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.

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.

The Flexor Pollicis Longus and its Relation to the Anterior and Posterior Interosseous Nerves

1998 ◽  
Vol 23 (2) ◽  
pp. 170-172 ◽  
Author(s):  
S. SHIRALI ◽  
M. HANSON ◽  
G. BRANOVACKI ◽  
M. GONZALEZ
Keyword(s):  
Median Nerve ◽  
Upper Extremities ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Anterior Interosseous Nerve ◽  
Flexor Digitorum

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.

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.

scholarly journals Variaciones musculares del antebrazo como factores de compresión neurovascular

2008 ◽  
Vol 36 (01) ◽  
pp. 008-013
Author(s):  
H.F. Bianchi
Keyword(s):  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Pronator Teres ◽  
Flexor Digitorum

Se lleva a cabo una revisión de variaciones musculares del antebrazo volar consideradas como factores potenciales de compresión de los nervios mediano e interóseo anterior y de la arteria ulnar, las cuales se encuentran vinculadas al flexor digitorum sublimis, al flexor pollicis longus y al pronator teres. El estudio mostró que en relación al flexor digitorum sublimis podemos describir arcadas tendinosas y fascículos accesorios, mientras que el flexor pollicis longus mostró al fascículo accesorio conocido como músculo de Gantzer, clasificado de acuerdo a su inserción distal según terminara en el flexor pollicis longus, flexor digitorum profundus o en el flexor digitorum sublimis. La variación del pronator teres consistió en el reemplazo del fascículo profundo por un fascículo tendinoso. Se relacionaron los hallazgos con los nervios y arteria mencionados, señalando su importancia en los síndromes de compresión incluyendo al de Volkmann y en los problemas derivados de la terminación del fascículo de Gantzer en el tendón del índice del flexor digitorum profundus

Median Nerve Compression, with Tendon Ruptures, after Colles’ Fracture

1984 ◽  
Vol 9 (2) ◽  
pp. 139-141 ◽  
Author(s):  
F. Y. H. WONG ◽  
R. W. H. PHO
Keyword(s):  
Median Nerve ◽  
Index Finger ◽  
Corrective Osteotomy ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Colles Fracture ◽  
Tendon Ruptures ◽  
Flexor Pollicis Longus Tendon ◽  
Flexor Digitorum

A rare case of rupture of the flexor pollicis longus tendon following a Colles’ fracture is described. The patient also had a ruptured flexor digitorum profundus to the index finger and compression of the median nerve of the same hand. The ruptures were noted after four weeks of plaster immobilisation. Decompression of the median nerve and corrective osteotomy was performed but no tendon repair was attempted. The patient regained good function of the hand.

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.

Musculoaponeurotic Variations along the Course of the Median Nerve in the Proximal Forearm

1987 ◽  
Vol 12 (3) ◽  
pp. 359-363
Author(s):  
A. L. DELLON ◽  
SUSAN E. MACKINNON
Keyword(s):  
Median Nerve ◽  
Nerve Compression ◽  
Flexor Digitorum Superficialis ◽  
Flexor Pollicis Longus ◽  
Pronator Teres ◽  
Proximal Forearm ◽  
Flexor Digitorum

31 cadaver arms have been dissected to study the variations in the anatomy of the muscles and fibrous arches which might cause compression of the median nerve in the forearm. Pronator teres always had a superficial head and usually a deep head. Flexor digitorum superficialis varied greatly in its site of origin. The median nerve might be crossed by two, one or no fibro-aponeurotic arches. Gantzer’s muscle, an accessory head of flexor pollicis longus, was present in 45% of cadavers. No ligament of Struthers was found. Possible sites and causes of nerve compression are discussed.

Patterns of median nerve branching in the cubital fossa: implications for nerve transfers to restore motor function in a paralyzed upper limb

2021 ◽  
pp. 1-10
Author(s):  
Jayme A. Bertelli ◽  
Neehar Patel ◽  
Francisco Soldado ◽  
Elisa Cristiana Winkelmann Duarte
Keyword(s):  
Median Nerve ◽  
Nerve Transfer ◽  
Flexor Digitorum Profundus ◽  
Medial Branch ◽  
Flexor Digitorum Superficialis ◽  
Pronator Quadratus ◽  
Motor Branch ◽  
Cubital Fossa ◽  
Flexor Digitorum ◽  
Single Branch

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.

Musculoaponeurotic Variations along the Course of the Median Nerve in the Proximal Forearm

1992 ◽  
Vol 17 (6) ◽  
pp. 702-702
Author(s):  
A. L. Dellon ◽  
Susan E. Mackinnon
Keyword(s):  
Median Nerve ◽  
Nerve Compression ◽  
Flexor Digitorum Superficialis ◽  
Flexor Pollicis Longus ◽  
Pronator Teres ◽  
Proximal Forearm ◽  
Flexor Digitorum

31 cadaver arms have been dissected to study the variations in the anatomy of the muscles and fibrous arches which might cause compression of the median nerve in the forearm. Pronator teres always had a superficial head and usually a deep head. Flexor digitorum superficialis varied greatly in its site of origin. The median nerve might be crossed by two, one or no fibro-aponeurotic arches. Gantzer's muscle, an accessory head of flexor pollicis longus, was present in 45% of cadavers. No ligament of Struthers was found. Possible sites and causes of nerve compression are discussed.

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