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

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.

2001 ◽  
Vol 94 (5) ◽  
pp. 795-798 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Tunç Cevat Öğün ◽  
Mustafa Büyükmumcu

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.


Folia Medica ◽  
2017 ◽  
Vol 59 (1) ◽  
pp. 106-109 ◽  
Author(s):  
Atoni Dogood Atoni ◽  
Charles Aidemise Oyinbo

Abstract Documented anatomical variations are important not only for the study of the subject of anatomy, but also in clinical situation. This knowledge would aid surgeons in planning a preoperative strategy for surgical procedures and reconstructive surgery. The right forearm of a 35-year-old embalmed male cadaver present a splitting of the median nerve in the proximal 1/3 of the forearm to form medial and lateral divisions that accommodate an anomalous muscle. The split median nerve reunites at the distal 1/3 and continues as a single nerve. The anomalous muscle arises by muscle fibers from flexor digitorum superficialis and inserted by tendon into flexor digitorum profundus. There was no such variation in the left forearm. The knowledge of such anatomical variations is important to clinicians and surgeons in interpreting atypical clinical presentations and avoiding unusual injury during surgery.


1992 ◽  
Vol 17 (5) ◽  
pp. 507-509 ◽  
Author(s):  
T. W. PROUDMAN ◽  
P. J. MENZ

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.


2021 ◽  
pp. 1-10
Author(s):  
Jayme A. Bertelli ◽  
Neehar Patel ◽  
Francisco Soldado ◽  
Elisa Cristiana Winkelmann Duarte

OBJECTIVE The purpose of this study was to describe the anatomy of donor and recipient median nerve motor branches for nerve transfer surgery within the cubital fossa. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS In the cubital fossa, the first branch was always the proximal branch of the pronator teres (PPT), whereas the last one was the anterior interosseous nerve (AIN) and the distal motor branch of the flexor digitorum superficialis (DFDS) on a consistent basis. The PT muscle was also innervated by a distal branch (DPT), which emerged from the anterior side of the median nerve and provided innervation to its deep head. The palmaris longus (PL) motor branch was always the second branch after the PPT, emerging as a single branch together with the flexor carpi radialis (FCR) or the proximal branch of the flexor digitorum superficialis. The FCR motor branch was prone to variations. It originated proximally with the PL branch (35%) or distally with the AIN (35%), and less frequently from the DPT. In 40% of dissections, the FDS was innervated by a single branch (i.e., the DFDS) originating close to the AIN. In 60% of cases, a proximal branch originated together with the PL or FCR. The AIN emerged from the posterior side of the median nerve and had a diameter of 2.3 mm, twice that of other branches. When dissections were performed between the PT and FCR muscles at the FDS arcade, we observed the AIN lying lateral and the DFDS medial to the median nerve. After crossing the FDS arcade, the AIN divided into: 1) a lateral branch to the flexor pollicis longus (FPL), which bifurcated to reach the anterior and posterior surfaces of the FPL; 2) a medial branch, which bifurcated to reach the flexor digitorum profundus (FDP); and 3) a long middle branch to the pronator quadratus. The average numbers of myelinated fibers within each median nerve branch were as follows (values expressed as the mean ± SD): PPT 646 ± 249; DPT 599 ± 150; PL 259 ± 105; FCR 541 ± 199; proximal FDS 435 ± 158; DFDS 376 ± 150; FPL 480 ± 309; first branch to the FDP 397 ± 12; and second branch to the FDP 369 ± 33. CONCLUSIONS The median nerve's branching pattern in the cubital fossa is predictable. The most important variation involves the FCR motor branch. These anatomical findings aid during nerve transfer surgery to restore function when paralysis results from injury to the radial or median nerves, brachial plexus, or spinal cord.


2013 ◽  
Vol 02 (04) ◽  
pp. 195-199
Author(s):  
Amar Jayanthi A. ◽  
Arunkumar K G.

Abstract Background and aim: The variations in the course and communicating branches of musculocutaneous nerve is of clinical importance in the treatment of recurrent compression neuropathies and in the diagnosis of median nerve lesions. Most of the reports on anatomical variations of musculocutaneous nerve are single case studies and such studies with emphasis on gender difference in a sample of Keralite population are rarely reported. The objective of the present study is to observe the variations in the course of musculocutaneous nerve with special reference to communications with other nerves of the arm and to study the correlation between gender and variations of the nerve. Materials and Methods: Two hundred and sixty four arms were dissected in the department of Anatomy, Government medical college, Thrissur and studied for variations of muculocutaneous nerve. Analysis was done with epi info, using proportions, confidence interval and Chi Square test. The communications noted were classified using the available classifications of Le Minor, Venieratos and Anagnostopoulou and Choi et al. Results: Nerve variations were seen in 24.2 % cases which include, absence of the nerve (3.4%), nerve not piercing coracobrachialis (12.4%) and communication to median nerve (15.1 %). All the variations observed were statistically not significant. The embryological basis for the axonal pathfinding is considered as a result of both guidance molecules and electrical activity that change the calcium homeostasis within the growth cone to regulate growth cone turning. Conclusion: Variations that were observed in the present study may give sufficient and relevant data on the nerves, among Keralite population in which studies are few.


2009 ◽  
Vol 32 (3) ◽  
pp. 315-322 ◽  
Author(s):  
Claude Pierre-Jerome ◽  
Robert D. Smitson ◽  
Raj K. Shah ◽  
Valeria Moncayo ◽  
Michael Abdelnoor ◽  
...  

2006 ◽  
Vol 21 (3) ◽  
pp. 137-141
Author(s):  
Richard J Lederman

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.


1998 ◽  
Vol 23 (2) ◽  
pp. 170-172 ◽  
Author(s):  
S. SHIRALI ◽  
M. HANSON ◽  
G. BRANOVACKI ◽  
M. GONZALEZ

Sixty paired cadaver upper extremities were dissected to study the anatomy of the flexor pollicis longus in the forearm and its relation to the median and anterior interosseous nerves. An accessory head was noted in 33 (55%) of 60 specimens. The accessory head was noted to pass anterior to the anterior interosseous nerve in all specimens. The accessory head was noted to pass posterior to the median nerve in 57 specimens, and anterior to the nerve in three. Tendon or muscle anomalies were noted in eight specimens (13%), seven of which involved an anomalous attachment between the FPL and the flexor digitorum profundus of the index.


2018 ◽  
Vol 46 (1) ◽  
pp. 10
Author(s):  
João Augusto Rodrigues Alves Diniz ◽  
Bruna Miniz Rodrigues Falcão ◽  
Ediane Freitas Rocha ◽  
Joyce Galvão De Souza ◽  
Artur Da Nobrega Carreiro ◽  
...  

Background: Brown-throated sloths are mammals of the order Xenarthra, suborder Pilosa, family Bradypodidae. These folivorous and arboreal animals, which possess a peculiar type of arboreal quadrupedalism, move through the forest canopy by means of suspensory locomotion. On the ground, their extremely slow movements make them easy targets for road accidents, often leading to serious injury or even death. This paper describes the forelimb muscles of the brown-throated sloth (Bradypus variegatus), updating the literature on the subject to help veterinarians in clinical and surgical interventions on this species, and to provide data for comparative animal anatomy.Materials, Methods & Results: Five brown-throated sloths (Bradypus variegatus Schinz, 1825), two adults and three babies were dissected. The animals were donated by the Arruda Câmara Zoo and Botanical Park in João Pessoa, state of Paraíba, Brazil, where they were thawed and fixed in 10% formalin. The sloths’ forelimbs were dissected by lifting and folding over a skin flap to expose, identify and describe the underlying musculature. The dissection revealed the following muscles: supraspinatus, infraspinatus, deltoideus, teres major, subscapularis, coracobrachialis, brachialis, biceps brachii, triceps brachii, anconeus epitrochlearis, dorsoepitrochlearis, brachioradialis, supinator, pronator teres, pronator quadratus, extensor carpi radialis, extensor carpi ulnaris, extensor carpi obliquus, flexor carpi radialis, flexor carpi ulnaris, extensor digitorum communis, extensor digitorum lateralis, palmaris longus, flexor digitorum superficialis, flexor digitorum profundus, extensor indicis longus second finger, extensor indicis brevis second finger, extensor digitorum third finger, abductor digitorum second finger, abductor digitorum third finger, palmaris brevis, and interosseous muscles. Characteristics found in this species revealed differences in the muscular development of the upper forelimb, whose muscles are less developed than those of the lower forelimb, which are visibly more developed with greater muscle density. An interesting feature of this musculature is the presence of three flexor tendons, short and thick, originating from the flexor muscles, which give the hand of the brown-throated sloth a hook-like aspect.Discussion: Our observations indicate that some of the muscles are very similar to those of other animals of this order and also of domestic mammals. However, the most relevant characteristics resemble those of arboreal animals and humans, since the forearm and hand pronation and supination muscles are essential for their arboreal habits. Therefore, all the pronator and supinator muscles of the brown-throated sloth are well developed. Due to the functional adaptations of the species of the family Bradypodidae, the shoulder muscles, especially the deltoideus, are more developed, providing greater support to the shoulder joint, and their origin and insertion assist in faster and easier movements, albeit exerting less force. The group of flexor muscles in this species gives the forearm stronger and more concentrated action than the extensor muscles. This study enabled us not only to produce a more precise description of the muscles of the forelimb of this species but also to update the literature, since there are few relevant studies on the subject and the terms in the literature are outdated and no longer in use. Keywords: sloth, Bradypodidae, morph


2021 ◽  
Vol 10 (12) ◽  
pp. e483101220884
Author(s):  
Beatriz Pereira Vaz Tamiozzo ◽  
Eduardo Tavares Lima Trajano ◽  
Marco Aurélio dos Santos Silva ◽  
Larissa Alexsandra da Silva Neto Trajano

Knowledge of a persistent median artery, defined as an anatomical vascular variation, is of clinical importance because it can be an unusual etiology of carpal tunnel syndrome. This report describes the case of a 42-year-old female patient with acute pain and paresthesia involving the volar aspect of the first, second, and third fingers of the left hand. The clinical manifestations pointed to compressive neuropathy of the median nerve, and diagnostic imaging showed anatomical vascular variation. Details were collected through interviews with the patient, and photographic records of imaging exams were thoroughly analyzed. This case study shows the importance of the identification and knowledge about anatomical variations considering that under specific pathological conditions, they can be a cause of clinical syndromes. Such knowledge is also important in the field of surgery for the prevention of iatrogenic injuries.


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