An Anomaly of the Median Artery Associated with the Anterior Interosseous Nerve Syndrome

1992 ◽  
Vol 17 (5) ◽  
pp. 507-509 ◽  
Author(s):  
T. W. PROUDMAN ◽  
P. J. MENZ
Keyword(s):  
Flexor Digitorum Profundus ◽  
Vascular Compression ◽  
Pronator Quadratus ◽  
Pronator Teres ◽  
Longus Muscle ◽  
Anterior Interosseous Nerve ◽  
Median Artery ◽  
Anterior Interosseous Nerve Syndrome ◽  
Pronator Quadratus Muscle ◽  
Flexor Digitorum

The anterior interosseous nerve syndrome is characterized by paralysis of the flexor pollicis longus muscle, the flexor digitorum profundus muscle to the index and middle fingers, and the pronator quadratus muscle. The most common cause is entrapment of the anterior interosseous nerve near its origin from the median nerve by a variety of structures. Compression is most frequently caused by the deep head of the pronator teres muscle, or the fibrous arcade of the flexor digitorum superficialis muscle. Vascular compression has been reported infrequently. A patient with anterior interosseous nerve syndrome was found at operation to have the median artery passing through the anterior interosseous nerve just below the elbow. This artery has not previously been associated with the syndrome. A cadaver dissection confirmed the relationship.

ANTERIOR INTEROSSEOUS NERVE SYNDROME

Hand Surgery ◽  
1998 ◽  
Vol 03 (01) ◽  
pp. 57-62 ◽  
Author(s):  
Gary L. Arishita ◽  
Tsu-Min Tsai
Keyword(s):  
Conservative Treatment ◽  
Upper Extremity ◽  
Surgical Decompression ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Pronator Quadratus ◽  
Steroid Injections ◽  
Anterior Interosseous Nerve ◽  
Anterior Interosseous Nerve Syndrome ◽  
Flexor Digitorum

The anterior interosseous nerve syndrome was first described in 1948. It comprises less than 1% of all upper extremity nerve palsies. Patients have a characteristic pinch deformity, with paralysis or weakness of the muscles innervated by the anterior interosseous nerve, flexor pollicis longus, radial portion of the flexor digitorum profundus, and pronator quadratus. Electromyograms are positive in most patients presenting with motor complaints. Treatment is related to the specific etiology. Conservative treatment includes avoidance of strenuous forearm work, immobilization, steroid injections, and anti-inflammatory medications. If the presentation suggests nerve compression, and the EMG reveals evidence of axonal interruption, then surgical decompression should be performed. We present a series of six patients seen over a 7-year period. Improvement was noted in all the patients postoperatively.

Anterior interosseous nerve compression after supracondylar fracture of the humerus: a metaanalysis

1999 ◽  
Vol 90 (6) ◽  
pp. 1053-1056 ◽  
Author(s):  
Alexander Joist ◽  
Uwe Joosten ◽  
Dirk Wetterkamp ◽  
Michael Neuber ◽  
Axel Probst ◽  
...  
Keyword(s):  
Index Finger ◽  
Interphalangeal Joint ◽  
Nerve Compression ◽  
Flexor Digitorum Profundus ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Content Type ◽  
Anterior Interosseous Nerve ◽  
Anterior Interosseous Nerve Syndrome ◽  
Fine Print

Object. The authors conducted a metaanalysis of reports of anterior interosseous nerve syndrome, a rare nerve compression neuropathy that affects only the motor branch of the median nerve. This syndrome is characterized by paralysis of the flexor pollicis longus, the flexor digitorum profundus to the index finger, and the pronator quadratus, with weakness on flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger without sensory loss.Methods. The authors reviewed reports of 34 cases of anterior interosseous nerve syndrome combined with supracondylar fractures of the humerus in children. They have added a new case identified in a 7-year-old boy in whom a diagnosis was made from the clinical findings and whose treatment and outcome are analyzed. The ages of patients reported in the literature ranged from 4 to 10 years. Ten patients (29%) were treated with closed reduction and application of a cast, whereas 25 patients (71%) were treated with open reduction and fixation of the fracture.Conclusions. All patients regained full flexion and strength after 4 to 17 weeks. The fractures that were surgically treated showed no entrapment of the anterior interosseous nerve.

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

2013 ◽  
Vol 03 (01) ◽  
pp. 69-71
Author(s):  
Soubhagya R. Nayak ◽  
Suranjali Sharma ◽  
Hasi Dasgupta ◽  
Kalyan Bhattacharya
Keyword(s):  
Anatomical Variation ◽  
Flexor Digitorum Profundus ◽  
Neurovascular Compression ◽  
Peripheral Nerve Disorder ◽  
Anterior Interosseous Nerve ◽  
Male Cadaver ◽  
Clinically Significant ◽  
Anterior Interosseous Nerve Syndrome ◽  
Flexor Digitorum ◽  
Forearm Flexor

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.

Neurotization as an alternative for restoring finger and wrist extension

2001 ◽  
Vol 94 (5) ◽  
pp. 795-798 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Tunç Cevat Öğün ◽  
Mustafa Büyükmumcu
Keyword(s):  
Median Nerve ◽  
Motor Nerve ◽  
Flexor Digitorum Profundus ◽  
Posterior Interosseous Nerve ◽  
Flexor Pollicis Longus ◽  
Pronator Quadratus ◽  
Content Type ◽  
Pronator Teres ◽  
Flexor Digitorum ◽  
Fine Print

Object. In cases of irreparable injuries to the radial nerve or in cases in which nerves are repaired with little anticipation of restoration of function, tendon transfers are widely used. In this study, the authors searched for a more natural alternative for selectively restoring function, with the aid of a motor nerve transfer. Methods. Ten arms from five cadavers were used in the study. The posterior interosseous nerve and the median nerve together with their motor branches were exposed in the proximal forearm. The possibility of posterior interosseous nerve neurotization via the median nerve through its motor branches leading to the pronator teres, flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles was investigated. The lengths of the nerves from points of divergence and their widths were measured using calipers, and the means with standard deviations of all nerves were calculated. Motor branches to the pronator teres, flexor pollicis longus, and pronator quadratus muscles were found to be suitable for neurotization of the posterior interosseous nerve at different levels and in various combinations. The motor nerve extending to the flexor digitorum profundus muscle was too short to use for transfer. Conclusions. These results offer a suitable alternative to tendon transfer for restoring finger and wrist extension in cases of irreversible radial palsy. The second step would be clinical verification in appropriate cases.

A Cadaveric Study of Needle Insertion at Pc6 in Eight Wrists of Four Subjects and An Understanding of the Anatomy

2012 ◽  
Vol 30 (1) ◽  
pp. 44-46 ◽  
Author(s):  
Hyun Joo Oh ◽  
Yee Kyoung Ko ◽  
Sa Sun Cho ◽  
Sang Pil Yoon
Keyword(s):  
Median Nerve ◽  
Clinical Importance ◽  
Acupuncture Point ◽  
Anatomical Variations ◽  
Needle Insertion ◽  
Flexor Digitorum Profundus ◽  
Pronator Quadratus ◽  
Adjacent Structures ◽  
Median Artery ◽  
Flexor Digitorum

The anatomical structures vulnerable to acupuncture around the PC6 acupuncture point were investigated. Needles were inserted in PC6 of eight wrists from four cadavers to a depth of 2 cm, the forearms were dissected and the adjacent structures around the path of the needles were observed. The needles passed between the tendons of the palmaris longus and flexor carpi radialis muscles and then penetrated the flexor digitorum superficialis, flexor digitorum profundus and pronator quadratus muscles. The inserted needles were located adjacent to the median nerve. To minimise the risk of unintended injury by acupuncture, it is recommended that needles should not be inserted deeply at the PC6 acupuncture point. An understanding of the anatomical variations of the median nerve and the persistent median artery in the forearm is of clinical importance when performing acupuncture procedures.

Transient Proximal Median Nerve Entrapment in a Tetraplegic Hand Cyclist Following a 24-Hour Endurance Race

2021 ◽  
Author(s):  
Søren Bruno Elmgreen
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Unusual Case ◽  
Endurance Athlete ◽  
Nerve Entrapment ◽  
Pronator Teres ◽  
Anterior Interosseous Nerve ◽  
Tunnel Syndrome ◽  
Anterior Interosseous Nerve Syndrome

ABSTRACT Median nerve entrapment is a frequent disorder encountered by all clinicians at some point of their career. Affecting the distal median nerve, entrapment occurs most frequently at the level of the wrist resulting in a carpal tunnel syndrome. Median nerve entrapment may also occur proximally giving rise to the much less frequent pronator teres syndrome and even less frequent anterior interosseous nerve syndrome, which owing to the paucity of cases may prove challenging to diagnose. An unusual case of anterior interosseous syndrome precipitated by extraordinary exertion in a tetraplegic endurance athlete is presented with ancillary dynamometric, electrodiagnostic, ultrasonographic, and biochemical findings.

scholarly journals The prevalence and anatomical characteristics of the accessory head of the flexor pollicis longus muscle: a meta-analysis

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1255 ◽  
Author(s):  
Joyeeta Roy ◽  
Brandon M. Henry ◽  
Przemysław A. Pękala ◽  
Jens Vikse ◽  
Piravin Kumar Ramakrishnan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Flexor Pollicis Longus ◽  
Anatomical Variant ◽  
Anatomical Characteristics ◽  
Pooled Prevalence ◽  
Longus Muscle ◽  
Anterior Interosseous Nerve ◽  
Language Restriction ◽  
Anterior Interosseous Nerve Syndrome ◽  
The Right

Background and Objectives.The accessory head of the flexor pollicis longus muscle (AHFPL), also known as the Gantzer’s muscle, was first described in 1813. The prevalence rates of an AHFPL significantly vary between studies, and no consensus has been reached on the numerous variations reported in its origin, innervation, and relationships to the Anterior Interosseous Nerve (AIN) and the Median Nerve (MN). The aim of our study was to determine the true prevalence of AHFPL and to study its associated anatomical characteristics.Methods.A search of the major electronic databases PubMed, EMBASE, Scopus, ScienceDirect, and Web of Science was performed to identify all articles reporting data on the prevalence of AHPFL in the population. No date or language restriction was set. Additionally, an extensive search of the references of all relevant articles was performed. Data on the prevalence of the AHFPL in upper limbs and its anatomical characteristics and relationships including origin, insertion, innervation, and position was extracted and pooled into a meta-analysis using MetaXL version 2.0.Results.A total of 24 cadaveric studies (n= 2,358 upper limb) were included in the meta-analysis. The pooled prevalence of an AHFPL was 44.2% (95% CI [0.347–0.540]). An AHFPL was found more commonly in men than in women (41.1% vs. 24.1%), and was slightly more prevalent on the right side than on the left side (52.8% vs. 45.2%). The most common origin of the AHFPL was from the medial epicondyle of the humerus with a pooled prevalence of 43.6% (95% CI [0.166–0.521]). In most cases, the AHFPL inserted into the flexor pollicis longus muscle (94.6%, 95% CI [0.731–1.0]) and was innervated by the AIN (97.3%, 95% CI [0.924–0.993]).Conclusion.The AHFPL should be considered as more a part of normal anatomy than an anatomical variant. The variability in its anatomical characteristics, and its potential to cause compression of the AIN and MN, must be taken into account by physicians to avoid iatrogenic injury during decompression procedures and to aid in the diagnosis and treatment of Anterior Interosseous Nerve Syndrome.

Anterior Interosseous Neuropathy in Instrumental Musicians

2006 ◽  
Vol 21 (3) ◽  
pp. 137-141
Author(s):  
Richard J Lederman
Keyword(s):  
Index Finger ◽  
Age At Onset ◽  
Flexor Digitorum Profundus ◽  
Left Index Finger ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Neuralgic Amyotrophy ◽  
Electrodiagnostic Testing ◽  
The Right ◽  
Flexor Digitorum

The anterior interosseous nerve is a pure motor branch of the median nerve supplying the flexor pollicis longus, flexor digitorum profundus of the index and middle fingers, and pronator quadratus. Anterior interosseous neuropathy is rare and typically causes weakness of flexion of the tips of the thumb and index finger. Four instrumentalists, 3 violinists and 1 pianist (3 males, 1 female), seen from 1986 to 2002 at our clinic, are the subjects of this report. Age at onset ranged from 16 to 76 yrs. A possible precipitating factor was identified in each. One violinist could not hold the bow; two others noted inability to stabilize the distal left first (index) finger. The pianist noted impaired dexterity of the right hand. Examination showed weakness of flexion of the distal phalanx of the index finger and thumb and variable weakness of forearm pronation. Electrodiagnostic testing confirmed the diagnosis in all four patients. All improved over time. One symphony violinist continued to play for over 15 yrs, despite some persisting difficulty with the left index finger. Another violinist recovered function almost completely but suffered a stroke affecting the opposite hand 2.5 years later. The third violinist retired from the symphony on disability because his recovery was delayed for >1 yr. The young pianist is playing 4 to 5 hrs/day. It is likely that at least three of the four had a localized form of neuralgic amyotrophy.

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