scholarly journals TRANSFER OF THE RADIAL NERVE BRANCHES FOR THE TREATMENT OF THE ANTERIOR INTEROSSEOUS NERVE LESION: AN ANATOMICAL STUDY

2019 ◽  
Vol 27 (6) ◽  
pp. 298-303
Author(s):  
Fernando César Matavelli Júnior ◽  
Lucas Gobbi ◽  
Marcos Paulo Sales dos Santos ◽  
Edie Benedito Caetano ◽  
Luiz Angelo Vieira ◽  
...  
Keyword(s):  
Median Nerve ◽  
Radial Nerve ◽  
Case Series ◽  
Anatomical Study ◽  
Flexor Digitorum Profundus ◽  
Common Trunk ◽  
Nerve Lesion ◽  
Level Of Evidence ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

ABSTRACT Objective: This anatomical study aimed to analyze the possibility of transferring the radial nerve branches destined to the brachioradialis (BR), extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), and supinator (SM) muscles to innervate the AIN. Methods: Ten limbs from five male cadavers were prepared by intra-arterial injection of a solution of 10% glycerol and formalin. Results: The presence of only one branch to the BR muscle was noted in 7 limbs and two branches were noted in three limbs. In two members of a common trunk with branch to the ECRL. In eight cases, we identified one branch for the ERLC and two branches in two cases. We identified only one branch for the ECRB, while in six limbs, two branches were noted, penetrating the muscular body at two different points. We identified at least two branches innervating the supinator muscle. The AIN was detached from the median nerve distal to the intercondylar line of the humerus. In seven limbs, it originated from the nervous fascicles of the posterior region of the median nerve and from the posterolateral fascicles in three limbs. The flexor pollicis longus and flexor digitorum profundus muscles received more than one branch of the AIN in all limbs. Conclusion: The radial nerve branches for the ECRL, ECRB, and supinator muscles can be transferred directly to the AIN or to one of its branches after intraneural dissection, without tension even in elbow movements. Level of Evidence IV; Case series.

scholarly journals MRI Study on the Distance between the Distal Radius and the Flexor and Extensor Tendons: Is There Any Room for Error/Hardware?

2019 ◽  
Vol 08 (06) ◽  
pp. 470-476
Author(s):  
Minke Bergsma ◽  
Jemara Board ◽  
Job N. Doornberg ◽  
Inger Sierevelt ◽  
Mark Rickman ◽  
...  
Keyword(s):  
Distal Radius ◽  
Magnetic Resonance Images ◽  
Dorsal Side ◽  
Flexor Digitorum Profundus ◽  
Dorsal Cortex ◽  
Level Of Evidence ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

Abstract Purpose This study aims to quantify the distances between the cortex of the distal radius and flexor and extensor tendons. Methods We analyzed 50 magnetic resonance images (MRI) of intact wrist without pathology. The distances between the volar cortex and the flexor pollicis longs (FPL), index flexor digitorum profunduns (FDPi), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) were measured at the level of the watershed line and 3- and 6-mm proximal to this level. The distances between the dorsal cortex and the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor pollicis longus (EPL), extensor indicis proprius (EIP), and the extensor digitorum communis (EDC) were measured at the level of Lister's tubercle and 5-mm distal to this level. Analysis was descriptive. Results At the watershed line, the FPL, FDPi, FDP, and FDS were located at an average of 3.1, 2.4, 3.6, and 5.1 mm, respectively, volar to the volar cortex. The distances of the FDP and FDS increased at 3-mm proximal to the watershed line and increased for all four tendons at 6-mm proximal to the watershed line. Dorsally, at Listers' tubercle the ECRL, ECRB, EPL, EIP, and EDC were identified at an average of 0.7, 0.5, 0.5, 2.6, and 3.2 mm, respectively, dorsal to the dorsal cortex of the distal radius. At 5-mm more distal, these tendons were located on average 1.2, 1.0, 0.7, 1.9, and 1.8 mm, respectively, dorsal to the dorsal cortex. Conclusion On the volar side, on average there is enough room for a volar plate when staying proximal to the watershed line. On the dorsal side, there is virtually no room for protruding screws as physical anatomical space is limited to a maximum of 0.7 mm from cortex to the closest tendon (the FDP), with screw increments being 2 mm. Level of Evidence This is a Level II Study.

scholarly journals ARCADE OF FLEXOR DIGITORUM SUPERFICIALIS MUSCLE: ANATOMICAL STUDY AND CLINICAL IMPLICATIONS

2018 ◽  
Vol 26 (1) ◽  
pp. 36-40
Author(s):  
EDIE BENEDITO CAETANO ◽  
JOÃO JOSÉ SABONGI NETO ◽  
LUIZ ANGELO VIEIRA ◽  
MAURÍCIO FERREIRA CAETANO ◽  
JOSÉ EDUARDO DE BONA ◽  
...  
Keyword(s):  
Case Series ◽  
Anatomical Study ◽  
Nerve Compression ◽  
Clinical Implications ◽  
Flexor Digitorum Superficialis ◽  
Flexor Muscle ◽  
Level Of Evidence ◽  
Ulnar Head ◽  
A Site ◽  
Flexor Digitorum

ABSTRACT Objective: The arcade of the flexor digitorum superficialis muscle (FDS) is an anatomical structure which has not yet been widely studied and is a site of nerve compression. The aim of this study was to analyze the arcade of the FDS muscle and its relations with the median and anterior interosseous nerves through anatomic dissections. Method: Fifty arms from 25 adult cadavers (21 males and 4 females) were dissected; 18 were previously preserved in formalin and glycerin and 7 fresh specimens were dissected in the Laboratory of Anatomy. Results: The arcade of the superficial flexor muscle was identified in all dissected limbs. The radial and humeral heads were present in all specimens, and the ulnar head in 16 (32%). We identified two varieties of the arcade structure: a fibrous arcade in 32 specimens (64%), and a muscular arcade in 11 specimens (22%). In 4 specimens (8%) the arcade was very fine and so transparent that the nerve could be seen within the arcade. In 3 forearms the arcade was considered irregular because of discontinuity between the fibers that comprised this structure. Conclusion: The fibrous arcade of the FDS muscle may be a potential cause of nerve compression of the median and interosseous anterior nerves. Level of Evidence IV; Case series.

scholarly journals STRUTHERS’ LIGAMENT AND SUPRACONDYLAR HUMERAL PROCESS: AN ANATOMICAL STUDY AND CLINICAL IMPLICATIONS

2017 ◽  
Vol 25 (4) ◽  
pp. 137-142 ◽  
Author(s):  
Edie Benedito Caetano ◽  
João José Sabongi Neto ◽  
Luiz Angelo Vieira ◽  
Maurício Ferreira Caetano ◽  
José Eduardo de Bona ◽  
...  
Keyword(s):  
Median Nerve ◽  
Brachial Artery ◽  
Case Series ◽  
Anatomical Study ◽  
Nerve Compression ◽  
Clinical Implications ◽  
Level Of Evidence ◽  
Pronator Teres ◽  
Compressive Neuropathy ◽  
Anatomy Laboratory

ABSTRACT Objective: The objective of this study was to determine the frequency and anatomical characteristics of Struthers’ ligament and the supracondylar humeral process and evaluate the clinical implications in compressive neuropathy of the median nerve . Method: We dissected 60 arms from 30 cadavers (26 males and 4 females): 15 were previously preserved in formalin and glycerin and 15 were dissected fresh in the Anatomy Laboratory for this paper. The relationships between Struthers’ ligament and the median nerve and brachial artery and veins were documented with drawings and photos . Results: The supracondylar humeral process was not found in any of the 60 dissected arms. Struthers’ ligament was identified in six arms (two bilateral); in all cases high insertion of the pronator teres muscle was observed . Conclusion: Struthers’ ligament is an aponeurotic structure that may or may not be associated with the supracondylar humeral process, and is an important potential site of median nerve compression in the lower third of the arm. Level of Evidence IV, Case Series.

scholarly journals INNERVATION OF THE MEDIAN NERVE MOTOR BRANCHES IN THE FOREARM AND ITS CLINICAL SIGNIFICANCE

2020 ◽  
Vol 28 (5) ◽  
pp. 251-255
Author(s):  
EDIE BENEDITO CAETANO ◽  
JOÃO PAULO NUNES TOLEDO ◽  
SÉRGIO APARECIDO DO AMARAL JÚNIOR ◽  
LUIZ ANGELO VIEIRA ◽  
BEATRIZ D’ANDREA PIGOSSI ◽  
...  
Keyword(s):  
Median Nerve ◽  
Case Series ◽  
Anatomical Variations ◽  
Level Of Evidence ◽  
Pronator Teres ◽  
Nerve Transfers ◽  
Anterior Interosseous Nerve ◽  
Anatomy Laboratory ◽  
Flexor Digitorum ◽  
Normal Standard

ABSTRACT Objective: To analyse the anatomical variations of the median nerve motor branches in the elbow region. Methods: Twenty upper limbs of 10 adult male cadavers were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde. All cadavers belonged to the institution anatomy laboratory. Results: We found a great variability within the distribution of median nerve branches leading to forearm muscles. Only three limbs (14%) presented the normal standard of innervation described in anatomy treatises. The pronator teres muscle (PTM), flexor carpi radialis (FCR), palmaris longus (PL), and the flexor digitorum superficialis (FDS) received exclusive innervation from the median nerve in all forearms. The anterior interosseous nerve (AIN) also originated from the median nerve in all dissected limbs. Conclusion: A thorough understanding of the anatomy of the median nerve branches is important for performing surgeries such as: approach to the proximal third of the forearm, alleviation of pronator teres and anterior interosseous nerve compression syndromes, and distal nerve transfers. It also enables a better understanding the recovery of muscle function after a nerve injury. Level of Evidence IV, Case series.

scholarly journals Median to radial nerve transfer after traumatic radial nerve avulsion in a pediatric patient

2019 ◽  
Vol 24 (2) ◽  
pp. 209-214 ◽  
Author(s):  
Ellen L. Larson ◽  
Katherine B. Santosa ◽  
Susan E. Mackinnon ◽  
Alison K. Snyder-Warwick
Keyword(s):  
Pediatric Patient ◽  
Radial Nerve ◽  
Sensory Nerve ◽  
Nerve Transfer ◽  
Orthopedic Procedures ◽  
Pronator Teres ◽  
Nerve Transfers ◽  
Muscle Groups ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

This case report describes an isolated radial nerve avulsion in a pediatric patient, treated by combination sensory and motor median to radial nerve transfers. After traumatic avulsion of the proximal radial nerve, a 12-year-old male patient underwent end-to-end transfer of median nerve branches to flexor carpi radialis and flexor digitorum superficialis to the posterior interosseous nerve and extensor carpi radialis nerve, respectively. He underwent end-to-side sensory transfer of the superficial radial sensory to the median sensory nerve. Pronator teres to extensor carpi radialis brevis tendon transfer was simultaneously performed to power short-term wrist extension. Within months after surgery, the patient had regained 9–10/10 sensation in the hand and forearm. In the following months and years, he regained dexterity, independent fine-finger and thumb motions, and 4–5/5 strength in all extensors except the abductor pollicis longus muscle. He grew 25 cm without extremity deformity or need for secondary orthopedic procedures. In appropriate adult and pediatric patients with proximal radial nerve injuries, nerve transfers have advantages over tendon transfers, including restored independent fine finger motions, regained sensation, and reinnervation of multiple muscle groups with minimal donor sacrifice.

Sonographic study of repair, gapping and tendon bowstringing after primary flexor digitorum profundus repair in zone 2

2018 ◽  
Vol 43 (5) ◽  
pp. 480-486 ◽  
Author(s):  
Lisa Reissner ◽  
Nadja Zechmann-Mueller ◽  
Holger Jan Klein ◽  
Maurizio Calcagni ◽  
Thomas Giesen
Keyword(s):  
Clinical Outcomes ◽  
Ultrasound Examination ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Repair Site ◽  
Heterotopic Ossifications ◽  
Finger Motion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report sonographic findings with clinical outcomes after zone 2 flexor digitorum profundus tendon repairs in ten fingers. The tendons underwent a six-strand M-Tang core repair, no circumferential suture, and partial or complete division of the pulleys. Over 12 months after surgery and using ultrasound, we found no gapping at the repair site during finger motion. When the pulleys were divided, there was sonographic evidence of tendon bowstringing, but the bowstringing was minimal. Clinically, we did not find any fingers that displayed tendon bowstringing or had functional loss. With ultrasound examination, the repaired tendons remained enlarged over 12 months. Two patients developed heterotopic ossifications at the repair site without tendon gliding, and these required tenolysis. We conclude that the tendon repair site does not gap when a strong core suture is used in the repair without adding peripheral sutures. There is no notable tendon bowstringing clinically, though the repaired tendons have sonographic evidence of minor bowstringing. Level of evidence: III

Flexor digitorum profundus with or without flexor digitorum superficialis tendon repair in acute Zone 2B injuries

2020 ◽  
Vol 45 (10) ◽  
pp. 1034-1044
Author(s):  
Ahmed F. Sadek
Keyword(s):  
Tendon Repair ◽  
Flexion Contracture ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Level Of Evidence ◽  
Power Grip ◽  
Contralateral Hand ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

A total of 53 patients with complete cuts of two flexor tendons in Zone 2B treated over a 9-year period was reviewed. Twenty-three patients (28 fingers) had only flexor digitorum profundus repair, while 30 patients (36 fingers) had both flexor digitorum profundus and flexor digitorum superficialis repairs, with a mean follow-up of 21 months (range 12–84). The decision to repair the flexor digitorum superficialis was made according to intraoperative judgement of ease of repair and gliding of the flexor digitorum profundus tendon. Two groups of patients showed no significant differences in total range of active or passive digital motion and power grip percentage to the contralateral hand. However, the values of power grip were statistically superior in the patients with both tendons repaired. The patients after flexor digitorum profundus-only repairs showed significantly greater but still mild flexion contracture (mean 20 °) of the operated digits. The Tang gradings were the same with 89% good and excellent rates in both groups. The conclusion is that although repair of both flexor digitorum profundus and flexor digitorum superficialis tendons is slightly more preferable based on increased grip strength, the repair of the flexor digitorum superficialis together with flexor digitorum profundus is not mandatory. Whether or not to repair flexor digitorum superficialis is an intraoperative decision based on the ease of gliding of the repaired tendon(s). Level of evidence: III

scholarly journals Anatomical study of the transfer of flexor digitorum superficialis nerve branch of median nerve to restore wrist extension and forearm pronation

2019 ◽  
Vol 17 (3) ◽  
Author(s):  
Edie Benedito Caetano ◽  
Luiz Angelo Vieira ◽  
Cristina Schmitt Cavalheiro ◽  
Marcel Henrique Arcuri ◽  
Rodrigo Guerra Sabongi
Keyword(s):  
Median Nerve ◽  
Anatomical Study ◽  
Flexor Digitorum Superficialis ◽  
Nerve Branch ◽  
Wrist Extension ◽  
Flexor Digitorum

Delayed Transfer of the Extensor Carpi Radialis Brevis Branch of the Radial Nerve to the Anterior Interosseous Nerve for Restoration of Thumb and Index Finger Flexion: Case Report

2020 ◽  
Vol 81 (06) ◽  
pp. 571-574
Author(s):  
Renan Salomão ◽  
Jairo Porfírio de Oliveira ◽  
Carolina Fernandes Junger ◽  
Luiz Cezar Soares Ricardo ◽  
Carlos Roberto de Lima ◽  
...  
Keyword(s):  
Median Nerve ◽  
Radial Nerve ◽  
Spontaneous Recovery ◽  
Index Finger ◽  
Upper Extremities ◽  
Nerve Branch ◽  
Finger Flexion ◽  
Anterior Interosseous Nerve ◽  
Extensor Carpi Radialis ◽  
High Median

AbstractHigh median nerve injuries (HMNIs) are rare lesions involving the upper extremities and affect the median nerve from its origin to the emergence of the anterior interosseous nerve (AIN). Proximal reconstruction has long been considered the gold standard in treating HMNI, but thumb and index flexion and pinch and grip weakness are consistently not recovered. We report the surgical results of a patient affected by an HMNI with partial spontaneous recovery after a gunshot wound. AIN function was successfully restored in a delayed fashion by transferring the radial nerve branch to the extensor carpi radialis brevis to the AIN.

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