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Yanai T, Onuma K, Crotin RL, Monda D. A novel method intersecting three-dimensional motion capture and medial elbow strength dynamometry to assess elbow injury risk in baseball pitchers. Sci Rep 2023; 13:12253. [PMID: 37507460 PMCID: PMC10382501 DOI: 10.1038/s41598-023-39504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
In baseball pitching, resultant elbow varus torque reaches the peak value of 50-120 N m, exceeding the joint failure limit that risks damage to the ulnar collateral ligament (UCL). In-vivo methodology is lacking to assess whether pitchers have sufficient muscular strength to shield UCL and how strongly the elbow musculature must contract to minimize valgus loading on UCL. This study introduces a method to assess relative percentages of muscular varus strength required to unload the UCL. The maximum voluntary isometric varus strength (MVIVS) produced by the medial elbow musculature and the maximum resultant varus torques at elbow in pitching fastballs and other types were measured for two professional pitchers. Simulation was conducted to determine the relative percentages of MVIVS required to unload the UCL to varying degrees and the impact of athletes' previous UCL reconstruction on the relative percentages was examined. The maximum resultant varus torque in pitching was found to range 72-97%MVIVS depending on the type of pitch. The elbow musculature had to produce 21-49%MVIVS to avoid acute failure of intact UCL whereas the corresponding requirements were 39-63%MVIVS for UCL reconstructed joint. The method offers new insight into baseball pitcher's training/rehabilitation and physical assessment to reduce the risk of UCL injury.
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Affiliation(s)
- Toshimasa Yanai
- Research Institute of Baseball Science and Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 359-1192, Japan.
| | - Kengo Onuma
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Ryan L Crotin
- Human Performance Laboratories, Louisiana Tech University, Ruston, LA, USA
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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Schwabl C, Hörmann R, Strolz CJ, Drakonaki E, Zimmermann R, Klauser AS. Anatomical Variants of the Upper Limb Nerves: Clinical and Preoperative Relevance. Semin Musculoskelet Radiol 2023; 27:129-135. [PMID: 37011614 PMCID: PMC10069954 DOI: 10.1055/s-0043-1761952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Profound knowledge of nerve variations is essential for clinical practice. It is crucial for interpreting the large variability of a patient's clinical presentation and the different mechanisms of nerve injury. Awareness of nerve variations facilitates surgical safety and efficacy. Clinically significant anatomical variations can be classified into two main groups: variability in the course of the nerve and variability of structures surrounding the nerve. In this review article we focus on the most common nerve variants of the upper extremity and their clinical relevance.
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Affiliation(s)
- Christoph Schwabl
- Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elena Drakonaki
- Independent MSK Radiology Practice, Heraklion, Crete, Greece
| | - Robert Zimmermann
- Department of Surgery, University Hospital for Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison. Diagnostics (Basel) 2022; 12:diagnostics12102433. [PMID: 36292122 PMCID: PMC9600501 DOI: 10.3390/diagnostics12102433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
The diagnostic process that allows pronator syndrome to be differentiated reliably from carpal tunnel syndrome remains a challenge for clinicians, as evidenced by the most common cause of pronator syndrome misdiagnosis: carpal tunnel syndrome. Pronator syndrome can be caused by compression of the median nerve as it passes through the anatomical structures of the forearm, while carpal tunnel syndrome refers to one particular topographic area within which compression occurs, the carpal tunnel. The present narrative review is a complex clinical comparison of the two syndromes with their anatomical backgrounds involving topographical relationships, morphology, clinical picture, differential diagnosis, and therapeutic options. It discusses the most frequently used diagnostic techniques and their correct interpretations. Its main goal is to provide an up-to-date picture of the current understanding of the disease processes and their etiologies, to establish an appropriate diagnosis, and introduce relevant treatment benefiting the patient.
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Yarbrough B, Chan PYW, Tan V. Unusual Anatomic Location of the Median Nerve Within the Pronator Teres Muscle: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00034. [PMID: 36049029 DOI: 10.2106/jbjs.cc.22.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 57-year-old man presented with pain and paresthesia in both hands and was diagnosed with pronator teres syndrome. Surgical decompression of the left elbow and forearm revealed the median nerve in an unusual anatomic location, specifically running within the pronator teres muscle. CONCLUSION Anatomic anomalies of the pronator teres muscle and the path of the median nerve have been described. However, there are no reports of the median nerve entering and traveling within the pronator teres. Surgeons should be aware of this anomaly to avoid potential iatrogenic injury when performing an anterior surgical approach to the elbow and proximal forearm.
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Affiliation(s)
- Ben Yarbrough
- Institute for Hand and Arm Surgery, Madison, New Jersey
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Olewnik Ł, Ruzik K, Szewczyk B, Podgórski M, Aragonés P, Karauda P, Tubbs RS, Sanudo JR, Pires MB, Polguj M. The relationship between additional heads of the quadriceps femoris, the vasti muscles, and the patellar ligament. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9569101. [PMID: 35224103 PMCID: PMC8866009 DOI: 10.1155/2022/9569101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The quadriceps femoris consists of four muscles: the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis. However, the effect of additional quadriceps femoris heads on the vasti muscles and patellar ligaments is unknown. The aims of the present study are to determine the relationship between additional quadriceps femoris heads and the vasti muscles and patellar ligaments and to review the morphology of the vastus lateralis, vastus medialis, and vastus intermedius. MATERIALS AND METHODS One hundred and six lower limbs (34 male and 19 female cadavers) fixed in 10% formalin were examined. RESULTS On all lower extremities, the vastus lateralis consisted of superficial, intermediate, and deep layers. The vastus medialis, on the other hand, consisted of only the longus and obliquus layers. The quadriceps head had one or more supplementary heads in 106 dissected limbs from 68 cadavers (64.1%). The distal portion of the patella was wider in lower limbs without supplementary heads than in type IA but narrower than in type IIIA. In general, the distal portion of the patella was narrower in specimens with a supplementary head than in those without (19.03 SD 3.18 mm vs. 20.58 SD 2.95 mm, p = 0.03817). Other patellar ligament dimensions did not differ significantly. CONCLUSION The quadriceps femoris muscle is characterized by high morphological variability. Occurrence of extra heads is at the level of 64.1%. The vastus lateralis consists of three parts (superficial, intermediate, and deep), and vastus medialis consists of two (longus and oblique).
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jose Ramon Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | | | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
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The Subscapularis Muscle: A Proposed Classification System. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7450000. [PMID: 34931169 PMCID: PMC8684517 DOI: 10.1155/2021/7450000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/30/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
Background On the basis of the available literature, we proposed the hypothesis that the number of muscle bellies is morphologically constant. The main purpose of this study was to examine the morphological variability of the SM and to create a new classification of it based on number of muscle bellies. Methods Sixty-six adult cadavers of Central European population (45 females, 21 males) were obtained and fixed in 10% formalin before examination. Results The SM was found in all 66 specimens (45 females, 21 males, 31 left and 35 right sides). After meticulous dissection, we distinguished nine types on the basis of number of bellies. Type I was characterized by single belly and occurred in 1.5%. Type II had a double belly and was present in 3%. Type III, the most common type, occurring in almost 32% of the studied population, had three bellies. The frequency of type IV, characterized by four bellies, was also high, just over 30%. The following types were less frequent: type V with five bellies (18.2%), type VI with six bellies (7.6%), type VII with seven bellies (3%), type VIII with eight bellies (1.5%), and type IX with nine bellies (3%). All of the types had origin on the anterior surface of the scapula. Conclusions The SM is morphologically variable in the number of its bellies. Evolutionary changes are probably the reason. The most common type was the SM with three bellies, in line with Larson's model of the division of the SM into three parts. Subsequent studies should be carried out based on MRI or ultrasonography examination to confirm if it is possible to show all types (presented in this study) among group of patients during MRI.
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Potu BK, Ravishankar MV. Innervation Patterns of the Pronator Teres Muscle and Their Possible Role in Neurotization: A Systematic Review of Cadaveric Studies. ACTA MEDICA (HRADEC KRÁLOVÉ) 2021; 64:77-84. [PMID: 34331426 DOI: 10.14712/18059694.2021.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Contrary to the classic anatomical description, many recent studies have reported wide variations in branching patterns and location of motor branches that are supplying the pronator teres muscle. To understand these variations and their implications in surgical procedures of the nerve transfers, a systematic review was performed on the innervation of pronator teres muscle from cadaveric studies. METHODS A systematic literature search was performed in databases such as Medline, PubMed, Google Scholar, SciELO, ScienceDirect, Cochrane reviews and orthopedics textbooks using the search terms "pronator teres nerve branches"; AND "number" OR "location" OR "length" OR "diameter" yielded 545 article links. Articles were evaluated according to PRISMA guidelines. RESULTS A total of twenty cadaveric studies including 648 branches have registered 52.9% of two branch innervation pattern followed by 31.3%-single branch pattern; 13.5%-three branch pattern; 1.7%-four branch pattern, and 0.4%-five branch patterns, respectively. Of the 403 branches studied for their location in relation with the humeral intercondylar line, most branches were located distal to the line (50.3%), followed by 32.7% (proximal to it) and 16.8% at the line, respectively. The distance of branches located proximal and distal to humeral intercondylar line was in the range of 1.25-10 cm, and 1.1-7.5 cm, respectively. The mean length and diameter of nerves reported were 4.37 ± 2.43 cm, and 1.5 mm, respectively. CONCLUSIONS Our data defined the morphometrics of nerve branches and they often met the required diameter for neurotization procedures. Our findings also demonstrated that the morphometrics, branching pattern and their location vary between populations and this information is very vital for surgeons during the nerve transfers.
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Affiliation(s)
- Bhagath Kumar Potu
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Kingdom of Bahrain.
| | - M V Ravishankar
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Szewczyk B, Polguj M, Paulsen F, Podgórski M, Duparc F, Karauda P, Olewnik Ł. A proposal for a new classification of coracobrachialis muscle morphology. Surg Radiol Anat 2021; 43:679-688. [PMID: 33564931 PMCID: PMC8105249 DOI: 10.1007/s00276-021-02700-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The coracobrachialis muscle (CRM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. It inserts to the medial part of the humerus between the attachment of the medial head of the triceps brachii and the brachial muscle. Both the proximal and distal attachments of the CRM, as well as its relationship with the musculocutaneus nerve, demonstrate morphological variability. MATERIAL AND METHODS One hundred and one upper limbs (52 left, and 49 right) fixed in 10% formalin solution were examined. RESULTS Three main types, with subtypes, were identified. The most common was Type I (49.5), characterized by a single muscle belly with a classical origin from the coracoid process, medially and posteriorly to the tendon of the biceps brachii. Type II (42.6%), characterized by two heads, was divided into two subtypes (A-B) depending on its origin: Type IIA, where one head originated from the coracoid process posteriorly to the tendon of the biceps brachii and the second head from the short head of the biceps brachii, and Type IIB, in which both heads originated from the coracoid process; however, the superficial head fused with the insertion of a short head of the biceps brachii, while the deep head was directly originating. Finally, Type III (7.9%) was characterized by three heads: two originated from the coracoid process (superficial and deep), and the third from a short head of the biceps brachii. Two types of insertion and two types of musculocutaneous nerve (MCN) relative to CRM could be distinguished. CONCLUSION An adapted classification is needed for all clinicians working in this area, as well as for anatomists. The CRM demonstrates morphological variability in both its proximal and distal attachments, as well as the variable course of the MCN relative to the CRM. WHAT IS KNOWN ABOUT THIS SUBJECT "AND" WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Not much is known about the variability of coracobrachialis muscle. The present paper introduces a completely new classification, both clinical and anatomical.
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Affiliation(s)
- Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Erlangen, Germany
- Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - Michał Podgórski
- Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine, Rouen University, Mont-Saint-Aignan, France
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Zielinska N, Szewczyk B, Tubbs RS, Olewnik Ł. Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure? Surg Radiol Anat 2021; 43:763-769. [PMID: 33656594 PMCID: PMC8105208 DOI: 10.1007/s00276-021-02721-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/18/2021] [Indexed: 02/01/2023]
Abstract
The flexor pollicis longus (FPL) is located in the anterior compartment of the forearm. It is morphologically variable in both point of origin and insertion. An additional head of the FPL can lead to anterior interosseous syndrome. This report presents a morphological variation of the FPL (additional head in proximal attachment and bifurcated tendinous insertion in distal attachment) and an unrecognized structure that has not so far been described in the literature. This structure originates in six heads (attached to the FPL or interosseous membrane) that merge together, and inserts on to the FPL. All the variations noted have clinical significance, ranging from potential nerve compression to prevention of tendon rupture.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA USA
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Two muscular variations in the elbow associated with the anterior interosseous nerve. Surg Radiol Anat 2021; 43:735-739. [PMID: 33590265 PMCID: PMC8105242 DOI: 10.1007/s00276-021-02706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/02/2021] [Indexed: 10/25/2022]
Abstract
The coexistence of different muscular-neurovascular variations is of significant clinical importance. A male cadaver, 76 years old at death, was subjected to routine anatomical dissection; the procedure was performed for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz. The right forearm and hand were dissected using standard techniques according to a strictly specified protocol. The presence accessory head of the flexor pollicis longus may potentially compress the anterior interosseous nerve. The present case report describes a rare variant of the ulnar head of the pronator teres, characterized by two independent bands (i.e., two proximal attachments). The main band originates from the coronoid process and the second originates from the tendon of the biceps brachii. This type of attachment could potentially affect the compression of the ulnar artery running between the two bands. Additionally, the accessory head of the flexor pollicis longus was observed, which started on the medial epicondyle; its coexistence with a high division median nerve creates a potential pressure site on the anterior interesosseous nerve.
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Vij N, Kiernan H, Miller-Gutierrez S, Agusala V, Kaye AD, Imani F, Zaman B, Varrassi G, Viswanath O, Urits I. Etiology Diagnosis and Management of Radial Nerve Entrapment. Anesth Pain Med 2021; 11:e112823. [PMID: 34221946 PMCID: PMC8236840 DOI: 10.5812/aapm.112823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 02/06/2023] Open
Abstract
Context The anatomy of the radial nerve is prone to entrapment, each with different symptomology. Compression of entrapment of the radial nerve can occur near the radiocapitellar joint, the spiral groove, the arcade of Frohse, the tendon of the extensor carpi radialis brevis (ECRB), and at the radial tunnel. Those who require repetitive motions are at increased risk of peripheral neuropathy syndromes, including repetitive pronation and supination, trauma, or systemic disease; however, t the influence of all risk factors is not well understood. Depending on the location of entrapment, radial nerve entrapment syndrome presents different symptoms. It may include both a motor component and a sensory component. The motor component includes a dropped arm, and the sensory component can include pain and paresthesia in the distribution of the radial nerve that resolves with rest and exacerbates by repetitive pronation and supination. Evidence Acquisition Diagnostic evaluation for radial nerve entrapment, apart from clinical symptoms and physical exam, includes electromyography, nerve conduction studies, ultrasonography, and magnetic resonance imaging. Conservative management for radial nerve entrapment includes oral anti-inflammatory medications, activity modification, and splinting. Some recently performed studies mentioned promising minimally invasive techniques, including corticosteroid injections, peripheral nerve stimulation, and pulsed radiofrequency. Results When minimally invasive techniques fail, open or endoscopic surgery can be performed to release the nerve Conclusions Endoscopic surgery has the benefit of decreasing incision size and reducing time to functional recovery.
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Corresponding Author: University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
| | - Hayley Kiernan
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sam Miller-Gutierrez
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | - Veena Agusala
- Texas Tech University Health Sciences Center, School of Medicine in Lubbock, TX, USA
| | - Alan David Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Zaman
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, USA
| | - Ivan Urits
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA, USA
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Adler JA, Wolf JM. Proximal Median Nerve Compression: Pronator Syndrome. J Hand Surg Am 2020; 45:1157-1165. [PMID: 32893044 DOI: 10.1016/j.jhsa.2020.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/23/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023]
Abstract
Pronator syndrome (PS) is a compressive neuropathy of the median nerve in the proximal forearm, with symptoms that often overlap with carpal tunnel syndrome (CTS). Because electrodiagnostic studies are often negative in PS, making the correct diagnosis can be challenging. All patients should be initially managed with nonsurgical treatment, but surgical intervention has been shown to result in satisfactory outcomes. Several surgical techniques have been described, with most outcomes data based on retrospective case series. It is essential for clinicians to have a thorough understanding of median nerve anatomy, possible sites of compression, and characteristic clinical findings of PS to provide a reliable diagnosis and treat their patients.
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Affiliation(s)
- Jeremy A Adler
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL.
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13
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The subscapularis tendon: A proposed classification system. Ann Anat 2020; 233:151615. [PMID: 33068734 DOI: 10.1016/j.aanat.2020.151615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The subscapularis muscle originates from the medial two-thirds and from the lower two-thirds of the groove on the subscapular fossa of the scapula and inserts into the lesser tubercle of the humerus. Our initial hypothesis is that it shows little morphological variation. The aim of this study is to demonstrate and classify the morphological variability of the subscapularis muscle. METHODS Classical anatomical dissection was performed on 64 upper limbs (44 females, 20 males, 30 left and 34 right, fixed in 10% formalin). The mean age "at death" of the cadavers was 75.6 years (range 48-95), and the group comprised equal numbers of female and male adults (Central European population). Upon dissection, the following morphological features were assessed: the number of tendons of the SM, the type of insertion of each tendon of the SM, morphometric measurements of the SM. RESULTS Four types of morphology (based on number of tendons) were observed in the cadavers. Type I was characterized by a single band. This was the most common type, occurring in 43.7% of all cases. Type II was characterized by a double tendon (superior and inferior); it occurred in 9.4%. Type III had three tendons (superior, middle, and inferior). It was the rarest type (7.8% of cases). Type IV, called "multiband", was the second most common (39.1%) and was divided into five subtypes. CONCLUSIONS The subscapularis muscle is highly morphologically variable. Knowledge of particular types of insertion is essential for both clinicians (for example orthopedists, physiotherapists) and anatomists.
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Olewnik Ł, Zielinska N, Karauda P, Duparc F, Georgiev GP, Polguj M. The co-occurrence of a four-headed coracobrachialis muscle, split coracoid process and tunnel for the median and musculocutaneous nerves: the potential clinical relevance of a very rare variation. Surg Radiol Anat 2020; 43:661-669. [PMID: 32979058 PMCID: PMC8105253 DOI: 10.1007/s00276-020-02580-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/15/2020] [Indexed: 11/12/2022]
Abstract
The coracobrachialis muscle (CBM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. Both the proximal and distal attachment of the CBM, as well as its relationship with the musculocutaneus nerve demonstrate morphological variability, some of which can lead to many diseases. The present case study presents a new description of a complex origin type (four-headed CBM), as well as the fusion of both the short biceps brachii head, brachialis muscle and medial head of the triceps brachii. In addition, the first and second heads formed a tunnel for the musculocutaneus and median nerves. This case report has clear clinical value due to the split mature of the coracoid process, and is a significant indicator of the development of interest in this overlooked muscle.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine, Rouen University, Mont-Saint-Aignan, France
| | - Georgi P Georgiev
- Department of Orthopaedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
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15
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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16
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Zielinska N, Olewnik Ł, Karauda P, Tubbs RS, Polguj M. A very rare case of an accessory subscapularis muscle and its potential clinical significance. Surg Radiol Anat 2020; 43:19-25. [PMID: 32656573 PMCID: PMC7838069 DOI: 10.1007/s00276-020-02531-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Abstract
The subscapularis muscle is the largest muscle of the rotator cuff and its main function is internal rotation. It is morphologically variable in both point of origin and insertion. The presence of an accessory subscapularis muscle can lead to brachial plexus neuropathy. This report presents a very rare accessory subscapularis muscle originating from two distinct bands on the subscapularis and teres major muscles. The insertion was divided among four tendons. The fourth tendon is bifurcated. One of these was connected to the tendon of the subscapularis muscle and the other three inserted into the base of the coracoid process of the scapula. This anomalous muscle has the potential to entrap the nerves of the posterior cord such as the axillary, lower subscapular, and thoracodorsal nerves.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, Grenada, USA
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
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17
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Helfenstein Júnior M. Uncommon compressive neuropathies of upper limbs. Best Pract Res Clin Rheumatol 2020; 34:101516. [DOI: 10.1016/j.berh.2020.101516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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18
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Narayanan S, Adikesavan PN. Coexistence of variant pronator teres muscle and variant course of the neurovascular structures in the arm: clinical significance. Surg Radiol Anat 2020; 42:249-252. [DOI: 10.1007/s00276-019-02413-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
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19
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Olewnik Ł, Podgórski M, Polguj M, Ruzik K, Grzelak P. Is ultrasound effective in determining variation of the insertion of the extensor hallucis longus tendon? Clin Anat 2020; 33:1235-1239. [DOI: 10.1002/ca.23572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology Medical University of Lodz Łódź Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute Lodz Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology Medical University of Lodz Łódź Poland
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology Medical University of Lodz Łódź Poland
| | - Piotr Grzelak
- Polish Mother's Memorial Hospital Research Institute Lodz Poland
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20
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The Superficial Venous System of the Forelimb of the Anubis Baboon ( Papio anubis): The Distribution of Perforating Veins and Venous Valves. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3147439. [PMID: 31687386 PMCID: PMC6800957 DOI: 10.1155/2019/3147439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022]
Abstract
The superficial veins of the forelimb show high variability, both in man and in other primates, regarding the number of main venous trunks, their course, as well as the origin and location of openings. The distinction between two venous systems–the superficial and deep was made based on the relation of specific venous channels to the deep fascia; both groups of veins anastomose to each other through perforators piercing the deep fascia. In our work, we paid special attention to the organization of the venous system within the forelimb of the Anubis baboon (Papio anubis), as well as communications between the superficial and deep venous system. The main aim of the study was a detailed examination of the location of venous valves and perforating veins in forelimb of Anubis baboon. In the Anubis baboon, we observed the absence of the basilic vein. The main vessel within the forelimb, in the superficial venous system, was a well-developed cephalic vein. In all the cases, the cephalic vein opened into the external jugular vein. Also, in all of the examined specimens, there was an additional anastomosis connecting the cephalic and external jugular vein, i.e., persistent jugulocephalic vein located anterior to the clavicle. The venous vessels in the Anubis baboon were arranged in two main layers: superficial and deep, with both systems being connected by perforators located at the level of the carpus and cubital fossa. The number of venous valves within the cephalic vein was greater on the forearm the same as the mean intervalvular distance.
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21
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Ferrer-Peña R, Calvo-Lobo C, Gómez M, Muñoz-García D. Prediction Model for Choosing Needle Length to Minimize Risk of Median Nerve Puncture With Dry Needling of the Pronator Teres. J Manipulative Physiol Ther 2019; 42:366-371. [PMID: 31262581 DOI: 10.1016/j.jmpt.2018.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to relate forearm anthropometric measures to ultrasound pronator teres depth to determine the necessary needle length to prevent median nerve (MN) injury during pronator teres dry needling. METHODS We conducted a study employing a diagnostic accuracy prediction model (NCT03308279) at a Spanish university center. The study recruited 65 participants to predict the depth of the MN (measured with ultrasound) in the pronator teres using a decision tree algorithm to reduce the risk of MN puncture using 2 needle lengths (13 mm or 25 mm). The decision tree was developed by automatically selecting a cutoff for body mass index, forearm length and circumference, and pronator teres thickness. RESULTS For forearm circumferences ≤27.5 cm, the predictive value for the 13-mm needle was 92%. For forearm circumferences >27.5 cm and forearm lengths ≤26.75 cm, the predictive value for the 25-mm needle was 100%. CONCLUSION Based upon the findings of this study, we suggest that needle length should be selected according to forearm anthropometric measures to prevent MN injury during pronator teres dry needling.
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Affiliation(s)
- Raúl Ferrer-Peña
- Departamento de Fisioterapia and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain.
| | - Miguel Gómez
- Departamento de Fisioterapia and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Muñoz-García
- Departamento de Fisioterapia and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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22
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Zdilla MJ, Pacurari P, Celuck TJ, Andrews RC, Lambert HW. A Gantzer muscle arising from the brachialis and flexor digitorum superficialis: embryological considerations and implications for median nerve entrapment. Anat Sci Int 2018; 94:150-153. [PMID: 30382571 DOI: 10.1007/s12565-018-0466-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
Gantzer muscles are variant muscles in the anterior forearm inserting into the flexor pollicis longus or, less often, the flexor digitorum profundus. The presence of Gantzer muscles can cause a compressive neuropathy affecting the anterior interosseous nerve (Kiloh-Nevin syndrome). These muscles must also be considered when anterior forearm fasciotomies are performed for the management of acute compartment syndrome. In this case report, a novel Gantzer muscle originated from the flexor digitorum superficialis as well as the investing fascia of the brachialis muscle; the latter site is a novel proximal attachment not previously reported. In addition, the Gantzer muscle possessed rare characteristics because it (1) possessed a split tendinous distal insertion into both the flexor pollicis longus and flexor digitorum profundus, (2) exhibited a triangular morphology, and (3) was innervated by the median nerve. Most importantly, the dual origin of this Gantzer muscle formed a tunnel containing branches of the median nerve; therefore, this report documents a unique anatomical scenario in which the Gantzer muscle may compress and cause entrapment of aspects of the median nerve.
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Affiliation(s)
- Matthew J Zdilla
- Department of Natural Sciences and Mathematics, West Liberty University, CSC 139, P. O. Box 295, West Liberty, WV, 26074, USA. .,Department of Graduate Health Sciences, West Liberty University, West Liberty, WV, USA. .,Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA.
| | - Paula Pacurari
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Tyler J Celuck
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Reed C Andrews
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - H Wayne Lambert
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
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23
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Olewnik Ł, Waśniewska A, Polguj M, Podgórski M, Łabętowicz P, Ruzik K, Topol M. Morphological variability of the palmaris longus muscle in human fetuses. Surg Radiol Anat 2018; 40:1283-1291. [PMID: 30022223 PMCID: PMC6208680 DOI: 10.1007/s00276-018-2069-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/11/2018] [Indexed: 11/26/2022]
Abstract
Purpose The palmaris longus (PL) muscle is characterized by high-morphological variability. It is clinically important as it is routinely harvested for the reconstruction of other tendons. The study characterizes the morphology of the PL in human fetuses and creates a new classification based on its variations that would relate to the spectrum of morphological variability in adults. Methods Eighty spontaneously aborted human foetuses (44 male, 36 female, 160 upper limbs), aged 18–38 weeks of gestation, were examined. Results The palmaris longus muscle was present in 62.5% of fetuses. The absence was bilateral in 26.25%, and unilateral in 22.5%. Nine types of palmaris longus muscles were identified based on the morphology of its insertion (Types I–IX). All types originated on the medial epicondyle of the humerus. The most common type was Type I, which was characterized by insertion to the palmar aponeurosis (52%). The rarest types were Type VII and Type IX (1% each). Type VII was characterized by partial doubling of the muscle belly, which then turned into two separate tendons that inserted together into the palmar aponeurosis. Type IX was characterized by fusion with the flexor carpi ulnaris muscle. Conclusion Our findings concerning morphological variability of the PL in fetuses present a new perspective on the understanding nature of the morphological variation of the PL muscle in adults. List of evidence Basic Science Study.
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Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland.
| | - Anna Waśniewska
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Piotr Łabętowicz
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Lodz, Poland
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24
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The Plantaris Muscle Tendon and Its Relationship with the Achilles Tendinopathy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9623579. [PMID: 29955614 PMCID: PMC6000875 DOI: 10.1155/2018/9623579] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
Abstract
Purpose Although the plantaris muscle (PM) is vestigial in humans, it has a significant clinical role in procedures such as grafting. However, recent reports suggest its potential involvement in the tendinopathy of the midportion of the Achilles tendon. The aim of the study is therefore to evaluate morphological variation of the PM with regard to its potential conflict with the Achilles tendon. Material and Methods Classical anatomical dissection was performed on 130 lower limbs (71 right, 59 left) fixed in 10% formalin solution. The morphology of the PM was assessed regarding the relationship between the course of the plantaris tendon and the calcaneal tendon. Results The PM was present in 89.2% of cases. The findings indicate the presence of a new type of PM tendon insertion in which the tendon is inserted into the tarsal canal flexor retinaculum, potentially affecting the tendinopathy of the tibialis posterior muscle. In 26 cases (22.4%), insertion blended with the Achilles tendon (Type II), which may increase the risk of Achilles tendinopathy. Conclusion The anatomical variation of PM tendon morphology may create a potential conflict with the Achilles tendon and the tibialis posterior tendon, thus increasing the possibility of tendinopathy.
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25
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Olewnik Ł, Wysiadecki G, Polguj M, Podgórski M, Jezierski H, Topol M. Anatomical variations of the palmaris longus muscle including its relation to the median nerve - a proposal for a new classification. BMC Musculoskelet Disord 2017; 18:539. [PMID: 29258498 PMCID: PMC5738140 DOI: 10.1186/s12891-017-1901-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The palmaris longus (PL) muscle is characterised by high morphological diversity, and its tendon crosses the median nerve (MN) at different levels. Due to the fact that the palmaris longus tendon is routinely harvested for reconstruction of other tendons, knowledge of its morphological variations is clinically important. Therefore, the purpose of the study was to suggest a new morphological classification of the PL muscle and characterise the relationship of its tendon to the median nerve. METHODS Standard dissection was performed on 80 randomised and isolated upper limbs (40 left and 40 right) fixed in a 10% formalin solution. Measurements of muscle belly and tendon were obtained. The course and location of tendon insertion, as well as its relationship to the median nerve, were noted. RESULTS The palmaris longus muscle was present in 92.5% of specimens. Three types of palmaris longus muscle were identified based on the morphology of its insertion (types I-III) and these were further subdivided into three subgroups (A-C) according to the ratio of the length of the muscle belly and its tendon. The most frequent was type I (78.8%), where the tendon attached to the palmar aponeurosis, and subtype B, where the tendon-to-belly ratio was 1-1.5 (41.1%). The mean distance from the interstyloid line to the crossing between the median nerve and the palmaris longus tendon was 31.6 mm. In addition, two types of palmaris longus were described. CONCLUSION The presented classification of palmaris longus muscle types allows a better characterization of its diversity and may be useful in planning tendon grafting.
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Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Łódź, Poland.
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Łódź, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Hubert Jezierski
- Department of Trauma and Orthopaedic Surgery, Hospital of Ministry of Interior and Administration in Lodz, ul. Północna 42, 91-425, Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, ul. Narutowicza 60, 90-136, Łódź, Poland
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