Palmaris Brevis Research Articles

THE USE OF THE PALMARIS BREVIS FLAP IN RECURRENT CARPAL TUNNEL SYNDROME

In failed cases of primary carpal tunnel release, the addition of the highly vascular palmaris brevis turnover flap as an adjunct to internal neurolysis discourages scarring and provides a nutrient bed for axonal regeneration. In fact, the palmaris muscle flap actually may suppress the growth of nerve fibers into the overlying scar. Experimentally, classic neuromas do not form when a severed nerve is placed in an innervated muscle, particularly those with minimal excursion, as is the case with the turned over palmaris cushion. Major advantages of the palmaris turnover muscle are (1) proximity of the muscle to the operative field, obviating the need for a distant graft source; (2) negligible functional motor loss as a result of forfeiting this muscle; (3) no separate scar is created in raising this flap; and (4) adequate padding of the subcutaneous fat is still left at the donor site to protect the ulnar neurovascular bundle. Although postoperative healing and rehabilitation time are relatively lengthened by the more extensive dissection, subjective assessments of pain relief and clinical improvements in grip strength, pinch strength, and sensory parameters justify the use of the palmaris brevis turnover flap in recalcitrant carpal tunnel cases.

Biochemical and clinical study of muscle atrophy at thenar and hypothenar eminences in patients with cirrhosis.

The results of various biochemical examinations in 14 patients with cirrhosis (6 males and 8 females) with muscle atrophy at the thenar and hypothenar eminence (muscle atrophy group; mAG) were compared with those in 13 patients (8 males and 5 females) with cirrhosis without muscle atrophy at these sites (non-muscle atrophy group; NmAG). All patients were elderly men and women (mAG and NmAG, mean age, 69 +/- 3 years and 60 +/- 7, respectively). In most mAG patients, muscle atrophy was accompanied by palmar erythema. Muscle atrophy was histologically demonstrated by biopsy. Furthermore, electromyography and magnetic resonance study of the cervical spinal cord revealed that the atrophy was of myogenic rather than neurogenic origin. The Child-Pugh score, body mass index and sex hormone level in urine (total 24 h) in the two groups were compared along with the biochemical results. There were no significant differences between the two groups in urine estrogen and testosterone levels. The urinary creatinine excretion was significantly reduced in mAG. The creatine phosphokinese, lactate dehydrogenase isoenzyme and aldolase levels in serum did not differ significantly in the two groups, whereas the serum albumin level was significantly increased in NmAG. Significant differences were observed only for the serum albumin level, age and body mass index. Thus, we consider that palmar muscle atrophy in patients with cirrhosis is not due to hormonal excess in serum, but may be attributable to advanced age and diminished physical strength.

La tendinite du grand palmaire physiopathologie et résultats du traitement chirurgical. A propos de 28 cas

The results of a 27 cases of flexor carpi radialis tenosynovitis, operated between 1984 and 1992 and followed for an average of 30 months, are reported. This study confirms the female predominance of this disease (25 women for two men) and its development mainly after the age of fifty. Pain along the course of the tendon is a constant sign, frequently associated with dysaesthesia in the territory of the palmaris brevis branch of the median nerve as well as synovial swelling. Surgery was indicated because of failure of apparently correctly conducted medical treatment. The technique consists of synovectomy and resection of all sources of irritation of the tendon in its sheath. The development of trapezium or scaphoid osteophytes is a common cause of irritation. The functional result obtained was good or excellent in 22 cases. This study confirmed the existence of a close relationship between the development of flexor carpi radialis tenosynovitis and the presence of external osteoarthritis of the carpus, as this combination of lesions was observed in 20 of the 27 cases. Carpal osteoarthritic lesions appear to be responsible for the great majority of cases of flexor carpi radialis tendinitis observed in women over the age of 50 years. Following failure of medical treatment, surgical treatment is effective provided it includes treatment of any osteoarthritic lesions present.

The New Palmaris Brevis Musculocutaneous Flap

The palmaris brevis muscle is thin and subcutaneous on the ulnar side of the palm, attached to the medial border of the palmar aponeurosis. It ends in the dermis of the hand's ulnar border. A new musculocutaneous flap composed of the palmaris brevis muscle and its overlying hypothenar skin is presented. The free flap, from the vascular pedicle of the ulnar artery, was made. This flap sacrifices the ulnar artery. It was applied to 3 patients with palmar thumb defects, all of whom were successfully reconstructed.

最掌筋けんによる顔面神経麻ひの再建

For reconstruction of facial paralysis, dynamic operative methods such as cross-face nerve transplantation and free muscle transplantation with neurovascular anastomosis are often performed. However, optimal reconstruction of the muscles of facial expression is very difficult. An appropriate operative method should be selected in each patient based on age, the underlying disease, the degree of paralysis, and the patient's desire to be treated.We performed palliative operations in 2 patients with complete facial paralysis. Patient 1 (81 years old) with Bell's palsy was treated by suspension of the lower eyelid, tarsectomy of the central area, and skin resection of the lateral area. Patient 2 (79 years old) after operation for parotid tumor (mucoepidermoid carcinoma) was treated by suspension of the lower eyelid and mouth angle, and skin resection of the upper area of the eyebrow and nasolabial groove and around the lips. The tendon of the long palmar muscle was used for suspension in both patients, and adequate results were obtained.The improvement achieved by palliative suspension is expected to be maintained for 5-10 years. If quality of life is a goal, this operation is appropriate for reconstruction of paralysis in aged patients. In our patients, adequate results could be obtained by using the tendon of the long palmar muscle.

Intrinsic Hand Muscles of the Japanese Monkey, <i>Macaca fuscata</i>

Anatomy of the intrinsic hand muscles in the Japanese monkeys was studied with an improved method to dissect the muscles and nerves in water after removal of the skeletal framework. The thenar eminence contained four muscles, namely m. abductor pollicis brevis, m. opponens pollicis, m. flexor pollicis brevis, and m. adductor pollicis. The hypothenar eminence contained four muscles, namely m. palmaris brevis, m. abductor digiti minimi, m. flexor digiti minimi brevis, and m. opponens digiti minimi. Majority of the thenar muscles are fused more or less with each other, so that clear separation of these muscles was difficult. The lumbrical muscles arose from the palmar parts of four main tendons of the deep flexor muscle to the second, third, fourth, and fifth digits. The mm. contrahentes arose mainly from a medial tendinous septum attached on the palmar surface to the third metacarpus, and included three muscles destined to the second, fourth and fifth digits. The interossei were found on the radial side of the second, third, fourth and fifth finger as well as on the ulnar side of the second, third and fourth finger. The intrinsic hand muscles in the Japanese monkey received innervation either from the median or the ulnar nerve. Branching pattern of these nerves to the individual muscles was fundamentally similar to those in man except for the fact that the median and the ulnar nerve in the Japanese monkey do not communicate to make a loop in the thenar muscles. A separate branch from the median nerve to the deep head of m. flexor pollicis brevis (accessory recurrent nerve) was described for the first time in the macaque monkey.

Ulnar artery palmar to palmaris brevis: cadaveric study and three case reports

Three cases in which the ulnar artery was palmar to the palmaris brevis muscle at the level of the wrist are described and the results of a cadaveric study are presented. The anomaly was confined to the level of Guyon's canal with a normal position of the artery proximally in the forearm and distally in the palm. In spite of its superficial location, the artery was patent in all patients and no symptoms referable to the ulnar artery were present. The ulnar nerve was found dorsal to the palmaris brevis in Guyon's canal in all three patients. An accessory muscle was found in one patient, but no other anatomic anomalies were seen. A cadaveric study of 43 limbs revealed a similar anomaly of the ulnar artery in 1 cadaver. In the presence of this anomaly the ulnar artery may be at increased risk during surgical exploration of Guyon's canal. Exposure of the artery in the forearm prior to exploration of Guyon's canal is recommended.

Palmaris brevis turnover flap as an adjunct to internal neurolysis of the chronically scarred median nerve in recurrent carpal tunnel syndrome

Thirteen hands in 11 patients with previous carpal tunnel releases were treated by microscopic internal neurolysis and palmaris brevis "turnover" flaps. All patients in the series had positive electrodiagnostic testing, dysesthetic wrist pain, and numbness in the median nerve distribution before operation. Average age was 41.9 years (range, 27 to 62 years). Ten were male and 3 were female. Range of follow-up after the procedure was from 1 to 1 1/2 years. All hands with abnormal preoperative two-point discriminations or Semmes-Weinstein measurements showed numerical improvement in their sensory parameters. Thenar strength and bulk improved at least one grade in all six cases of thenar atrophy. Mean grip strength was 15.2% greater than before operation. Key pinch increased 5.5% and pulp pinch 31.9%. Subjective assessment of improvement ranged from 25% to 100%. All patients returned to their former jobs or to vocational retaining except the oldest patient who is semiretired.

Homology of the adductor pollicis and contrahentes muscles: a study of monkey hands.

The deep palmar muscles in monkey hands were studied. The contrahentes muscles mainly arose from the capitate bone, descended palmar to the deep palmar branch of the ulnar nerve and the palmar metacarpophalangeal nerves, and attached to the proximal phalanges or wing tendons of the second, fourth and fifth fingers. In relation to the deep palmar branch of the ulnar nerve and the palmar metacarpophalangeal nerves, the contrahentes muscles are homologous with the adductor pollicis and flexor indicis radialis muscles. The contrahentes muscles occasionally gave off some accessory slips which blended with the interosseous muscles. These findings suggest that the human adductor pollicis muscle is a well-developed remnant of a contrahens muscle, and that the human interosseous muscles contain some remnant of the contrahentes muscle. In fact, a well-developed remnant of a contrahens muscle was found in the fourth finger of a human hand. It is further considered that the human adductor pollicis muscle contains an element of the interosseous muscle of the thumb.

The palmaris brevis profundus. An anomalous muscle associated with ulnar nerve compression at the wrist

An anomalous muscle is uncommonly associated with ulnar nerve compression at the wrist. Anomalies of the palmaris longus, abductor digiti minimi, flexor digiti minimi, and flexor carpi ulnaris have been described. Another case is presented in which the anomalous muscle would appear to be a duplication of the palmaris brevis. This muscle has been named the "palmaris brevis profundus."

Analysis of the gross anatomical variations found in four cases of trisomy 13.

The variations and defects observed during detailed gross anatomical dissections of four cases of trisomy 13 are described. Emphasis is on the muscular system where previously undocumented variations, absences, and supernumerary elements were observed. A muscle phenotype which includes absence of palmaris longus, palmaris brevis, plantaris, and peroneus tertius, the presence of pectorodorsalis muscles and muscles from the central tendon of the diaphragm to the pericardium near the pulmonary veins, and variations in the extensor indicis, extensor carpi radialis longus and brevis, biceps, and suprahyoid muscles is discussed. The brain defects which include absent olfactory bulbs and tracts and hypoplastic commissures are compared to those defects seen in cases of alobar holoprosencephaly wherein severe defects of the ethmoid bone are concomitants. Previously well-documented defects of the viscera are included.

Hypothenar Dimpling

In two patients, the skin over both hypothenar eminences underwent intermittent, spontaneous, irregular, dimpling contractions. The dimpling was benign, and was the result of spontaneous discharge of motor units in the palmaris brevis muscle. Electrophysiological investigations localized the site of origin of the discharge to the ulnar nerve, possibly at the wrist, but there was no clinical or physiological evidence of neuropathy or of nerve compression. In many respects, the clinical and electrophysiological features of hypothenar dimpling resemble hemifacial spasm.

The palmaris brevis–a reconsideration of its anatomy and possible function

The palmaris brevis–a reconsideration of its anatomy and possible function

The Palmaris Brevis-A Reconsideration of Its Anatomy and Possible Function

1. An amplified description of the anatomy of the palmaris brevis muscle based on dissections of ten cadaver hands is reported. Specific details regarding its shape, attachments, its bipartite structure with separate innervation to each part, and presence of tendons are noted. 2. Structural boundaries of the pisohamate tunnel (loge of Guyon) are described, based on these dissections. 3. The function of the palmaris brevis is believed to be to protect the ulnar nerve and artery from overlying pressure. Contraction of the muscle appears to prevent displacement of the hypothenar pad by the pressure produced by gripping hard objects. As a result this pad of soft tissue is maintained over the ulnar neurovascular bundle and the risk of trauma to the nerve and artery from prolonged pressure is minimized. 4. In view of this possible function, we believe that in the surgical approach to this region the integrity of the palmaris brevis should be preserved.

Duplication of Hypothenar Muscles Simulating Soft-Tissue Tumor of the Hand

An unusual muscle anomaly is reported which simulated a soft-tissue neoplasm in the hand. It was considered to be a duplication of the hypothenar muscles. No identical case could be found in the literature. The function and appearance of the hand are reported to be excellent almost three years after excision of the anomalous three-headed muscle and the major portion of a very large palmaris brevis muscle. Section of the proximal pulley of the distal fibrous flexor tendon sheath of the little finger, because of a trigger finger, was also performed.

The anatomy of the hand of certain insectivores

Summary 1 Graphical reconstructions were studied from serial sections of the hands of Ptilocercus, Tupaia, Elephantulus and Crocidura 2 In all these insectivores and in Erinaceus the contrahentes and flexores breves profundi arise by a common fibrous sheet from the distal row of carpal bones, and have no metacarpal attachment. 3 The presence of this specialization suggests that the Insectivora constitute a, natural group. 4 Crocidura and other Soricidae have a complete set of smooth palmar, pads, and carpal vibrissae are developed, but many short palmer muscles have been lost. 5 The pollex is dwarfed in Elephantulus as in other Macroscelididae, and the thenar pads have been lost, but a full set of palmar muscles is retained. 6 The striation of the pads and the presence of raphes between the contrahentes in the Tupaiidae are probably arboreal specializations. 7 While the primitive eutherian hand probably resembled that of Crocidura in outward appearance, its musculature resembled that of Elephantulus, except that the flexores breves profundi arose from the metacarpals. 8 Hand anatomy constitutes no evidence either for or against the association of the Tupaiidae end Macroscelididae in a single suborder (Menotyphla) but divergent specialization of the contrahentes excludes any close association of the Tupaiidae with the Lemuridae.

Phylogeny of the distal musculature of the pectoral appendage

AbstractThe musculature of forearm and manus basically is divisible into dorsal matrix and ventral matrix of elbow, and dorsal matrix and ventral matrix of the podium. The former contributes to the present musculature of brachium and antibrachium, and the latter to the musculature of antibrachium and podium. The forearm muscles of the former category are divisible into humero‐radial (carpi radialis), humero‐podial (digitorum communis et sublimis), and humero‐ulnar (carpi ulnaris) components. The deep muscles of the forearm (mm. abductor pollicis longus, extensor pollicis longus, extensor indicis proprius; flexores digitorum profundus et pollicis longus) have been derived from podial matrices that have migrated proximally along the ulna. The short flexors of the hand have been derived from a superficial and a deep basic series: From the former have come mm. palmaris brevis, abductor pollicis brevis, superficial head of the flexor pollicis brevis, abductor et flexor digiti 5, and lumbricales. From the deep series have been derived mm. contrahentes (including adductor pollicis), interossei, opponens pollicis, deep head of flexor pollicis brevis, and opponens digiti 5.