Flexor Digitorum Superficialis Muscle Belly Research Articles

Feasibility of Nerve Transfer to Palmaris Longus in Forearm-Level TMR: Anatomic Study and Clinical Series.

Targeted muscle re-innervation (TMR) is increasingly being used for treatment of postamputation pain and myoelectric prosthesis (MYP) control. Palmaris longus (PL) is a potential target following transradial amputation. The purpose of this study was to determine the branching pattern of the median nerve (MN) as it pertains to the PL motor branch entry point (MEP) and to present clinical results of patients who had PL used as a target. Eight cadaveric arms were dissected and branching patterns of the MN were documented. Additionally, we reviewed adult patients from a prospectively collected database who underwent TMR using PL. We recorded patient-reported outcomes and signal strength generated by the PL. The average distance from the medial epicondyle to PL MEP was 53 mm. All palmaris motor branches passed through a chiasm within the flexor digitorum superficialis muscle belly, which was a mean of 18 mm away from the MN proper. Patients with long-term follow-up reported an average Pain visual analog scale of 3.3 and Disabilities of the Arm, Shoulder and Hand of 46.2. All but one patient were using an MYP, and all generated at least 10 mV of signal from the PL, which is ample signal for surface electrode detection and MYP control. There were no postoperative neuromas and only one patient-reported postoperative phantom limb pain. Palmaris longus is a suitable target for TMR. Our objective measurements and anatomic relationships may help surgeons consistently find the PL's motor branch. Our series of patients reveal sufficient signal strength and acceptable clinical outcomes following TMR using the PL.

Debulking and tenolysis of an anomalous flexor digitorum superficialis muscle belly in the palm: A case report and review of the literature

Flexor digitorum superficialis (FDS) anomalies can manifest in many ways. Prior case reports have described FDS variants being found incidentally as well being associated with nerve compression and mechanical symptoms. We present a case of an 83-year-old woman complaining pain and locking of the right index finger with associated tenderness at the level of the A1 pulley. Surgical exploration revealed an anomalous FDS muscle belly originating from the FDS tendon with adhesions to the flexor digitorum profundus (FDP) tendon. Tenolysis and dubulking of the anaomalous muscle and its tendon were performed leading to resolution of her symptoms. This case highlights the importance of remaining vigilant for anatomic variants during hand surgeries.

Trigger Wrist Associated with Carpal Tunnel Syndrome Caused by Flexor Digitorum Superficialis Muscle Belly Hypertrophy: A Case Report and Literature Review

Background: Trigger wrist is a rare disease with few reported cases in the literature. This condition presents with painful sensation and a clicking sound during finger or wrist movements. Case Report: In this report, we present a 32-year-old man suffering from trigger wrist along with carpal tunnel syndrome caused by muscle belly hypertrophy and extension to the carpal tunnel. The diagnostic approach and surgical techniques are explained. Conclusion: In cases of trigger wrist associated with carpal tunnel syndrome (CTS), there may be an underlying cause covering both the trigger wrist and CTS at the volar side of the wrist. Therefore, a precise clinical examination is recommended to avoid unnecessary surgery, releasing of A1 pulley, or steroid injection.

Carpal tunnel syndrome secondary to an accessory flexor digitorum superficialis muscle belly: case report and review of the literature.

Anomalous muscles usually do not cause symptoms but are of academic interest mainly discovered during cadaveric dissection. An aberrant muscle belly arising from the index finger flexor digitorum superficialis tendon causing carpal tunnel syndrome is rare. The management of such an anatomical variant is dependent on whether the median nerve compression is associated with a palpable mass. A brief case highlighting important management principles along with a complete literature review is reported.

Carpal tunnel syndrome and trigger finger at the wrist caused by an anomalous flexor digitorum superficialis of the index: a case report and review of literature

Carpal tunnel syndrome is usually idiopathic, but many extrinsic or intrinsic processes can cause such a syndrome [1]; anomalies affecting three muscles have been reported to be in relation with carpal tunnel syndrome [2]: hypertrophic or abnormal lumbrical [3–5], palmaris longus and its variants (profundus or reversed) [6–8], and anomalous flexor digitorum superficialis (FDS). In 21 cases of carpal tunnel syndrome, Tanzer described one patient who had FDS which extended completely through the canal [9]. Singer found, in his experience, 147 carpal tunnel release between 1983 and 1993, 74 variations in 60 hands, and introduced a classification of two types for the different anatomic variations [10]. A review of literature revealed that anomalous FDS associated with carpal tunnel syndrome is usually reported, but few cases were described about the association of carpal tunnel and trigger finger at the wrist. A case of a 38-year-old female patient presenting this association secondary to an anomalous FDS muscle belly of the index is described.

A rare variant of the median nerve as a reminder of the patient uniqueness

ObjectiveDespite the wealth of data concerning anatomical variation of the median nerve, it remains important to continue describing rare variations as they arise. This study represents a unique variation of the median nerve in the human forearm.Methods32 upper limbs of 16 embalmed cadavers were utilized using anatomical dissections.ResultsThe median nerve in a right forearm of a 61 year old male cadaver followed the pathway seen in the majority of cases except during the course within the epimysium of the deep surface of Flexor Digitorum Superficialis (FDS). About half way down the muscle belly, a substantial branch equal in diameter to the main trunk of the median nerve, branched off the main trunk and perforated the FDS muscle. This variant branch continued distally within the FDS muscle belly, until it reached the distal third of forearm. Then, this aberrant branch reunited with the main trunk of the median nerve as it emerged on the lateral aspect of the distal tendon of FDS (7.4cm distally from the branch point at a level 2.5cm proximal to the pisiform bone).ConclusionThe unique variation described in this study was not found to be described in the literature. It is a reminder of the concept of patient uniqueness and the need for individualization of medical, manual, and surgical treatments offered to patients.

“Trigger finger at the wrist” due to anomalous flexor digitorum superficialis muscle belly within the carpal tunnel

"Triggering of the fingers at the wrist" is a relatively unusual condition. It consists in a triggering at the wrist produced by finger motion. Its etiology and presentation may vary. This condition should be clearly differentiated from the other clinical entity called "trigger wrist", occurring on wrist movement. In the present article, we report the case of an anomalous flexor digitorum superficialis muscle belly, arising from the right ring finger at the carpal tunnel, in a 47-year old female patient, causing triggering of the right ring finger at the wrist and a carpal tunnel syndrome. Surgical excision of the muscle mass and carpal tunnel release relieved patient's symptoms and has led to the disappearance of the triggering phenomenon. To date, few cases of trigger finger at the wrist have been reported in the literature. These reported cases were reviewed. The clinical entity of "true trigger wrist" and its etiology are also discussed.

Anomalous flexor digitorum superficialis muscle belly presenting as a mass within the palm

Anomalies of the flexor digitorum superficialis muscle are extremely uncommon and usually present as a painful mass or pseudotumour within the palm. Diagnosis may be difficult because many other soft tissue tumours (lipomas, ganglions, giant cell tumours and hamartomas) may present similarly. Magnetic resonance imaging helps to define the extent and characteristics of this anomalous muscle belly and to distinguish it from a soft tissue sarcoma, whereas plain radiographs are of little value. Three types of flexor digitorum superficialis muscle anomalies have been described, and treatment consists of subtotal or total surgical debulking of the mass if symptoms persist or if the diagnosis is in question. Most patients have complete resolution and full recovery. To date, 20 cases have been reported in the literature, usually involving the right small finger. In the present paper, the case of an anomalous flexor digitorum superficialis muscle in a 17-year-old male patient's left index finger is reported. Symptoms were relieved following surgical debulking and hand-based occupational therapy.

Anomalous flexor digitorum superficialis muscle belly presenting as a mass within the palm

Anomalous flexor digitorum superficialis muscle belly presenting as a mass within the palm

A method for minimizing donor site complications of the radial forearm flap.

The great advantages of the radial forearm fasciocutaneous flap are offset by the dilemmas associated with its donor site. The most commonly encountered problems are the functional and cosmetic sequelae of skin graft loss with consequent exposure of volar forearm tendons, the superficial sensory branch of the radial nerve, and the radius. Techniques that minimize donor site morbidity are those that provide a well-vascularized bed for the protection of exposed tendon, nerve, and bone, and for the acceptance of skin grafts. A technique involving the mobilization of the flexor pollicis longus muscle belly in conjunction with the abductor pollicis longus with approximation to the flexor digitorum superficialis muscle belly provides stable, well-vascularized coverage of the radial forearm flap donor site, with reliable skin graft acceptance and no functional sequelae.

Anomalous flexor digitorum superficialis muscle belly: an unusual case of mass in the palm

A case of anomalous superficialis muscle belly in the palm is presented. Nineteen-such cases have been reported until now. Our case differs in that the anomalous muscle originated from the flexor digitorum superficialis tendon to the index finger by way of an accessory tendon.

Pseudotumor of the palm due to an anomalous flexor digitorum superficialis muscle belly

A pseudotumor of the palm was due to an anomalous flexor digitorum superficialis muscle belly. Magnetic resonance imaging is an excellent diagnostic tool to define the three dimensional extension of such an anomaly. Surgical resection of the anomalous muscle belly resulted in a complete relief of all symptoms.