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Objective: To analyze the anatomical variations of the innervation of the flexor digitorum superficialis muscle and to determine if the branch of the median nerve that supply this muscle is connected to the branches to the extensor carpi radialis brevis and the pronator teres muscles, without tension, and how close to the target-muscles the transfer can be performed. Methods: Fifty limbs of 25 cadavers were dissected to collect data on the anatomical variations of the branches to the flexor digitorum superficialis muscle. Results: This muscle received innervation from the median nerve in the 50 limbs. In 22 it received one branch, and in 28 more than one. The proximal branch was identified in 22 limbs, and in 12 limbs it shared branches with other muscles. The distal branch was present in all, and originated from the median nerve as an isolated branch, or a common trunk with the anterior interosseous nerve in 3 limbs, and from a common trunk with the flexor carpi radialis muscle and anterior interosseous nerve in another. It originated distally to the anterior interosseous nerve at 38, in 5 on the same level, and in 3 proximal to the anterior interosseous nerve. In four limbs, innervation came from the anterior interosseous nerve, as well as from the median nerve. Accessory branches of the median nerve for the distal portion of the flexor digitorum superficialis muscle were present in eight limbs. Conclusion: In 28 limbs with two or more branches, one of them could be connected to the branches to the extensor carpi radialis brevis and pronator teres muscles without tension, even during the pronation and supination movements of the forearm and flexion- extension of the elbow. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome (CTS) is characterized by median nerve action potential slowing, which can be shown in comparative orthodromic sensory nerve conduction studies between median and radial nerve (NCS-MR). A modified technique with simultaneous recording of both nerves (NCS-MRsimul) can also be used to detect median nerve slowing through the presence of double peak action potential (DPp). The study aims to correlate the presence of DPp with NCS-MR findings and with perineural edema in patients diagnosed with STC. Methods: Healthy individuals and patients with CTS for less than 12 months underwent NCS-MR and MRsimul. An ultrasonography evaluation was also performed to record the medial nerve sectional area (SA-MN) on the wrist and forearm, and the wrist-to-forearm ratio (WFR) was calculated. Results: We recruited 38 patients with CTS whose mean age was 54.8 ± 15.3 years and 18 healthy individuals. Distal latency difference between the median and radial nerves was higher in patients with CTS (0.80 ± 0.30 ms vs. 0.15 ± 0.20 ms, p = 0.015). NCS-MRsimul showed DPp in symptomatic individuals. SA-MN in the wrist was also higher in patients with CTS (8.9 ± 0.9 mm2 vs. 6.6 ± 0.7 mm2, p <0.003). Ultrasonography evaluation identified a synovial cyst and a neurinoma. Perineural edema traduced by higher SA-MN and WFR correlated positively with interpeak latency difference in NCS-MR and with the presence of DPp. Conclusions: DPp was associated with median nerve sensory action potential slowing and with perineural edema due to either CTS or to space-occupying lesions. [ABSTRACT FROM AUTHOR]

The anatomy of the palmar cutaneous branch of the median nerve (PCBMN) and its clinical implications have been described by various authors. Most of them report the palmar cutaneous branch of the median nerve in the carpal tunnel release surgery. However, few reports in the literature discuss the anatomical variations of this nerve which may represent a risk during palmar access to the approach of distal radius fractures, access to scaphoid and surgical tendon graft involving the carpal radial and long palmar flexor tendons. We reported a rare anatomical variation, in which we identified the duplication of the PCBMN, since we recorded only one case in the literature associating doubling the palmar cutaneous branch of the median nerve with a proximal branch originating from more than 17 cm above the palmar crease of the wrist. These variations endanger the PCBMN during surgical access to the distal forearm, and the proximal region of the palm. We did not identify any position of the two branches from the ulnar side of the tendon of the flexor carpi radialis muscle. [ABSTRACT FROM AUTHOR]

Theoretical framework: Carpal Tunnel Syndrome (CTS) is a musculoskeletal disorder affecting the functionality of the upper limbs. Objective: To assess symptom severity and functional status, using the Boston Carpal Tunnel Questionnaire (BCTQ), and quality of life, using the SF-36 v2, in the preoperative period and two months after surgery. Methodology: Prospective study of 50 patients (60.7±11.7 years) who underwent decompression surgery. Participants were mostly women (52 %), with 62 % of them being post-menopausal women. Diabetes (8%), overweight (48%), and class I (26%) and class II obesity (4%) were found to be risk factors for CTS. Results: In the preoperative period, the affected hand had significantly less grip and pinch strength than the contralateral hand. The follow-up results suggest a decrease in symptom severity and an increase in functional status. Conclusion: Significant changes towards improving health-related quality of life were observed in the SF-36 v2 subscales: physical functioning, bodily pain, mental health, role-emotional, social functioning and vitality. [ABSTRACT FROM AUTHOR]

The ulnar and median nerves are widely distributed, innervating the muscles of the forearm and hand. In the latter, it also registers the sensitivity of a significant part of the skin. A series of communicating branches (CB) is described on the path of these nerves, including: 1) the Martin-Gruber communicating branch, 2) the Marinacci communicating branch, 3) the Riché-Cannieu communicating branch and 4) the Berrettini communicating branch. The aim of this study was to establish a correct denomination of these CB, using Latin and eliminating the use of eponyms. The exploratory study included books on anatomy and scientific articles that detailed the anatomical aspects of these CB. To these were added the terms that these branches presented in the various anatomical lists and terminologies. Each term proposal was done in Latin, using the corresponding gender, number and case. The CB between the median and ulnar nerves are described in anatomy texts as well as a plethora of publications. The prevalence rates of the CB range between 1.7 and 94%; however, their inclusion in the anatomical terminologies has been limited. Based on the description of these branches and the presence of some of them in the existing terminologies, a proposal was prepared in line with the indications of the Federative International Programme on Anatomical Terminologies (FIPAT): 1) Ramus comunicans cum nervo ulnari, 2) Ramus comunicans cum nervo mediano, 3) Ramus communicans cum ramo profundo nervi ulnaris y 4) Ramus communicans cum nervo digitali palmari communi. Considering that terminologies are dynamic linguistic corpora, it is important to analyze constantly the incorporation of new terms that are in harmony with the scientific findings. The incorporation of new structures must follow FIPAT guidelines and include the grammatical aspects of Latin. [ABSTRACT FROM AUTHOR]

During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists. [ABSTRACT FROM AUTHOR]

The pronator teres syndrome is characterized by vague pain on the volar forearm surface, with median nerve paresthesias in the area of sensory innervation and minimal motor findings. The anterior interosseous nerve syndrome is a pure motor paralysis of the muscles innervated by this nerve: the flexor pollicis longus, the flexor digitorum profundus of the index and middle fingers, and the pronator quadratus. Typically, the results of electrodiagnostic studies are normal in patients with abnormal and pronator teres syndrome in people with anterior interosseous nerve syndrome. The pronator teres syndrome is a controversial diagnosis and is usually treated surgically. Anterior interosseous nerve syndrome is increasingly thought of as neuritis and often resolves spontaneously after prolonged observation. Surgical indications for nerve decompression include persistent symptoms for more than six months in patients with PTS or for a minimum period of 12 months, with no signs of motor improvement in people with anterior interosseous nerve syndrome. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and the anatomical features of the Struthers' arcade, Struthers ligament and supracondylar humeral process and to assess the clinical implication of these anatomical variations in ulnar and median nerve's compressive neuropathy. Method: We dissected 60 upper limbs of cadavers belonging to the Anatomy Discipline of the Faculty of measures and Health Sciences of the Catholic University of São Paulo (Campus Sorocaba) for this paper. In 40 limbs, the Struthers ligament and the Struthers Arcade were studied, and in only 20 the Struthers ligament (total 60 limbs). Results: We identified the Struthers arcade in the 40 dissected members (100%), and in two members (5%) the ulnar nerve previously passed the arcade. In 29 (72.5%) a variable portion of the triceps muscle was covering the ulnar nerve. In 9 members (22.5%) the nerve was covered by the aponeurotic expansion of the triceps. The supracondylar process of the humerus was not found in any of the 60 dissected arms. The Struthers ligament was identified in six members (two bilateral) and in all there was a high insertion of the pronator teres muscle. Conclusion: The Struthers arcade is a musculoaponeurotic channel that is a important site (potential) of ulnar nerve compression. The Struthers ligament is a aponeurotic structure that may or may not be associated with supracondylar humeral process, and represents a local potential median nerve compression in the lower third of the arm. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations. Materials and Methods: Two hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome severity. A median nerve area ≥9 mm2 was considered to be diagnostic of carpal tunnel syndrome. Results: Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001), paresthesia (p < 0.0001), Tinel's test (p < 0.0001), Phalen's test (p < 0.0001), BCTQ score (p < 0.0001), and years of formal education (p < 0.0001). Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24). Conclusion: The prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome is the most frequent entrapment neuropathy and it affects the median nerve. Different studies have compared the different therapies available for a conservative management. In this article, an experimental manual therapy protocol involving a global patient approach was tested. Assessment scales (DASH, VAS, Boston Questionnaire) and instrumental surveys (ENG and manometer) were administered before and after the treatment cycle. The results seem to show that the experimental conservative treatment proposed is an effective method to improve the clinical and functional condition of the patient. [ABSTRACT FROM AUTHOR]

The frequency of invasive therapeutic procedures has increased as medicine evolves, and the number of complications related to them has increased as a consequence. Subdermal contraceptive implants (SCI) offer benefits for female contraception, but implant and removal are associated with a complication rate of around 3%. In this article, we report and discuss a case of traumatic brachial artery pseudoaneurysm after an attempt to remove an SCI, complicated by compression of the median nerve. [ABSTRACT FROM AUTHOR]

Supracondylar are the most common fractures in the elbow joint during childhood with a peak between the ages five to seven. Besides, they are the second most common type of fracture in the pediatric population in general. The typical cause of the injury is the patient falling from their own height on the palm of the hand with the elbow in hyperextension. The diagnosis is based on the clinical suspicion according to the injury mechanism and the age of the patient, in addition to a standard elbow X-ray from two views. The Gartland classification is the most used instrument to establish the severity of the fracture and to guide the treatment, which can be orthopedic in non-displaced fracture, whereas the method of choice for correction of displaced fractures is closed reduction and percutaneous fixation. The most common complication is the neuropraxia of the median nerve. Others are the brachial artery injury, compartment syndrome, Volkamm ischemic contracture, sliding of the pins and ulna varus. [ABSTRACT FROM AUTHOR]

A variety of clinical cases observed in isolated lesions of the median and ulnar nerves does not agree with the classic pattern of innervation of the muscles from the thenar region. MATERIAL AND METHODS: We have studied the dissections of 40 hands of 20 fresh adult cadavers. The sex distribution was 18 males and 2 females. We investigated the innervation of the thenar muscles. RESULTS: The "abductor pollicis brevis" and the "oponens pollicis" muscles are innerved exclusively by the median nerve. The superficial head of "flexor pollicis brevis" has been innervated by the median nerve in 29 of the hands. In 11 received double innervation (from median and ulnar nerves).The deep head of "flexor pollicis brevis" showed a different find: in 27 there is double innervation, in 12 % the ulnar nerve is the exclusive nerve. DISCUSSION AND CONCLUSION: According with our studies the pattern of the innervation more frequent in relation to the "flexor pollicis brevis" muscles, and that must be considered as normal pattern, is that the superficial head receives innervation of the median nerve and the deep head receives innervation of the ulnar and median nerves. The "abductor pollicis brevis" and the "oponens pollicis" muscles are innerved exclusively by the median nerve The oblique head of "adutor pollicis" was innerved only by the ulnar nerve in 30 pieces, and in 10 the innervation was double. The transverse head of "adductor pollicis" received the ulnar nerve innervation in all dissected hands. [ABSTRACT FROM AUTHOR]

Current analysis compares transcutaneous electrical nerve stimulation and high voltage (HV) on healthy subjects. Twenty volunteers experienced the two electro-stimulating modalities. Nociception was evaluated by pressure and thermal stimuli on the upper left limb and electro-analgesia was applied for 20 minutes on the elbow articulation. TENS parameters comprised: phase of 200 µs and frequency of 100 Hz. In the case of HV: 50 µs and 100 Hz, positive pole on the median nerve region and negative pole on the ulnar region. There were no significant paralimiar differences of pain and pain intensity to the cold. HV was more agreeable and with a great number of adaptations. Parameters employed were not efficacious to change pain in healthy subjects; HV had a greater agreeability albeit accommodated several times. [ABSTRACT FROM AUTHOR]

The Labour Gymnastics emerged early last century, aiming moments of relaxation to employees, plus breaks for physical exercise being used as a support tool in Reducing symptoms of musculoskeletal disorders. Among the lesions can reach the upper limb has to carpal tunnel syndrome (CTS), with an Increased incidence of neuropathy Resulting from compression of the median nerve as it passes through the carpal tunnel. This study AIMS to the evaluate the influence of gymnastics in Preventing carpal tunnel in employees who work directly with computers syndrome. The type of this research is characterized as a literature review. The term Repetitive Strain Injury (RSI), adopted in Brazil, is being Gradually Replaced by Work-Related Musculoskeletal Disorders (MSDs). This designation highlights the term "disorder", rather than injury, which corresponds to what is perceived in practice an initial disturbances occur in early stage, such as fatigue, pain and heaviness in the limbs, appearing in an earlier stage, the injury results seem Indicate to the importance of Developing Gymnastics programs on prevention and reduction of occupational diseases, bringing great benefits to companies and workers. The gymnastics AIMS to provide benefits for both the employee and for the company, acting through stretching exercises, joint mobility and relaxation, to prevent and mitigate the onset of RSI/ WMSD, thus providing an improved quality of individual life. [ABSTRACT FROM AUTHOR]

Objective: The present study was aimed at assessing the quality of articles related to diagnostic accuracy of ultrasonography both in idiopathic and occupational carpal tunnel syndrome. Materials and Methods: A search was undertaken in electronic databases, selecting reports on systematic reviews, randomized clinical trials and observational studies. After four stages of analysis, from an initial screening to the evaluation by means of the assessment scale developed by the Critical Appraisal Skills Programme, the articles were classified according to levels of evidence, with their respective grades of recommendation. Results: Among 68 articles initially identified, only 4 have met all the methodological quality criteria proposed in the present study. Measurement of the cross-sectional area of the median nerve was the most important criterion for the diagnosis of carpal tunnel syndrome (cut-off point between 9 and 10 mm2: sensitivity = 82-86.3%; specificity = 48-87%). The four articles were given level of evidence "1b" and grade of recommendation "A". Conclusion: The sonographic evaluation of patients with clinical suspicion of carpal tunnel syndromecan be cost-effectively performed as a first-line test, reducing the need for electrodiagnostic testing in these patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the origin, frequency and anatomical variations of the palmar cutaneous branch of the median nerve (PCBMN) and its clinical implications in surgical procedures such as decompression of the carpal tunnel and volar approach to the wrist. Dissection of 30 forearms from 18 adult male specimens (9 bilateral, 7 right limbs and 5 left limbs) were performed using 2.5X magnification loupe in order to better understand the PCBMN. Origin, number, length, positioning, anatomical relations and variations were recorded and analyzed. The PCBMN was identified in all dissected forearms, being the most distal branch of the median nerve in all forearms. The average origin was 4.8 cm (ranging 3.8 to 6.5 cm) proximal to the wrist flexion crease. Anatomical variations of the PCBMN are not rare and could endanger the nerve during surgical approach for the volar wrist and proximal palm. We did not find the PCBMN positioned ulnar to the fourth metacarpal axis as well as radial to the flexor carpi radialis tendon. [ABSTRACT FROM AUTHOR]

La sindrome del tunnel carpale costituisce la più frequente neuropatia da compressione dell'arto superiore, originando dall'intrappolamento del nervo mediano nel canale carpale. Nel determinismo della sua comparsa risultano coinvolti numerosi fattori (precedenti fratture, traumatismi cronici, sport, hobbies, attività casalinghe). Vieppiù, è noto che tale malattia riconosce come primo momento etiopatogenetico non solo ripetuti movimenti di flesso-estensione del polso, ma anche malattie sistemiche o condizioni parafisiologiche (menopausa, gravidanza). La sindrome del tunnel carpale, se "secondaria" si manifesta generalmente con carattere di bilateralità soprattutto in donne tra i 30 ed i 60 anni. Di conseguenza risulta fondamentale, nel riconoscimento di una STC come malattia professionale, stabilire se la genesi sia prettamente professionale, ovvero connessa unicamente all'attività lavorativa svolta, o se diversamente possa essere considerata una patologia associata al lavoro, provocata o aggravata dall'azione concomitante di fattori professionali e non. Nel nostro studio abbiamo preso in considerazione un campione di videoterminalisti allo scopo di verificare la presenza di STC, attraverso la ricerca di sintomi soggettivi e segni obbiettivi, associati o meno alla presenza di un'anamnesi positiva per disendocrinopatie, amiloidosi, mesenchimopatie, insufficienza renale cronica in terapia sostitutiva o conservativa, diabete mellito, menopausa, gravidanza al fine di stabilire se l'attività lavorativa sia in grado di determinare una più elevata incidenza e prevalenza in particolari gruppi di lavoratori (esposti al medesimo rischio) rispetto alla popolazione generale. [ABSTRACT FROM AUTHOR]