Forearm Compartment Research Articles

Prehospital Dextrose Extravasation Causing Forearm Compartment Syndrome: A Case Report

Case: A 57-year-old woman was found at home by paramedics to be hypoglycemic with altered mental status. She had multiple attempts at IV access and eventually a 22G IV was established and D50 was infused into her right forearm. Extravasation of the dextrose was noted after approximately 12 g of the medication was infused. She was given a dose of glucagon intramuscularly and her mental status improved. Shortly after her arrival to the emergency department, she was noted to have findings of compartment syndrome of her forearm at the site of the dextrose extravasation. She was evaluated by plastic surgery and taken to the operating room for emergent fasciotomy. She recovered well from the operation. Discussion: D50 is well known to cause phlebitis and local skin necrosis as a complication. This case illustrates the danger of compartment syndrome after D50 extravasation. It is the first documented case of prehospital dextrose extravasation leading to compartment syndrome. There may be safer alternatives to D50 administration and providers must be acutely aware to monitor for D50 infusion complications.

Treatment of a symptomatic forearm muscle herniation with a wrap-around fascia lata graft

Muscle herniation in the extremity is a well-recognized cause of symptomatic pain on exertion. Only 17 cases involving the upper limb has been previously described, 11 of them involving the anterior compartment of the forearm and only 2 were caused by strenuous exertion. Treatment for this condition ranged from nonsurgical, primary closure with palmaris longus interweave, formal fasciotomy, to closure with a tensor fascia lata graft.This is a study of a 28-year-old man who had a symptomatic swelling on the volar aspect of his left forearm while working on a car-door assembly line that resulted in a significant decreased of his grip strength, work capacity and median nerve symptoms. It did not improve after 6 months of conservative management including hand therapy and splintage. The patient subsequently underwent a tensor fascia lata graft wrap-around. Postoperatively his symptoms resolved with improvement in his grip strength and hand function. The rationale for the treatment option chosen is discussed.

Nerve and Free Gracilis Muscle Transfers for Thumb and Finger Extension Reconstruction in Long-standing Tetraplegia

With spinal cord injuries, muscles below the level of the lesion remain innervated despite the absence of volitional control. This persistent innervation protects against denervation atrophy and may allow for nerve transfers to treat long-standing lesions within the spinal cord. We tested the hypothesis that in chronic spinal cord lesions, muscles remained viable for reinnervation. To test this hypothesis, we operated on 7 patients with tetraplegia to reconstruct thumb and finger extension after a mean interval of 5 years since injury. During surgery, if electrical stimulation of the posterior interosseous nerve (PIN) produced muscle contraction, the nerve to the supinator (NS) was transferred to the PIN. If no contractions were demonstrated, the muscles of the extensor compartment of the forearm were replaced via a free gracilis transfer with innervation supplied by the NS. After an average of 26 months, M3 recovery of thumb and finger extension was observed in the 3 upper limbs from the 2 youngest patients who underwent a nerve transfer. None of the free gracilis-treated patients achieved scores above M2. In our youngest patients aged 27 and 34 years, who were operated on 6 years after spinal cord injury, transfer of the NS to the PIN partially restored hand span. Therapeutic V.

Variations of the muscles of first extensor compartment of forearm

Variations of the muscles of first extensor compartment of forearm

Accessory tendon in extensor compartment of forearm – Its embryological and surgical importance

Accessory tendon in extensor compartment of forearm – Its embryological and surgical importance

Missed Extravasation Injury from Peripheral Infusion of Norepinephrine Resulting in Forearm Compartment Syndrome and Amputation

Missed Extravasation Injury from Peripheral Infusion of Norepinephrine Resulting in Forearm Compartment Syndrome and Amputation

A combined variation of Palmaris longus and Flexor digitorum superficialis: Case report and review of literature

The muscles of the anterior compartment of the forearm often exhibit anatomic variations. During dissection of the upper right limb of a preserved cadaver, morphological variations in the Palmaris longus and Flexor digitorum superficialis muscles were found. The Palmaris longus muscular fibers converged to a tendon that passed beneath the Flexor retinaculum, and inserted at the base of the middle phalanx of the fourth digit, replacing the tendon of Flexor digitorum superficialis. The Flexor digitorum superficialis was divided into two muscular heads: a digastric medial head giving tendons to the second and fifth digits, and a lateral head giving one tendon to the third digit. All these tendons were inserted in the respective digits by two bundles between which were located the tendon of the Flexor digitorum profundus muscle. Variations of flexor muscles must be documented because of their clinical significance and their potential use of these muscles in orthopaedic and reconstructive surgery.

An anomalous origin of accessory head of flexor digitorum profundus in forearm: A rare variant

IntroductionThe muscular variations in the forearm have been recognized as causing neurovascular compressions. These variations are mostly detected during routine anatomical dissections or during operations. A clinician should have a thorough knowledge of these variations for understanding the unusual symptoms and signs due to nerve compression. Here, we report the presence of a rare variant head of flexor digitorum profundus (FDP) muscle in forearm. Materials and methodsDuring routine cadaveric dissection done on the upper limb of a 52-year-old male in the Department of Anatomy, HIMSR, New Delhi, a well-developed muscle of anomalous origin was discovered in the flexor compartment of the forearm. The muscles, blood vessels and the nerves of the forearm were dissected carefully following the usual dissection steps. The specimen was studied in detail and photographs were taken. ObservationsThe anomalous muscle that appeared to be an accessory belly of FDP was taking origin from the middle two-fourths of radius and from the adjoining interosseous membrane. Distally, it was attached to the lateral aspect of FDP. The anterior interosseous nerve and vessels supplied the accessory belly and traversed deep to it. The FDP displayed the normal attachments and innervations other than this. ConclusionVery few cases have been reported on the origin of accessory belly of FDP. Awareness of the possibility of such anomalous muscle is important for neurophysicians and hand surgeons undertaking reconstructive procedures for compression syndromes and tenosynovitis.

Additional Muscle Belly and Abberant Muscle Fibers over the Extensor Retinaculam of Wrist

AbstractVariations in the extensor compartment of forearm are common and are significant to neurologists, surgeons and anatomists. The present case report describes a well-developed muscle belly medial to the tendons of extensor carpi radialis longus and extensor carpi radialis brevis. Muscle belly is originating from common extensor origin on lateral epicondyle and is inserted to base of third metacarpal; bilaterally. In addition to this, aberrant muscle fibres packed in a common connective tissue bundle over the dorsal digital expansion of left hand were also found. The above observations were noted during routine dissection of a 50 year old Indian male cadaver. The variant muscle having common extensor origin and muscle fibres over dorsal digital expansion were identified and protected. The blood supply and nerve supply were noted. The clinical significance of the variation is explained in detail.

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%.

An incidentally diagnosed uncommon anomalous flexor indicis profundus tendon

Muscle anomalies in the deep compartment of the forearm are rarely seen and generally do not cause any clinical findings. The flexor indicis profundus (FIP) muscle, which has a separate muscle belly from that of the flexor digitorum profundus (FDP) muscle, is one of the muscle variations in the deep compartment of the forearm. Here, we present a case of a patient with this rare anomaly detected during an operation for a hand injury. No pathologic finding was seen after the operation.

Skeletal Muscle Metastases to the Flexor Digitorum Superficialis and Profundus from Urothelial Cell Carcinoma and Review of the Literature.

Urothelial cell carcinoma (UCC) metastases to skeletal muscle are extremely rare and usually found in patients with advanced stage cancer. The most common sites of bladder cancer metastases are lymph nodes, lung, liver, and bones. Muscle is an unusual site of metastases from a distant primary cancer, due to several protective factors. We present a rare case of 76-year-old patient with metastases in the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) muscles, 2 years after a radical cystectomy for invasive UCC of the bladder. This case is the first description of a forearm lesion, with an extensive infiltration of the volar compartments of the forearm, and the first one with a clear functional impairment.

A Comparative study of plantaris and palmaris longus in South Indian population and their clinical applications

Background: The Plantaris and Palmaris longus muscles are small vestigial muscles having a small muscle belly and a long tendon, the Plantaris muscle is sandwiched between the Soleus and Gastronecmeus muscles present in the calf whereas, the Palmaris longus is present in the flexor compartment of the forearm. Though vestigial they are being used as autografts in various reconstructive surgeries. The aim of this study was to compare the percentage of agenesis of Palmaris longus and Plantaris in South India population and to discuss their clinical importance. Method: The Plantaris and Palmaris longus muscles were dissected in 30 adult embalmed cadavers (60 lower limbs), 10 females and 20 males, the average age of the cadavers was between 40-60 years. Variations pertaining to agenesis, aberrancy of its attachment in its origin and insertion were observed and noted. Result: It was observed that in each specimen there were variations in the thickness and length of Plantaris muscle and tendon. Agenesis of Plantaris was observed bilaterally in a male cadaver only, with the incidence of 3.33%.Whereas, agenesis of Palmaris longus was unilateral right sided 3.33% and on the left side 1.66%, seen in female cadavers only. Conclusion: The tendons of Plantaris and Palmaris longus muscles, which were once thought to be vestigial and degenerating structures, can be of maximum use as graft materials in various plastic & reconstructive surgeries, without producing residual defects. After reviewing the literature it was noted that the Palmaris longus muscle has been well understood and discussed compared to the Plantaris muscle. Keywords: Autografts, Palmaris longus, Plantaris, Tendon grafts

Accessory head of flexor digiti minimi: a case study

AbstractFlexor digiti minimi is a muscle of hypothenar eminence. It flexes the little finger at metacarpo­ phalangeal joint. During routine Anatomical dissection, an extra muscle was noticed in the flexor compartment of right forearm of a male cadaver. The identified muscle took origin from medial aspect of the Palmaris longus tendon just proximal to the wrist joint. When traced distally this muscle joined the fibers of the Flexor digiti minimi, and finally got inserted to palmar aspect of base of proximal phalanx of 5th digit. In its course, the muscle crossed median nerve and Ulnar artery. Because of this reason, this variation has the potential to cause compression of the structures mentioned above and is of interest to clinicians.

Double crush syndrome of the median nerve revealing a primary non-Hodgkin's lymphoma of the flexor digitorum superficialis muscle

Extranodal manifestations of lymphoma are well described in the literature and occur in 20 to 30% of patients. Skeletal muscle involvement is rare. We describe the case of a patient with non-Hodgkin's lymphoma in a forearm muscle. At the age of 86, the featured patient started experiencing continuous, progressive and high intensity pain that was more frequent at night and localized in the right dominant hand. It was associated with paresthesia and hypoesthesia, primarily in the thumb, index finger and middle finger. Clinical examination and electrodiagnosis led to the diagnosis of carpal tunnel syndrome. The patient underwent carpal tunnel release at a private hand center. The progression was unfavorable. Additional clinical examination and electrodiagnosis showed compression of the anterior interosseous nerve (double crush syndrome). The patient was referred to our university hand center for further management. Magnetic resonance imaging showed a large mass of about 20cm occupying the entire anterior compartment of the forearm and enclosing the median nerve. Biopsies were performed and revealed a diffuse large B-cell primary non-Hodgkin's lymphoma. The patient underwent chemotherapy and radiotherapy. Six months later, the patient was in complete remission. Muscular involvement during lymphoma is rare. Biopsy is mandatory; needless radical surgery can be avoided because lymphoma is primarily a non-surgical disease. The key points of the treatment process are reviewed.

Vascular Conditions of the Hand

Treating vascular conditions of the hand requires a thorough understanding of the vascular anatomy of the hand and upper extremity. Treatment options include both operative and nonoperative modalities, and may involve a multidisciplinary team including vascular surgeons, hand surgeons, interventional radiologists, medical internists, and hand therapists. This review discusses the vascular anatomy, patient evaluation, and treatment of vascular conditions of the hand. Figures show the large blood vessels of the arm, locations of the bifurcation of the radial and ulnar arteries, the vascular branches of the arm, the vascular anatomy of the hand and wrist, the location of the superficial palmar arch, upper extremity angiography, the clinical appearance and venograms of phlegmasia cerulean dolens, a high-flow arteriovenous malformation involving the right long finger, images of a patient who experienced blunt trauma to his distal palm from a wood splinter, a 28-year-old male who developed forearm compartment syndrome, volar and dorsal appearance of the left hand of a 56-year-old male with Raynaud phenomenon secondary to scleroderma, and intraoperative images of a patient who underwent digital palmar sympathectomies. A video shows a periarterial digital sympathectomy. Tables list the distinction between Raynaud disease and Raynaud phenomenon, comparison of investigational modalities of vascular conditions, interpretation of segmental arterial pressures, Wake Forest classification of vasospastic and vaso-occlusive disease, and Jones classification of vein bypass graft configurations in upper extremity vascular reconstruction. This review contains 12 figures, 1 video, 5 tables, and 66 references.

Analysis of crosstalk in the mechanomyographic signals generated by forearm muscles during different wrist postures.

In this study, we analyzed the crosstalk in mechanomyographic (MMG) signals generated by the extensor digitorum (ED), extensor carpi ulnaris (ECU), and flexor carpi ulnaris (FCU) muscles of the forearm during wrist flexion (WF) and extension (WE) and radial (RD) and ulnar (UD) deviations. Twenty right-handed men (mean ± SD age=26.7 ± 3.83 years) performed the wrist postures. During each wrist posture, MMG signals were detected using 3 accelerometers. Peak cross-correlations were used to quantify crosstalk. The level of crosstalk ranged from 1.69 to 64.05%. The wrist postures except the RD did not influence the crosstalk significantly between muscle pairs. However, muscles of the forearm compartments influenced the level of crosstalk for each wrist posture significantly. The results may be used to improve our understanding of the mechanics of the forearm muscles during wrist postures.

Factors associated with unplanned reoperation in perilunate dislocations and fracture dislocations.

Background Perilunate injuries are complex and uncommon injuries that are typically the result of a high-energy injury and are nearly always treated operatively. Little is known about factors associated with unplanned reoperations after surgery for perilunate injuries. Purpose To assess the rate and types of unplanned reoperation after operative treatment of a perilunate dislocation. Patients and Methods We reviewed 115 patients of all ages with unplanned reoperations after operative treatment of perilunate injuries at five hospitals. Planned removal of implants were not considered as unplanned reoperations. Results Sixteen patients had an unplanned reoperation, including four for compartment syndrome (three hand, one forearm); three for deep infection; three for malalignment or an errant screw; two for early salvage procedures; and four for other reasons. We considered seven unplanned reoperations necessary (forearm compartment syndrome, infection, loss of alignment, errant screw) and nine debatable or unnecessary (hand compartment syndrome, early salvage procedures, suspected malunion, etc.). Patients who had an unplanned reoperation were younger (median age 24 versus 34 years; p = 0.0034); had earlier surgery (median days to surgery 0 versus 3; p = 0.0068); and were more likely injured in a motor vehicle collision (50% versus 17%; p = 0.0070). Accounting for interaction among the variables using multivariable analysis, the factors independently associated with unplanned reoperation were young age (odds ratio 0.92) and motor vehicle collision accidents (odds ratio 4.1). Conclusion We conclude that higher-energy injuries may be at greater risk for unplanned reoperation, but more than half of the unplanned reoperations were for debatable indications. Level III Retrospective Cohort Review.

Accessory head of flexor digiti minimi: a case study

Flexor digiti minimi is a muscle of hypothenar eminence. It flexes the little finger at metacarpophalangeal joint. During routine Anatomical dissection, an extra muscle was noticed in the flexor compartment of right forearm of a male cadaver. The identified muscle took origin from medial aspect of the Palmaris longus tendon just proximal to the wrist joint. When traced distally this muscle joined the fibers of the Flexor digiti minimi,and finally got inserted to palmar aspect of base of proximal phalanx of 5th digit.In its course, the muscle crossed median nerve and Ulnar artery. Because of this reason, this variation has the potential to cause compression of the structures mentioned above and is of interest to clinicians.