Accessory head of flexor pollicis longus muscle in fetuses and adult cadavers and its relation to anterior interosseous nerve

Background and Objectives.The accessory head of the flexor pollicis longus muscle (AHFPL), also known as the Gantzer’s muscle, was first described in 1813. The prevalence rates of an AHFPL significantly vary between studies, and no consensus has been reached on the numerous variations reported in its origin, innervation, and relationships to the Anterior Interosseous Nerve (AIN) and the Median Nerve (MN). The aim of our study was to determine the true prevalence of AHFPL and to study its associated anatomical characteristics.Methods.A search of the major electronic databases PubMed, EMBASE, Scopus, ScienceDirect, and Web of Science was performed to identify all articles reporting data on the prevalence of AHPFL in the population. No date or language restriction was set. Additionally, an extensive search of the references of all relevant articles was performed. Data on the prevalence of the AHFPL in upper limbs and its anatomical characteristics and relationships including origin, insertion, innervation, and position was extracted and pooled into a meta-analysis using MetaXL version 2.0.Results.A total of 24 cadaveric studies (n= 2,358 upper limb) were included in the meta-analysis. The pooled prevalence of an AHFPL was 44.2% (95% CI [0.347–0.540]). An AHFPL was found more commonly in men than in women (41.1% vs. 24.1%), and was slightly more prevalent on the right side than on the left side (52.8% vs. 45.2%). The most common origin of the AHFPL was from the medial epicondyle of the humerus with a pooled prevalence of 43.6% (95% CI [0.166–0.521]). In most cases, the AHFPL inserted into the flexor pollicis longus muscle (94.6%, 95% CI [0.731–1.0]) and was innervated by the AIN (97.3%, 95% CI [0.924–0.993]).Conclusion.The AHFPL should be considered as more a part of normal anatomy than an anatomical variant. The variability in its anatomical characteristics, and its potential to cause compression of the AIN and MN, must be taken into account by physicians to avoid iatrogenic injury during decompression procedures and to aid in the diagnosis and treatment of Anterior Interosseous Nerve Syndrome.

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Prevalence of accessory head of flexor pollicis longus muscle and its relation to anterior interosseous nerve in Thai population

Clinical Anatomy ◽

10.1002/ca.20016 ◽

2004 ◽

Vol 17 (8) ◽

pp. 631-635 ◽

Cited By ~ 14

Author(s):

Pasuk Mahakkanukrauh ◽

Patcharin Surin ◽

Nutcharin Ongkana ◽

Manussabhorn Sethadavit ◽

Pidhyasak Vaidhayakarn

Keyword(s):

Flexor Pollicis Longus ◽

Thai Population ◽

Longus Muscle ◽

Anterior Interosseous Nerve

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Quantitation of and superficial surgical landmarks for the anterior interosseous nerve

Journal of Neurosurgery ◽

10.3171/jns.2006.104.5.787 ◽

2006 ◽

Vol 104 (5) ◽

pp. 787-791 ◽

Cited By ~ 15

Author(s):

R. Shane Tubbs ◽

James W. Custis ◽

E. George Salter ◽

John C. Wellons ◽

Jeffrey P. Blount ◽

...

Keyword(s):

Styloid Process ◽

Medial Epicondyle ◽

Upper Extremities ◽

Flexor Pollicis Longus ◽

Ulnar Styloid ◽

Pronator Quadratus ◽

Longus Muscle ◽

Anterior Interosseous Nerve ◽

The Mean ◽

Ulnar Styloid Process

Object There are scant data regarding the anterior interosseous nerve (AIN) in the neurosurgical literature. In the current study the authors attempt to provide easily identifiable superficial osseous landmarks for the identification of the AIN. Methods The AIN in 20 upper extremities obtained in adult cadaveric specimens was dissected and quantified. Measurements were obtained between the nerve and surrounding superficial osseous landmarks. The AIN originated from the median nerve at mean distances of 5.4 cm distal to the medial epicondyle of the humerus and 21 cm proximal to the ulnar styloid process. The distance from the origin of the AIN to its branch leading to the flexor pollicis longus muscle and to the point it travels deep to the pronator quadratus (PQ) muscle measured a mean 4 and 14.4 cm, respectively. The mean distance from the AIN branch leading to the flexor pollicis longus muscle to the proximal PQ muscle was 12.1 cm, and the mean distance between this branch and the ulnar styloid process was 7.2 cm. The mean diameter of the AIN was 1.6 mm at the midforearm. Conclusions Additional landmarks for identification of the AIN can aid the neurosurgeon in more precisely isolating this nerve and avoiding complications. Furthermore, after quantitation of this nerve, the AIN branches can be easily used for neurotization of the median and ulnar nerves, and with the aid of a transinterosseous membrane tunneling technique, passed to the posterior interosseous nerve.

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Two muscular variations in the elbow associated with the anterior interosseous nerve

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02706-9 ◽

2021 ◽

Author(s):

Łukasz Olewnik ◽

Bartłomiej Szewczyk ◽

Nicol Zielinska ◽

Dariusz Grzelecki ◽

Michał Polguj

Keyword(s):

Biceps Brachii ◽

Clinical Importance ◽

Ulnar Artery ◽

Flexor Pollicis Longus ◽

Main Band ◽

Anatomical Dissection ◽

Pronator Teres ◽

Anterior Interosseous Nerve ◽

Male Cadaver ◽

The Right

AbstractThe 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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Design of a Thumb Strength Testing Device

2018 Design of Medical Devices Conference ◽

10.1115/dmd2018-6952 ◽

2018 ◽

Author(s):

Christian Fry ◽

James Mardula ◽

Brandon Lee ◽

Davide Piovesan

Keyword(s):

Operating Conditions ◽

Pneumatic Cylinder ◽

Strength Testing ◽

Testing Device ◽

Flexor Pollicis Longus ◽

Strength Data ◽

Anterior Interosseous Nerve ◽

Compact Design ◽

Distal Section

The scope of the project was to design a pneumatic cylinder for measuring the resistive and applied force of the flexor pollicis longus (FPL) after anterior interosseous nerve (AIN) surgery. The patient’s distal section of the first phalange, of the thumb, is the area of evaluation. The device is intended for assessing both the quality of the surgery results as well as physical therapy progression. Criteria such as mobility, compact design, accuracy, repeatability, and ease of operation are some of the major requirements. The initial prototype is intended to collect FPL strength data to establish operating conditions.

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Loss of Flexor Pollicis Longus Function after Plating of the Radius

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(97)80405-6 ◽

1997 ◽

Vol 22 (3) ◽

pp. 375-376 ◽

Cited By ~ 8

Author(s):

P. KEOGH ◽

H. KHAN ◽

E. COOKE ◽

G. McCOY

Keyword(s):

Full Recovery ◽

Radius Fracture ◽

Conservative Approach ◽

Flexor Pollicis Longus ◽

Anterior Interosseous Nerve ◽

Postoperative Deficit

Six cases of loss of flexor pollicis longus function after plating of a radius fracture are presented. The exact aetiology of the postoperative deficit is uncertain, but is probably a traction neuropraxia of the anterior interosseous nerve branches to the flexor pollicis longus. All six patients had full recovery within 5 months. An initial conservative approach is recommended if this complication is encountered.

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EMG of the human flexor pollicis longus muscle: implications for the evolution of hominid tool use

Journal of Human Evolution ◽

10.1006/jhev.1997.0177 ◽

1998 ◽

Vol 34 (2) ◽

pp. 123-136 ◽

Cited By ~ 37

Author(s):

M.W. Hamrick ◽

S.E. Churchill ◽

D. Schmitt ◽

W.L. Hylander

Keyword(s):

Tool Use ◽

Flexor Pollicis Longus ◽

Longus Muscle

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