Bilateral Extensor Medii Digiti: A Rare Anatomical Variation

1993 ◽  
Vol 18 (5) ◽  
pp. 579-582 ◽  
Author(s):  
M. F. ABU-HIJLEH
Keyword(s):  
Tendon Transfer ◽  
Anatomical Variation ◽  
Morphological Variability ◽  
Proximal Phalanx ◽  
Hand Surgery ◽  
Middle Finger ◽  
Review Of The Literature ◽  
Male Cadaver ◽  
Clinically Significant ◽  
Transfer Procedures

A supernumerary extensor muscle to the middle finger was found to be present bilaterally in a male cadaver. It originated from the distal end of the ulna and its tendon inserted into the proximal phalanx of the middle finger. The bilateral presence and manner of insertion appear to be unique from a review of the literature. Morphological variability and clinical significance are reviewed. Such variations may be clinically significant during hand surgery, especially tendon transfer procedures.

scholarly journals PRESENCE OF TRIPLE GANTZER'S MUSCLE - A RARE ANATOMICAL VARIATION

2013 ◽  
Vol 03 (01) ◽  
pp. 69-71
Author(s):  
Soubhagya R. Nayak ◽  
Suranjali Sharma ◽  
Hasi Dasgupta ◽  
Kalyan Bhattacharya
Keyword(s):  
Anatomical Variation ◽  
Flexor Digitorum Profundus ◽  
Neurovascular Compression ◽  
Peripheral Nerve Disorder ◽  
Anterior Interosseous Nerve ◽  
Male Cadaver ◽  
Clinically Significant ◽  
Anterior Interosseous Nerve Syndrome ◽  
Flexor Digitorum ◽  
Forearm Flexor

AbstractAnomalous muscles usually do not result in adverse symptoms but are of academic interest. However, these muscles can create neurovascular compression at times. Muscle anomalies of the upper extremity are recognized causes of peripheral nerve disorder. Koloh-Nevin Syndrome (Anterior Interosseous Nerve Syndrome) caused by the compression neuropathy of the anterior interosseous nerve in the forearm is believed to occur because of its compression by the accessory heads of flexor pollics longus (FPLah) and flexor digitorum profundus (FDPah). The above two accessory muscles are also called Gantzer's muscle. During routine cadaveric dissection, we encountered multiple Gantzer's muscles in a 60 year-old- formalin embalmed male cadaver. Along with the usual FPLah and FDPah described by Gantzer, we too observed an accessory muscle in relation to the flexor digitorum superficialis (FDS). All the three anomalous muscles had a common origin from the under cover of the FDS fibers and by fibrous band above the insertion of brachialis. The presence of multiple additional muscles in the forearm flexor compartment is rare and clinically significant.

scholarly journals Bilateral Anatomical Variation in the Formation of Trunks of the Brachial Plexus - A Case Report

2018 ◽  
Vol 35 (01) ◽  
pp. 9-13
Author(s):  
E. Lasch ◽  
M. Nazer ◽  
L. Bartholdy
Keyword(s):  
Case Report ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Scientific Literature ◽  
Case Reports ◽  
Anatomical Variation ◽  
Male Cadaver ◽  
Motor Nerves ◽  
The Right

AbstractThis study presents a bilateral variation in the formation of trunks of brachial plexus in a male cadaver. The right brachial plexus was composed of six roots (C4-T1) and the left brachial plexus of five roots (C5-T1). Both formed four trunks thus changing the contributions of the anterior divisions of the cervical nerves involved in the formation of the cords and the five main somatic motor nerves for the upper limb. There are very few case reports in the scientific literature on this topic; thus making the present study very relevant.

scholarly journals TRENDS OF CONTEMPORARY LEPTOSPIROSIS (REVIEW OF LITERATURE)

2018 ◽  
Vol 23 (2) ◽  
pp. 93-100
Author(s):  
Vladimir N. Gorodin ◽  
D. L. Moysova ◽  
V. A. Bakhtina ◽  
S. V. Zotov
Keyword(s):  
Organ Dysfunction ◽  
Clinical Features ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Disease Complex ◽  
Modern Information ◽  
Clinically Significant

A review of the literature is devoted to one of the most common and clinically significant zoonoses - leptospirosis. The article summarizes modern information on prevalence, epidemiology, etiopathogenesis and clinical features, diagnosis of leptospirosis infection over the last 10 years. The particular attention is paid to the characterization of severe forms of the disease, complex approaches to the treatment of the disease, correction of organ dysfunction and hemostasis disorders; review.

scholarly journals Bilateral Variation of Forearm Flexor Muscles - A Case Report and Clinical Significance

2012 ◽  
Vol 01 (01) ◽  
pp. 040-043
Author(s):  
D. Malar ◽  
Keyword(s):  
Middle Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Flexor Carpi Ulnaris ◽  
Close Proximity ◽  
Flexor Muscles ◽  
Male Cadaver ◽  
Forearm Flexor Muscles ◽  
Flexor Digitorum ◽  
Forearm Flexor

AbstractDuring routine dissection, bilateral multiple variations of forearm flexor muscles were observed in a male cadaver. The variations were a) an additional belly arising from the coronoid process of ulna, distal to the origin of ulnar head of flexor digitorum superficialis, passing deep to flexor digitorum superficialis and joining the tendon of flexor digitorum profundus to the middle finger; b) an additional belly arising from the distal part of flexor carpi ulnaris and passing superficial to ulnar nerve and ulnar vessels in the Guyon's canal and c) the origin of second lumbricals from the profundus tendon in the carpal tunnel. An aberrant muscle may stimulate a ganglion or a soft tissue tumor or if in close proximity to a nerve, it may cause pressure neuritis. Identification of these variations is important in defining the anatomical features for clinical diagnosis and surgical procedures.

scholarly journals Basilar Thumb Arthritis: The Utility of Suture-Button Suspensionplasty

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Brent R. DeGeorge ◽  
Sagar S. Chawla ◽  
Bassem T. Elhassan ◽  
Sanjeev Kakar
Keyword(s):  
Functional Outcomes ◽  
Tendon Transfer ◽  
Proximal Phalanx ◽  
Pain Syndrome ◽  
Pinch Strength ◽  
Suture Button ◽  
Radiographic Outcomes ◽  
Pain Scores ◽  
Joint Arthritis

Background: We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis. Methods: Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio. Results: Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups. Conclusions: Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.

A SWOLLEN MIDDLE FINGER IN A MIDDLE-AGED FARMER

Hand Surgery ◽  
2012 ◽  
Vol 17 (01) ◽  
pp. 121-123 ◽  
Author(s):  
Somprakas Basu ◽  
Shilpi Bhadani ◽  
Vijay Kumar Shukla
Keyword(s):  
Proximal Phalanx ◽  
Middle Finger ◽  
Needle Aspiration ◽  
Excision Biopsy ◽  
Middle Aged ◽  
Cytological Examination ◽  
Diagnostic Dilemma ◽  
X Ray ◽  
The Right ◽  
Bony Erosion

Hand tumors are not common and a swollen finger poses considerable diagnostic dilemma. We present a case of a middle-aged farmer who had presented with a painless swelling of the middle finger of the right hand without any neurovascular deficit or evidence of metastasis. An X-ray of the finger showed cortical expansion and bony erosion of the proximal phalanx. A fine needle aspiration cytological examination was inconclusive. He underwent a digit amputation in view of subsequent morbidity and chances of recurrence following local excision. Biopsy proved it to be a giant cell tumor of the proximal phalanx. Following six months of treatment he is doing well. We herein highlight an unusual tumor of the finger and its diagnostic and treatment challenges.

Clinical Examination of the Extensor Pollicis Brevis: Anatomical Study and Description of a Novel Clinical Sign

2018 ◽  
Vol 23 (03) ◽  
pp. 330-335 ◽  
Author(s):  
Michael Lonne ◽  
David S. Sparks ◽  
Carl Stephan ◽  
Michael Wagels ◽  
Anthony Berger
Keyword(s):  
Clinical Examination ◽  
Anatomical Variation ◽  
Proximal Phalanx ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Clinical Test ◽  
Main Function ◽  
Extensor Pollicis Longus ◽  
Extensor Pollicis Brevis ◽  
Significant Difference

Background: The Extensor Pollicis Brevis (EPB) is an extrinsic thumb muscle whose main function is extension of the first metacarpophalangeal joint (MCPJ). It is subject to significant anatomical variation and may be absent, vestigial or have an anomalous distal attachment. Clinical examination of EPB is notoriously difficult and no reliable test has yet been described. We propose a novel test for the accurate examination of EPB. We sought to clarify the anatomical variations of EPB and to validate our clinical test using human cadaveric anatomical tests. Methods: A structured literature review of all human cadaveric anatomical studies describing the attachments of EPB was performed using MEDLINE and Embase with the key words “Extensor Pollicis Brevis”. A cadaveric anatomical study was performed using 18 unembalmed upper limbs. Positive and negative tests were simulated by manipulating the tendons of EPB, Extensor Pollicis Longus (EPL) and Flexor Pollicis Longus (FPL). Changes in tendon tension and joint position were measured and recorded. The EPB anatomy was then determined by dissection. Results: Anatomical variations were present in the majority of wrists, with only 35% of EPB tendons having a distal attachment to the proximal phalanx alone. EPB was absent in 5% of specimens. There was a significant difference between the change in MCPJ position between a positive (36 degrees; 95% CI 25 to 47 degrees) and negative (19 degrees; 95% CI 14 to 25 degrees) clinical test (p = 0.002). Conclusions: The functional importance of EPB depends on its congenital architecture in addition to the functional demands of the patient. We report a novel clinical test which is effective in demonstrating the integrity of the EPB. A positive test result is observed when a change in MCPJ position that occurs while the interphalangeal joint is brought into flexion from full thumb extension is 25 degrees or more.

Alternative to the Modified Jones Procedure: Outcomes of the Flexor Hallucis Longus (FHL) Tendon Transfer Procedure for Correction of Clawed Hallux

2005 ◽  
Vol 26 (12) ◽  
pp. 1021-1026 ◽  
Author(s):  
Nancy J. Kadel ◽  
Emily A. Donaldson-Fletcher ◽  
Sigvard T. Hansen ◽  
Bruce J. Sangeorzan
Keyword(s):  
Hallux Valgus ◽  
Repeated Measures ◽  
Tendon Transfer ◽  
Joint Angle ◽  
Operative Procedure ◽  
Proximal Phalanx ◽  
Drill Hole ◽  
Lateral View ◽  
Flexor Hallucis Longus ◽  
Valgus Angle

Background: The modified Jones procedure is the traditional operative procedure for correction of a clawed hallux, although the deformity may be caused by over-pull of one of three different muscles. In this study we present the radiographic and functional outcomes of flexor hallucis longus (FHL) tendon transfer as treatment for clawed hallux. The transfer is performed by drawing two thirds of the FHL tendon up through a drill hole in the proximal phalanx and then suturing it medially back to the remaining third. Methods: We retrospectively identified 19 patients (22 feet) who had FHL tendon transfer for correction of clawed hallux over a period of 5 years. Followup was an average of 51.0 (range 6 to 74; ± 3.8) months after the procedure. Outcome and patient satisfaction were determined using the Long-Form Musculoskeletal Function Assessment (MFA) score. Patients were asked whether they were satisfied, somewhat satisfied, or dissatisfied with the overall outcome and were asked about shoewear limitations. Preoperative and postoperative radiographs were evaluated in 15 patients (17 feet). We measured the hallux valgus and interphalangeal (IP) angles on the anteroposterior (AP) radiographs. On the lateral view we measured the angle of the IP joint, the metatarsophalangeal (MTP) joint, and the talometatarsal angle. Statistical analysis was done using a repeated measures ANOVA ( p < 0.05). Results: On the lateral radiographs, the hallux IP joint angle ( p < 0.0012; n = 15) and hallux MTP joint angle ( p < 0.0265; n = 15) were significantly reduced postoperatively. On AP radiographs, the hallux valgus angle ( p < 0.0334) was significantly reduced; however, the IP angle and the talometatarsal angle were not significantly different after surgery. Patients had an average MFA score of 14.6 (±3.8 standard error, range 1 to 35; n = 19). Thirteen patients were fully satisfied and six were somewhat satisfied with the overall result of the surgery. Four patients thought that their hallux limited the types of shoes they could wear, while 15 did not. Conclusion: It has been shown that clawed hallux can result from excessive motor function in one of three muscles: FHL tendon, peroneus longus (PL), and extensor hallucis longus (EHL). This study suggests that transfer of part of the tendon of the FHL is an effective alternative operative procedure for correction of clawed hallux.

An Unusual Case of Aneurysmal Bone Cyst of Proximal Phalanx in a 2 Year Old Child

2020 ◽  
Vol 25 (01) ◽  
pp. 114-118
Author(s):  
Anoop C. Dhamangaonkar ◽  
Ashwin Sathe ◽  
Subhashis Banerjee
Keyword(s):  
Aneurysmal Bone Cyst ◽  
Bone Cyst ◽  
Tertiary Care ◽  
Proximal Phalanx ◽  
Middle Finger ◽  
Treatment Modalities ◽  
Care Hospital ◽  
Multiple Treatment ◽  
Aneurysmal Bone Cysts ◽  
Paediatric Age

Aneurysmal bone cysts associated with tubular bones of the hand are rare and even rarer in the paediatric age-group. They are rapidly growing, destructive benign bone tumors. Multiple treatment modalities for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. We report a case of aneurysmal bone cyst of proximal phalanx of middle finger in a 2 year old child treated at our tertiary care hospital. The diagnosis was confirmed with pre-operative MRI, FNAC and post-operative histopathology. Curettage of the lesion and autologous bone grafting was performed. The hand was immobilized in a short below elbow slab for 4 weeks followed by physiotherapy. Excellent radiological and functional outcomes were obtained with no recurrence at a 5 year of follow up.

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