The Muscular Branching Patterns of the Ulnar Nerve to the Flexor Carpi Ulnaris and Flexor Digitorum Profundus Muscles

2005 ◽  
Vol 27 (4) ◽  
pp. 322-326 ◽  
Author(s):  
Tania Marur ◽  
Salih Murat Akkιn ◽  
Mehmet Alp ◽  
Selman Demirci ◽  
Levent Yalçιn ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Flexor Digitorum Profundus ◽  
Flexor Carpi Ulnaris ◽  
Branching Patterns ◽  
Flexor Digitorum

ANATOMIC CHARACTERISTICS OF A FASCIA AND ITS BANDS OVERLYING THE ULNAR NERVE IN THE PROXIMAL FOREARM: A CADAVER STUDY

2007 ◽  
Vol 32 (3) ◽  
pp. 302-307 ◽  
Author(s):  
M. SIEMIONOW ◽  
G. AGAOGLU ◽  
R. HOFFMANN
Keyword(s):  
Ulnar Nerve ◽  
Cadaver Study ◽  
Upper Extremities ◽  
Flexor Digitorum Profundus ◽  
Type I ◽  
Type Ii ◽  
Flexor Carpi Ulnaris ◽  
The Mean ◽  
Proximal Forearm ◽  
Flexor Digitorum

This study describes the characteristics of a fascia overlying the ulnar nerve for 10 cm distal to the midpoint of the retrocondylar groove. A total of 28 cadaver upper extremities were dissected. The ulnar nerve between the flexor carpi ulnaris and flexor digitorum profundus was traced distally underneath a thin fascia. The length of the fascia was measured and examined for the presence of segmental fascial thickenings, referred to as ‘Bands’. Two types of fascia were found. In Type I, three Bands were identified within the fascia and the mean length of the fascia was 5.6 cm. In Type II, four Bands were identified and the mean length of the fascia was 7.7 cm. The presence of Bands within the fascia overlying the ulnar nerve in the proximal forearm may require release at the time of decompression, or anterior transposition, of the ulnar nerve at the cubital tunnel.

Lumbrical Muscles Neural Branching Patterns: A Cadaveric Study With Potential Clinical Implications

Hand ◽  
2020 ◽  
pp. 155894472096388
Author(s):  
Michele R. Colonna ◽  
Maria Piagkou ◽  
Andrea Monticelli ◽  
Cesare Tiengo ◽  
Franco Bassetto ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cadaveric Study ◽  
Flexor Digitorum Profundus ◽  
Branching Patterns ◽  
Fresh Frozen ◽  
Innervation Patterns ◽  
Muscle Innervation ◽  
Lumbrical Muscle ◽  
Lumbrical Muscles ◽  
Flexor Digitorum

Background Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum profundus and course distally along the radial side of the corresponding metacarpophalangeal joints, in front of the deep transverse metacarpal ligament. The first and second lumbrical muscles are typically innervated by the median nerve, and third and fourth by the ulnar nerve. A plethora of lumbrical muscle variants has been described, ranging from muscles’ absence to reduction in their number or presence of accessory slips. The current cadaveric study highlights typical and variable neural supply of lumbrical muscles. Materials Eight (3 right and 5 left) fresh frozen cadaveric hands of 3 males and 5 females of unknown age were dissected. From the palmar wrist crease, the median and ulnar nerve followed distally to their terminal branches. The ulnar nerve deep branch was dissected and lumbrical muscle innervation patterns were noted. Results The frequency of typical innervations of lumbrical muscles is confirmed. The second lumbrical nerve had a double composition from both the median and ulnar nerves, in 12.5% of the hands. The thickest branch (1.38 mm) originated from the ulnar nerve and supplied the third lumbrical muscle, and the thinnest one (0.67 mm) from the ulnar nerve and supplied the fourth lumbrical muscle. In 54.5%, lumbrical nerve bifurcation was identified. Conclusion The complex innervation pattern and the peculiar anatomy of branching to different thirds of the muscle bellies are pointed out. These findings are important in dealing with complex and deep injuries in the palmar region, including transmetacarpal amputations.

scholarly journals Bilateral Variation of Forearm Flexor Muscles - A Case Report and Clinical Significance

2012 ◽  
Vol 01 (01) ◽  
pp. 040-043
Author(s):  
D. Malar ◽  
Keyword(s):  
Middle Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Flexor Carpi Ulnaris ◽  
Close Proximity ◽  
Flexor Muscles ◽  
Male Cadaver ◽  
Forearm Flexor Muscles ◽  
Flexor Digitorum ◽  
Forearm Flexor

AbstractDuring routine dissection, bilateral multiple variations of forearm flexor muscles were observed in a male cadaver. The variations were a) an additional belly arising from the coronoid process of ulna, distal to the origin of ulnar head of flexor digitorum superficialis, passing deep to flexor digitorum superficialis and joining the tendon of flexor digitorum profundus to the middle finger; b) an additional belly arising from the distal part of flexor carpi ulnaris and passing superficial to ulnar nerve and ulnar vessels in the Guyon's canal and c) the origin of second lumbricals from the profundus tendon in the carpal tunnel. An aberrant muscle may stimulate a ganglion or a soft tissue tumor or if in close proximity to a nerve, it may cause pressure neuritis. Identification of these variations is important in defining the anatomical features for clinical diagnosis and surgical procedures.

scholarly journals Unusual nerve supply of biceps from ulnar nerve and median nerve and a third head of biceps

2006 ◽  
Vol 39 (02) ◽  
pp. 172-174
Author(s):  
L Arora ◽  
R Dhingra
Keyword(s):  
Brachial Plexus ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Axillary Artery ◽  
Anatomical Variation ◽  
Musculocutaneous Nerve ◽  
Flexor Digitorum Profundus ◽  
Medial Side ◽  
Flexor Carpi Ulnaris ◽  
The 19Th Century

ABSTRACTVariations in branching pattern of the brachial plexus are common and have been reported by several investigators. Of the four main nerves traversing the arm, namely median, ulnar, radial and musculocutaneous, the ulnar and median nerve do not give any branches to muscles of the arm. Ulnar nerve after taking origin from medial cord of brachial plexus runs distally through axilla on medial side of axillary artery till middle of arm, where it pierces the medial intermuscular septum and enters the posterior compartment of arm. Ulnar nerve enters forearm between two heads of flexor carpi ulnaris from where it continues further. It supplies flexor carpi ulnaris , flexor digitorum profundus and several intrinsic muscles of hand . We recently observed dual supply of biceps muscle from ulnar and median nerves in arm. Musculocutaneous nerve was absent. Although communications between nerves in arm is rare, the communication between median nerve and musculocutaneous nerve were described from the 19th century which could explain innervation of biceps from median nerve. But no accurate description of ulnar nerve supplying biceps could be found in literature. Knowledge of anatomical variation of these nerves at level of upper arm is essential in light of the frequency with which surgery is performed to transfer nerve fascicles from ulnar nerve to biceps in case of brachial plexus injuries. We also observed third head of biceps, our aim is to describe the exact topography of this variation and to discuss its morphological.

Quantitation of and landmarks for the muscular branches of the ulnar nerve to the forearm for application in peripheral nerve neurotization procedures

2006 ◽  
Vol 104 (5) ◽  
pp. 800-803 ◽  
Author(s):  
R. Shane Tubbs ◽  
James W. Custis ◽  
E. George Salter ◽  
Jeffrey P. Blount ◽  
W. Jerry Oakes ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Nerve Trunk ◽  
Medial Epicondyle ◽  
Flexor Digitorum Profundus ◽  
Mean Diameter ◽  
The Mean ◽  
Lateral Branches ◽  
Flexor Digitorum

Object In neurotization procedures, donor nerves—either whole or in part—with relatively pure motor function can be carefully chosen to provide the optimal nearby motor input with as little donor site morbidity as possible. In this context, the ulnar nerve branches to the forearm muscles are relatively dispensable; however, quantitation of and landmarks for these branches are lacking in the literature. Methods The ulnar branches to the flexor carpi ulnaris (FCU) and flexor digitorum profundus (FDP) muscles in 20 upper extremities obtained in adult cadaveric specimens were dissected and quantified. In the forearm, a mean of four nerve branches led to the FCU and FDP muscles. A mean of 3.4 branches led to the FCU muscle; of these, one to three were medial branches and zero to two were lateral. Medial branches to the FCU muscle originated a mean of 2.7 cm inferior to the medial epicondyle. Lateral branches to the FCU muscle originated at a mean of 3.3 cm inferior to the medial epicondyle. The mean length of the medial branches was 3.2 cm, whereas the mean length of the lateral branches was 3.3 cm. All nerves had a single trunk for the FDP muscle, and in all specimens this branch was located deep to the main ulnar nerve trunk, originating from the ulnar nerve a mean of 2.7 cm inferior to the medial epicondyle. These branches had a mean length of 5.6 cm. The mean diameter of all medial and lateral branches to the FCU muscle was 1 mm, and the mean diameter of the branch to the FDP muscle was 2.1 mm. All branches to both the FCU and FDP muscles arose from the ulnar nerve, over its first approximately 5 cm from the level of the medial epicondyle. Additionally, all branches could be easily lengthened by gentle proximal dissection from the main ulnar nerve. Conclusions Ulnar branches to the forearm can be easily localized and used for neurotization procedures. The branch to the FDP muscle had the greatest diameter and longest length, easily reaching the median nerve and posterior interosseous nerve via a transinterosseous membrane tunneling procedure. Furthermore, this branch could be teased away from the main ulnar nerve trunk and made to reach the distal branches of the musculocutaneous nerve in the arm.

scholarly journals Innervation of the Flexor Digitorum Profundus: A Systematic Review

2017 ◽  
Vol 26 (2) ◽  
pp. 120-125
Author(s):  
Kun Hwang ◽  
Seung Jun Bang ◽  
Sook Hyun Chung
Keyword(s):  
Systematic Review ◽  
Nerve Injury ◽  
Ulnar Nerve ◽  
Flexor Digitorum Profundus ◽  
Communicating Branch ◽  
Anterior Interosseous Nerve ◽  
Flexor Digitorum ◽  
Forearm Length

Purpose: The aim of this study was to review the innervation of the flexor digitorum profundus (FDP). Methods: In PubMed and Scopus, terms (Flexor digitorum profundus OR FDP) AND (innervation OR nerve) were used, resulting in 233 and 281 papers, respectively. After excluding 142 duplicates, 73 abstracts were reviewed. Forty-seven abstracts were excluded, 26 full papers were reviewed, and 17 papers were analyzed. Results: In most cases (97.6%), the index FDP was innervated by the anterior interosseous nerve (AIN). Dual innervation from the AIN and ulnar nerve (UN) was observed in 2.4% of papers. In majority (76.8%), the middle FDP received dual innervation from the AIN and the UN. The rest was innervated by the AIN only (22.0%) or the UN only (1.2%). In most cases (85.4%), the ring FDP was innervated by the UN only. The rest (14.6%) received dual innervation from the AIN and the UN. In majority of cases (64.6%), the little FDP was innervated by the UN only. The rest (35.4%) received dual innervation from the AIN and the UN. The AIN entered the FDP at 107.63 (8.80) mm from the elbow, corresponding to 26.75% (2.17%) of the forearm length, measured proximally. The average number of AIN branches to the FDP was 2.27 (1.33). The average number of UN branches to the FDP was 1.37 (0.94). In 8.8% of limbs, a communicating branch supplied the FDP. Among the limbs with a communicating branch, 32.3% had branches supplying the FDP. Conclusion: The results of this study may be useful in managing nerve injury patients.

scholarly journals Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited

2015 ◽  
Vol 123 (5) ◽  
pp. 1216-1222 ◽  
Author(s):  
Mark A. Mahan ◽  
Jaime Gasco ◽  
David B. Mokhtee ◽  
Justin M. Brown
Keyword(s):  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Anterior Transposition ◽  
Flexor Carpi Ulnaris ◽  
Proximal Site ◽  
Anatomical Relationship ◽  
The Common ◽  
Proximal Forearm ◽  
Flexor Digitorum ◽  
Relationship Of

OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle. CONCLUSIONS The common aponeurosis encountered between the FDS and FCU muscles represents a potential site of posttransposition entrapment, which may account for a subset of failed anterior transpositions. Exploration of this region with release of this structure is recommended to provide an unconstrained distal course for a transposed ulnar nerve.

The Volar Distal Radioulnar Portal in Wrist Arthroscopy: An Anatomical Study

2020 ◽  
Author(s):  
Francisco J. Lucas ◽  
Vicente Carratalá ◽  
Ignacio Miranda ◽  
Cristobal Martinez-Andrade
Keyword(s):  
At Risk ◽  
Ulnar Nerve ◽  
Surgical Techniques ◽  
Anatomical Study ◽  
Neurovascular Bundle ◽  
Wrist Arthroscopy ◽  
Iatrogenic Injuries ◽  
Flexor Carpi Ulnaris ◽  
Human Cadavers ◽  
Triangular Fibrocartilage

Abstract Background Advances in wrist arthroscopy and the emergence of novel surgical techniques have created a need for new portals to the wrist. The aim of this study was to define and verify the safety of the volar distal radioulnar (VDRU) portal. Description of the Technique The VDRU portal is located ∼5 to 10 mm proximal to the proximal wrist crease, just on the ulnar edge of flexor carpi ulnaris tendon and radial to the dorsal cutaneous branch of the ulnar nerve. The ulnar styloid marks the distal point of the portal. Methods An anatomical study was performed on 12 upper extremity specimens of 6 human cadavers. Iatrogenic injuries of neurovascular structures potentially at risk were assessed, and the distance from the portal to these structures was measured. Results No iatrogenic injuries of the structures at risk occurred. Mean distances from the VDRU portal to the ulnar neurovascular bundle, the radial branch of the dorsal sensory branches of the ulnar nerve (DSBUN), and the ulnar branch of the DSBUN were 9.29 ± 0.26 mm, 8.08 ± 0.25 mm, and 10.58 ± 0.23 mm, respectively. There were no differences between left and right wrists. The distances from the VDRU portal to the ulnar neurovascular bundle and the ulnar branch of the DSBUN were significantly shorter in women; this distance was not less than 7 mm in any case. Conclusions The VDRU portal is safe, reproducible, and facilitates the implementation of various techniques related to triangular fibrocartilage complex pathology.

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