The sublime bridge: anatomy and implications in median nerve entrapment

2010 ◽  
Vol 113 (1) ◽  
pp. 110-112 ◽  
Author(s):  
R. Shane Tubbs ◽  
Tyler Marshall ◽  
Marios Loukas ◽  
Mohammadali M. Shoja ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Range Of Motion ◽  
Median Nerve ◽  
Nerve Entrapment ◽  
Pronator Teres ◽  
The Sublime ◽  
Potential Site ◽  
Mean Width ◽  
Pronator Syndrome ◽  
Relationship Of ◽  
The Relationship

Object The sublime bridge is a potential site of entrapment of the median nerve in the forearm. To the authors' knowledge, this structure and its relationship to the median nerve have not been studied. The aim of the present study was to quantitate this structure and elucidate its relationship to the median nerve. Methods Sixty adult cadaveric forearms underwent dissection of the sublime bridge. Relationships of this structure were observed, and measurements of its anatomy were made. The relationship of the median nerve to the sublime bridge was observed with range of motion about the forearm. Results The sublime bridge was found to be tendinous in the majority (45 [75%]) of specimens and muscular in the remaining forearms (15 [25%]). The maximal mean width of the sublime bridge was 7 cm proximally, and the minimal mean width was 3 cm distally. The mean distance from the medial epicondyle to the apex of the sublime bridge was found to be 8.1 cm. The relation of the median nerve to the bridge was always intimate. On 2 sides (1 left and 1 right) from different male specimens, the median nerve was attached to the deep aspect of the sublime bridge by a strong connective tissue band, thus forming a tunnel on the deep aspect of this structure. With range of motion of the forearm, increased compression of the median nerve by the overlying sublime bridge was seen with extension but no other movement. Conclusions Based on the authors' study, pronator syndrome is an incorrect term applied to compression of the median nerve at the sublime bridge. This potential site of median nerve compression is distinct and has characteristics that can clinically differentiate it from compression of the median nerve between the heads of the pronator teres. The authors hope that these data will be of use to the surgeon in the evaluation and treatment of patients with proximal median nerve entrapment.

Gantzer’s Muscle

1996 ◽  
Vol 21 (2) ◽  
pp. 269-270 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Median Nerve ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Nerve Supply ◽  
Flexor Pollicis Longus ◽  
Pronator Syndrome ◽  
Anterior Interosseous Nerve ◽  
Dual Origin ◽  
Relationship Of ◽  
The Relationship

The relationship of Gantzer’s muscle (the accessory head of flexor pollicis longus; FPL) to the median nerve and its anterior interosseous branch is debated. In an anatomical study of 25 limbs, the incidence, origin, insertion, nerve supply and relations of Gantzer’s muscle have been documented. The muscle was found in 13 of the 25 (52%) limbs and was supplied by the anterior interosseous nerve. It arose from the medial humeral epicondyle in 85% and had a dual origin from the epicondyle and coronoid process in the rest. Its insertion was to the ulnar part of FPL and its tendon. Gantzer’s muscle always lay posterior to both the median and anterior interosseous nerves. Anatomical variations in which Gantzer’s muscle may contribute to median nerve compression in pronator syndrome are discussed.

Neurilemoma of the Median Nerve - Surgical Strategies Based on a Case Report

2014 ◽  
Vol 86 (9) ◽  
Author(s):  
Łukasz Ulatowski ◽  
Anna Kaniewska
Keyword(s):  
Case Report ◽  
Median Nerve ◽  
Nerve Trunk ◽  
Reconstruction Technique ◽  
Nerve Reconstruction ◽  
Surgical Strategies ◽  
Second Procedure ◽  
Relationship Of ◽  
The Relationship ◽  
Neural Sheath

AbstractThe study presented a case of a patient with a neurilemoma of the median nerve. It presented as a six centemeters tumor, at the level of the proximal one third of the arm with only mild paraesthesias within frst to third ray of the hand. MRI showed the relationship of the tumor and the median nerve, and allowed for the preliminary diagnose of a benign peripheral neural sheath tumor (neurilemoma or neurofibroma). During the first operation the tumor has not been excised, because nerve reconstruction technique was not available. During the second procedure excision of the tumor has been performed without resection of the median nerve trunk with no postoperative deficiencies. The paper provides a detailed description of a surgical procedure. The presented case, like current publications shows that peripheral neural sheath tumor may be usually excised without resection of the nerve trunk, although the possibility of nerve fascicles injury or the need to excise them in the case of neurofibroma clearly suggest that these type of operations should be carried out in centers with microsurgical facilities.

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.

The Relationship of Vitamin B6 Status to Median Nerve Function and Carpal Tunnel Syndrome Among Active Industrial Workers

1996 ◽  
Vol 38 (5) ◽  
pp. 485-491 ◽  
Author(s):  
Alfred Franzblau ◽  
Cheryl L. Rock ◽  
Robert A. Werner ◽  
James W. Albers ◽  
Matthew P. Kelly ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Vitamin B6 ◽  
Nerve Function ◽  
Industrial Workers ◽  
Tunnel Syndrome ◽  
Relationship Of ◽  
The Relationship

The relationship of median nerve F-wave parameters with severity and subtypes of carpal tunnel syndrome1

2014 ◽  
Vol 27 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Recep Aygül ◽  
Dilcan Kotan ◽  
Hızır Ulvi ◽  
Mutlu Kuyucu ◽  
Gökhan Özdemir ◽  
...  
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Wave Parameters ◽  
F Wave ◽  
Relationship Of ◽  
The Relationship

scholarly journals 2017 Roger A. Mann Award Winner

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Judith F. Baumhauer ◽  
Dishan Singh ◽  
Mark Glazebrook ◽  
Chris Blundell ◽  
Gwyneth de Vries ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Symptoms ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Cartilage Loss ◽  
Grading System ◽  
Active Peak ◽  
Relationship Of ◽  
The Relationship ◽  
And Cartilage

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is a very common symptomatic problem affecting one in 40 patients over the age of 50 years. A variety of treatment options exist and, as is common in surgery, grading systems are used to assess severity of the condition and aid in the guidance of treatment. The most commonly used grading system for HR uses radiographic images, great toe range of motion and clinical symptoms. This study examines the relationship of radiographic and motion findings to observed intra-operative cartilage loss in patients with HR and explores hallux rigidus grade and cartilage loss as predictive variables for treatment outcomes. Methods: A prospective, randomized non-inferiority study examining outcomes of arthrodesis compared to hemiarthroplasty of the first metatarsal phalangeal joint (Cartiva®) was performed.2 All randomized and treated patients were included in this study. Patients underwent pre-operative clinical examination, including measures of joint motion, radiographic assessment and HR grade. Operatively, observations of cartilage loss on the metatarsal head and opposing proximal surfaces were recorded. All patients’ data, irrespective of treatment, were aggregated and Spearman Rank Correlation coefficients used to assess for strength of correlation of active peak dorsiflexion and cartilage loss to HR grade. Outcomes data were then separated by treatment group and two-sided Fisher’s Exact test assessed these variables’ impact on clinical success (p<0.05). Results: In 202 patients, 59 (29%), 110 (55%), and 33 (16%) were classified as Coughlin1 Grades 2, 3, and 4, respectively. There was no correlation between grade and active peak dorsiflexion (-0.02, p=0.78). While rank correlations between grade and cartilage loss on the proximal phalanx and metatarsal head statistically significantly differed from zero, the magnitudes of the correlations were small, 0.176 (p=0.01) and 0.224 (p=0.001), respectively (Table 1). Among Grade 4 patients, 36.4% had no metatarsal cartilage remaining; but this was also found in 8.5% of Grade 2 patients. Similarly, 52.5% of Grade 2 patients had ≥50% metatarsal cartilage remaining; but this was also found in 21.2% of Grade 4 patients. None of the observed factors were significantly associated with likelihood of achieving composite success. Conclusion: This study examines the relationship of motion and intra-operative cartilage loss findings with a commonly used clinical and radiographic grading system for hallux rigidus. This study population included only candidates with HR considered a candidate for arthrodesis based on review of clinical symptoms however the Grade assigned maybe Coughlin Grade 2, 3 or 4. Irrespective of the Grade, positive outcomes were demonstrated within both treatment groups. The weak correlations of preoperative motion and intra-operative cartilage loss to grade suggests that clinical symptoms should be a significant determinant guiding the treatment option rather than radiographic or range of motion factors.

Median Nerve Compression within the Humeral Head of Pronator Teres

1994 ◽  
Vol 19 (6) ◽  
pp. 709-710 ◽  
Author(s):  
N. TULWA ◽  
D. LIMB ◽  
R. F. BROWN
Keyword(s):  
Median Nerve ◽  
Humeral Head ◽  
Nerve Compression ◽  
Fibrous Band ◽  
Compression Neuropathy ◽  
Pronator Teres ◽  
Anterior Aspect ◽  
Pronator Syndrome ◽  
Anatomical Arrangement ◽  
A Site

We describe a case of the pronator syndrome caused by compression of the median nerve by a fibrous band as the nerve passed through the humeral head of origin of pronator teres. This rare anatomical arrangement resulted in displacement of the median nerve to the anterior aspect of the medial humeral epicondyle and, as far as we are aware, has not previously been described as a site of compression neuropathy.

scholarly journals THE RELATIONSHIP OF RANGE OF MOTION, HIP SHOULDER SEPARATION, AND PITCHING KINEMATICS

2020 ◽  
Vol 15 (6) ◽  
pp. 1119-1128
Author(s):  
Garrett S. Bullock ◽  
Jeff Strahm ◽  
Tessa C. Hulburt ◽  
Edward C. Beck ◽  
Brian R. Waterman ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Separation ◽  
Relationship Of ◽  
The Relationship

Compounds

2020 ◽  
pp. 111-141
Author(s):  
Michael Spitzer
Keyword(s):  
Major Part ◽  
Categorical Theory ◽  
Basic Emotions ◽  
The Sublime ◽  
Complex Emotions ◽  
The Common ◽  
Relationship Of ◽  
Topic Theory ◽  
The Relationship ◽  
Practice Period

The major part of this chapter surveys how music expresses the ten complex emotions of wonder, the sublime, nostalgia, hope, pride, shame, jealousy, envy, disgust, and boredom. Building on the categorical theory of Chapter 2, it explores the extent that complex emotions compound basic ones, or whether they constitute essential emotions in themselves. The chapter considers issues such as display rules, the reality of basic emotions, and the relationship of emotions to topic theory. The survey of ten complex emotions includes a rehabilitation of wonder, and negative emotions that are normally considered nonaesthetic, such as jealousy and disgust. As in Chapter 2, each of the ten complex emotions is considered in relation to an analysis of music from the common practice period.

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