneous nerve of forearm. A muscular branch of the median nerve was supplying the short and long head of biceps muscle. In the middle of arm, the median nerve was found to be giving a separate branch, which supplied the brachialis muscle and continued in the cubital fossa with normal relation to biceps tendon and brachial artery. There was no variation seen in distribution of median nerve in the flexor compartment of forearm and hand. Knowledge of such anatomical variation is of interest to the anatomist and surgeons.

Median ulnar nerves communication in the forearm: a study with autopsy material.

The incidence of median-ulnar communication in the forearm presents variability in different population groups. The aim of this study was to determine the incidence and morphologic expression of the median-ulnar communication in a sample of the Colombian population. One hundred and eight forearms of autopsy material at the National Institute of Forensic Medicine of Bucaramanga, Colombia were studied. Using an approach of the flexor compartment of forearm the median and ulnar nerves were dissected and the communications between these two structures were characterized. The communicating branch occurred in 28 (25.9%) forearms. It occurred unilaterally in 12 specimens and bilaterally in 8, with statistically significant difference (P=0.01). The communication between the anterior interosseous and ulnar nerves was most frequent, observed in 13 (46.4%) forearms. The length of the communicating branch was 56.9 +/- 8.3 mm. The distance of the proximal and distal points of the communicating branch to the bi- epicondylar line was 59.6 +/- 15.4 mm and 102.7 +/- 23.5 mm respectively. The length of the forearm was 269.8 +/- 15.9 mm. A projection of the communicating branch from the upper third to the midthird of the forearm was observed. The incidence of the median-ulnar communication in the present study is in the high rank reported in the literature; there is an agreement with prior studies in finding more numerous communicating branches in the right forearm. The median-ulnar communication should be taken into account for surgical approach of the forearm.

PRESENCE OF TRIPLE GANTZER'S MUSCLE - A RARE ANATOMICAL VARIATION

AbstractAnomalous muscles usually do not result in adverse symptoms but are of academic interest. However, these muscles can create neurovascular compression at times. Muscle anomalies of the upper extremity are recognized causes of peripheral nerve disorder. Koloh-Nevin Syndrome (Anterior Interosseous Nerve Syndrome) caused by the compression neuropathy of the anterior interosseous nerve in the forearm is believed to occur because of its compression by the accessory heads of flexor pollics longus (FPLah) and flexor digitorum profundus (FDPah). The above two accessory muscles are also called Gantzer's muscle. During routine cadaveric dissection, we encountered multiple Gantzer's muscles in a 60 year-old- formalin embalmed male cadaver. Along with the usual FPLah and FDPah described by Gantzer, we too observed an accessory muscle in relation to the flexor digitorum superficialis (FDS). All the three anomalous muscles had a common origin from the under cover of the FDS fibers and by fibrous band above the insertion of brachialis. The presence of multiple additional muscles in the forearm flexor compartment is rare and clinically significant.

Long-term Results of Surgical Decompression of Chronic Exertional Compartment Syndrome of the Forearm in Motocross Racers

Background: Chronic exertional compartment syndrome (CECS) is occasionally observed in the forearm flexor muscles of motocross racers. Long-term results of fasciectomy and fasciotomy for this syndrome are scarce. Purpose: To study the long-term effects of 2 surgical techniques for forearm flexor CECS. Study Design: Case series; Level of evidence, 4. Methods: A database of patients with forearm CECS who underwent surgery was analyzed. Long-term pain reduction (visual analog scale [VAS], 0-100) and efficacy were evaluated using a questionnaire. Results: Data of 24 motocross racers were available for analysis. Intracompartmental pressures during rest, during provocation, and after 1 and 5 minutes of provocation were 15 ± 4, 78 ± 24, 29 ± 10, and 25 ± 7 mm Hg, respectively. Painful sensations in the forearm were reduced from 53 to 7 (median VAS; P < .001). Both fasciectomy (n = 14) and fasciotomy (n = 10) were equally effective. More than 95% (23/24) of the patients were satisfied with the postoperative result after 5 ± 2 years’ follow-up. Conclusion: Surgical fasciotomy and fasciectomy of the forearm flexor compartment are equally successful in motocross racers suffering from forearm CECS.

Accessory muscle in the forearm: a clinical and embryological approach

Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.

Das muskuläre Kompartmentsyndrom am Unterarm bei Hemmkörperhämophilie

Acute compartment syndrome is a complication in which microcirculation is impaired due to increased tissue pressure within a confined (osteo-fibrous) space and leads to neuromuscular dysfunction. A serious complication of haemophilia is the development of inhibitors. In this case the immune system produces antibodies to factor VIII or IX during substitution therapy of haemophilia A or B. These antibodies are directed against both, the substituted and the endogenous factors. A man (age: 81 years) with originally moderate haemophilia A who at the age of 63 developed an inhibitor during treatment of a bleeding event. Painful swelling in the left forearm occurred without any recollection of trauma, and failed to subside under factor substitution initially performed by the patient. This finding necessitated emergency fasciotomy of the forearm flexor compartment. In order to keep the complication rate as low as possible in the presence of hemophilia with inhibitors, the patients should only be treated in a specially equipped interdisciplinary treatment center.

Forearm muscle hernia: a case report

An unusual case of muscle hernia in the forearm flexor compartment is reported. This was repaired with a fascia lata onlay graft from the patient's thigh. At 6 months after surgery there was no recurrence and the patient remained symptom free at the time of this report.

Compartment syndrome caused by a traumatized vascular hamartoma

A case report is presented of a traumatized vascular hamartoma producing a forearm flexor compartment syndrome; such a case has not been reported previously. The role of minor trauma in this case was important. There is a need for a high degree of suspicion in order to make an early, accurate diagnosis. Delayed surgical decompression and resection of the pathologic muscle resulted in a dramatic improvement in sensibility and digital mobility.