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El síndrome del pronador redondo consiste en un atrapamiento del nervio mediano en su recorrido entre los vientres musculares del músculo pronador redondo. Es un cuadro poco común que habitualmente se confunde con otras neuropatías compresivas del miembro superior. Se presenta un caso infrecuente de síndrome del pronador redondo asociado a la compresión del nervio cubital en el codo y del nervio mediano en la muñeca. El estudio electrofisiológico detectó un atrapamiento del nervio mediano en la muñeca y una neuropatía cubital a nivel del codo. La ecografía dinámica del antebrazo constató una afectación morfológica del nervio mediano a su paso por el músculo pronador redondo. El paciente mejoró con la administración de corticoides y técnicas de rehabilitación y readaptación. Conclusiones: Se debe sospechar un síndrome del pronador redondo en pacientes que consultan por alteraciones sensitivas en el antebrazo y la muñeca. El diagnóstico diferencial con otras neuropatías compresivas es fundamental, porque la detección precoz permite indicar medidas terapéuticas conservadoras que eviten una progresión hacia la lesión estructural del nervio.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve (MN). The objective of this study was to evaluate and compare the cross-sectional surface area of the canalis carpi (CC), median nerve (MN), and flexor tendons (FTs) in patients diagnosed with unilateral carpal tunnel syndrome (CTS) with those of the unaffected side, utilizing magnetic resonance imaging (MRI). Additionally, the study aimed to assess and compare the volume of the CC and MN between the affected and unaffected sides. 18 unilateral CTS female patients were included in this study. Magnetic resonance images were obtained using a 1.5-T MRI scanner. The sectional surface area and volume of the CC, MN, and structures inside were measured using Analyze version 12.0 software. The sectional surface area and volume of the CC and MN were significantly larger on the CTS side than on the healthy side (p<0.05). The results showed that the cross-sectional surface area of CC gradually decreased towards the beginning and end of the CC, but the values were higher on the side with CTS than on the healthy side (p<0.05). The cross-sectional surface area of the CC, MN, and FTs was significantly larger on the CTS side compared to the healthy side. Furthermore, the volumes of the CC and MN were notably elevated on the CTS side in comparison to the healthy side. The measurement of these parameters using MRI may be useful in the diagnosis and assessment of CTS. [ABSTRACT FROM AUTHOR]

El nervio mediano desciende por el brazo y, en el codo, comienza a atravesar estructuras que pueden generar compresión, como el ligamento de Struthers, el lacertus fibrosus, el pronador redondo, el flexor superficial de los dedos. Finalmente, en la muñeca, se encuentra otro sitio de compresión producido por el ligamento transverso del carpo. Todas estas estructuras pueden provocar signos y síntomas de atrapamiento nervioso y favorecer el deterioro funcional del nervio. Nuestro objetivo es dar a conocer una actualización sobre estos sitios de atrapamiento del nervio mediano, y cómo realizar un diagnóstico preciso e indicar un tratamiento adecuado.

The median-ulnar communicating branch (MUCB) is the communication that originates from the median nerve (MN) or one of its branches, to join the ulnar nerve (UN) in the human forearm. With a prevalence that oscillates between 8% and 32%, when this MUCB is present, it establishes that axons from the MN move to the UN, modifying the normal innervation of the muscles of the hand. Our aim was to determine the prevalence, biometry and topography and anatomical relationships of the MUCB. Additionally, the coexistence of this MUCB with other connections between the MN and UN was established. A descriptive, quantitative, non experimental and transectional study was conducted. Thirty adult human forearms belonging to the cadaveric donation program of the Pontificia Universidad Católica de Chile were dissected. The samples were fixed in formalin and stored at 4 °C. The MUCB appeared in 5 cases (17%). Of these, three originated from the anterior interosseous nerve (60%) and two (40%) arose from the branch that the MN gives it to the superficial muscles of the anterior compartment of the forearm. These were classified according to the literature consulted, obtaining that Group Ic occurred in three cases (60%), and Group Ia in two (40%). The average MUCB length was 53.9 mm. The origin of the MUCB was on average 21% of the length of the forearm from the biepicondylar line. The connection of this MUCB with the UN was located on average at 44% from this line. In three cases (60%) the coexistence of the MUCB and a connection between the common palmar digital nerves was observed. These findings confirm that the RCMU is generally established between the anterior interosseous nerve of forearm and NU, and its presence could modify the nerve distribution of the hand. [ABSTRACT FROM AUTHOR]

The case report of a 36 years patient is described. He went to the Orthopedics and Traumatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, with a rusty big wire, ingrowing in the right wrist palmar face, with paresthesias in the innervation area of the median nerve. The x-ray revealed that inside the wrist structures there was 10 cm of the big wire, with the distal portion bent in hook form, reason why an emergency surgical intervention was carried out. Regional anesthesia, sedation and ischemia were used and the strange body was removed in sense contrary to the bend that presented. After the anesthetic effect eased the paresthesias of the index finger tip persisted that disappeared completely 4 months after the accident. He went back to his usual works 2 months after the operation.

Objetivo: Evaluar los resultados de la retinaculotomía endoscópica para tratar el síndrome del túnel carpiano mediante la técnica de doble portal de Chow, entre enero de 2006 y diciembre de 2015. Materiales y Métodos: Estudio de 179 pacientes (edad promedio 48.2 años [rango 32-68]), con 217 casos de síndrome del túnel carpiano idiopático y un seguimiento promedio de 97.9 meses. Los pacientes eran 145 mujeres (81%) (31 bilaterales) y 34 hombres (19%) (7 bilaterales) y fueron evaluados con la Symptom Severity Scale (SSS) y la Functional Status Scale (FSS) del Boston Carpal Tunnel Questionnaire (BCTQ). Resultados: El puntaje medio de la SSS-BCTQ fue de 3,20 + 0,26 antes de la cirugía, mejoró a 1,30 + 0,12 a los 6 meses y se mantuvo en 1,25 + 0,11 a largo plazo. El puntaje medio de la FSS-BCTQ fue de 2,57 + 0,29 antes de la cirugía, mejoró a 1,28 + 0,18 a los 6 meses y se mantuvo en 1,20 + 0,09 a largo plazo. Hubo 7 casos (3,2%) de neuropraxia posquirúrgica transitoria. No hubo conversiones a técnica abierta. Conclusión: La liberación endoscópica del túnel carpiano con la técnica de Chow es un método quirúrgico eficaz y seguro para tratar el síndrome del túnel carpiano idiopático. Palabras clave: Síndrome del túnel carpiano; técnica de doble portal de Chow; liberación endoscópica; compresión neural; nervio mediano. Nivel de Evidencia: III

Resumen Introducción y objetivo En nuestra práctica diaria encontramos variaciones anatómicas que tienen repercusión tanto diagnóstica como terapéutica. Con este artículo ponemos el acento en la importancia de las variaciones anatómicas vasculares, presentando un caso anatómico de arteria mediana persistente que altera la vascularización de los dedos de la mano y que frecuentemente se asocia a la presencia de un nervio mediano bífido. Tras este hallazgo, realizamos una revisión bibliográfica y un estudio clínico para poner en relieve la asociación de esta malformación con el síndrome del túnel carpiano (STC). Material y método Dividimos nuestro estudio en 2 partes: una anatómica y otra clínica. El estudio anatómico de un antebrazo presentó como hallazgo una arteria mediana palmar persistente responsable de la vascularización del 1er y 2º dedos de la mano, asociada a un nervio mediano bífido. Continuamos con una revisión bibliográfica y un estudio prospectivo para conocer el porcentaje de arterias medianas encontradas en la cirugía del STC en pacientes escogidos de manera aleatoria en función de su incorporación a la lista de espera de nuestro hospital durante un periodo de 4 meses. Resultados Fueron intervenidos 128 pacientes de STC encontrando arteria mediana persistente en 3 casos, lo que corresponde a un 2.34% del total valorado. Discusión El porcentaje de presentación de arteria mediana persistente en nuestro estudio coincide con los diversos estudios revisados en adultos. Coincidimos con ellos en la importancia del conocimiento de las variaciones anatómicas por si mismas y de su implicación en la sintomatología del STC. También es importante tenerlas en cuenta cuando nos enfrentamos a una lesión traumática o cuando disecamos un colgajo.

Introduction: The median artery is considered a supernumerary artery. It is significant to know the incidence of the median artery during surgical approaches like endoscopic release of the median nerve in the forearm during a compression of the median nerve in the pronator syndrome. Therefore, the present study aims to describe the incidence and origin of the median artery. Materials and method: For the development of this study, 32 cadaveric elbows, forearms and hands were submitted to a dissection and fixed in 10% formalin solution. Results: From 32 examined cadavers, the median artery was found in 2 cases (6,25%). Likewise in 100% of the cases the median artery was originated from the ulnar artery, as a collateral branch. Conclusion: Based on the results, the frequency of the persistent median artery is low. However, its origin in the ulnar artery has a high periodicity. [ABSTRACT FROM AUTHOR]

The objective of this study was to characterize the communication between ulnar and the median nerve in the superficial palmar region from a sample of mestizo-raced population predominant in Latin America. The superficial palmar regions of 53 fresh cadaveric specimens were evaluated, whom of which underwent necropsy procedure at the Institute of Legal Medicine. Dissection was performed by planes until visualizing the presence of the Communicating Branch (CB) between the digital branches of the ulnar nerve (UN) and the median nerve (MN). Qualitative and morphometric evaluation of the CB was carried out.A CB were observed in 82/106 (77.4 %) of the cadaveric specimens studied, of which, 38/53 (71.7 %) were bilateral, 15/53 (28.3 %) unilateral; this being a statistically significant difference (p <0.002). Oblique trajectory of the CB between the fourth and third common digital nerve was observed in 70 (85.4 %) specimens, while the CB with transverse trajectory was found in 7 (8.5 %) regions and in a plexiform form in 5 (6.1 %) cases. The length of the CB was 20.2 ± 5.1 mm and the distances from the upper edge of the flexor retinaculum to the proximal and distal points of the CB were 25 ± 6 mm and 37.4 ± 8.3 mm respectively. The anatomical characteristics of the CB patterns, as well as the morphometric CB findings and their points of reference from the carpal flexor retinaculum, make it possible to delimit a safe area of surgical access in the first-fifth proximal of the palmar region, during the surgical approach of carpal tunnel syndrome. [ABSTRACT FROM AUTHOR]

La compresión mecánica de un nervio periférico en dos sitios diferentes a lo largo de su trayecto se define como síndrome de doble compresión. Esta enfermedad se basa en la teoría de la mayor susceptibilidad que tendría un nervio a nivel distal cuando este también se encuentra comprimido, en forma asintomática, a nivel proximal, debido a una alteración en el flujo axonal. Si bien la descompresión del túnel carpiano es una cirugía con resultados previsibles, hay pacientes operados por síndrome de túnel carpiano que no mejoran después de una cirugía, como cabría esperar. Si se excluye de este análisis a las comorbilidades, como diabetes, casos avanzados con atrofia muscular o descompresiones insuficientes, muchos de estos fracasos terapéuticos podrían estar fundamentados por el escaso diagnóstico de un segundo sitio de compresión concomitante. No obstante, existe gran controversia alrededor del síndrome de doble compresión que involucran no solo a su existencia, sino también a su incidencia y fisiopatología. El objetivo de esta publicación es presentar una revisión bibliográfica crítica del síndrome de doble compresión centrada en el compromiso del nervio mediano tanto en la muñeca como en el codo. Abstract The mechanical compression of a peripheral nerve at two different sites is defined as double compression syndrome. This concept is based on the theory of the higher susceptibility that a nerve would present at a distal level when it is also compressed asymptomatically at a more proximal site. While carpal tunnel release is a surgery with predictable results, there are patients undergoing carpal tunnel decompression who do not have the expected improvement after surgery. Excluding from this analysis comorbidities such as diabetes, advanced cases with thenar atrophy, or incomplete decompressions, many of these therapeutic failures could be explained on the sub diagnosis of a second concomitant compression site. Despite this, there exists a big controversy around the double compression syndrome involving not only its existence but also its incidence and pathophysiology. Our objective is to perform a critical literature review of the double compression syndrome focused on the entrapment of the median nerve in the wrist and elbow.

Introducción. La cirugía de síndrome del túnel del carpo (STC) es efectiva, aunque algunos reportes muestran satisfacción de solo el 75% luego de los procedimientos. La escala funcional HiOb es la que mejor se correlaciona con el estado neurofisiológico del nervio mediano. Objetivo. Determinar los resultados clínicos, funcionales y electrofisiológicos luego de una liberación quirúrgica en pacientes con STC. Materiales y métodos. Estudio analítico y descriptivo de pacientes con STC operados entre 2013 y 2014. Todos los individuos tenían pruebas clínicas y electrofisiológicas pre y post quirúrgicas. Resultados. Se estudiaron 36 pacientes con edad promedio de 49 años; los signos clínicos prequirúrgicos más frecuentes fueron Phalen y elevación de manos (91%). El seguimiento mínimo fue 6 meses. Hubo mejoría del dolor; de los signos de Tinel, de Phalen y de elevación de manos; en la escala HiOb, y en el Cuestionario de Boston, tanto en la función como en los síntomas. Los resultados electrofisiológicos mostraron mejoría en latencia distal motora del nervio mediano, latencia distal sensitiva del nervio mediano y delta sensitivo. Conclusiones. La liberación quirúrgica del STC es un procedimiento eficaz en la mejoría del dolor, los síntomas, las escalas funcionales y los hallazgos electrofisiológicos. El signo de Tinel prequirúrgico se asocia a peores resultados en el cuestionario de Boston.

Resumen Introducción Una de las técnicas más extendidas para tratar la recidiva del síndrome del túnel del carpo (STC), es la interposición de un colgajo de almohadilla grasa hipotenar vascularizada (técnica de Strickland). Esa técnica es la empleada por la Unidad de Cirugía de Muñeca y Mano del Servicio de Traumatología del Hospital Universitario Príncipe de Asturias. El objetivo de este estudio, es revisar los pacientes intervenidos de recidiva del STC en dicha unidad mediante esa técnica, y comprobar su evolución a medio y largo plazo. Material y Método En este trabajo se lleva a cabo un estudio retrospectivo de tipo descriptivo. La población estudiada es la muestra de pacientes operados mediante la técnica de Strickland, para la recidiva del STC, intervenidos entre el 2010 y el 2017, habiendo pasado un mínimo de 6 meses desde esa última intervención. Conclusión Pese a las limitaciones de este estudio, los datos avalan que se obtiene mejoría objetiva y subjetiva en un número elevado de pacientes con STC recidivado: al menos el 50% de los pacientes intervenidos se encuentran satisfechos; siendo bajo el índice de complicaciones.

The case report of a 36 years patient is described. He went to the Orthopedics and Traumatology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, with a rusty big wire, ingrowing in the right wrist palmar face, with paresthesias in the innervation area of the median nerve. The x-ray revealed that inside the wrist structures there was 10 cm of the big wire, with the distal portion bent in hook form, reason why an emergency surgical intervention was carried out. Regional anesthesia, sedation and ischemia were used and the strange body was removed in sense contrary to the bend that presented. After the anesthetic effect eased the paresthesias of the index finger tip persisted that disappeared completely 4 months after the accident. He went back to his usual works 2 months after the operation. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The lumbrical muscles (LM) of the human hand are key in proprioception of flexion and finger extension. The description of its innervation indicates that the median nerve (MN) innervates the two lateral LMs (L1 and L2) and the ulnar nerve (UN) the medial LMs (L3 and L4). Various authors have reported a great variability of this innervation, both in which nerve delivers branches for these muscles, as well as in the distribution of their branches and the presence of common trunks. On the other hand, the number of branches that each LM receives and the motor points (Mp) of these have been scarcely reported. The aim of this study was to determine the number, location and Mp of the branches destined for the LM of the human hand. Likewise, the most frequent innervation pattern was established. For this, 24 formalized hands, belonging to the anatomy laboratory, of the Universidad Andrés Bello, Viña del Mar, Chile, were used. Conventional depth plane dissection was performed. In all cases, the branch of the L1 muscle originated from the palmar digital nerve proper to the index finger, in the same way, in 100 % the L2 was supplied with a branch of the common palmar digital nerve from the second interosseous space. In relation to the LM, in 100 % both muscles were innervated by branches of the deep branch of the UN (DBUN). In the case of L3, 92 % presented a common trunk with the second palmar interosseous muscle. Likewise, in 79 % of the cases, there was a common trunk between the L4 and the third palmar interosseous muscle. In 29 %, the L3 presented a dual innervation. The distance between of the Mp-BEstL was 63.96 mm for L1, 67.91 mm for L2 and 68.69 mm for L3. This distance was 69.87 mm for L3 and 69, 21 mm for L4. The results obtained contribute to the anatomical knowledge of the innervation of the lumbrical muscles and is useful in neurosurgery procedures that seek to restore the functionality of the hand. [ABSTRACT FROM AUTHOR]

We report a rare case of the tendinous insertion of coracobrachialis muscle which has not been reported in the literature. The insertion of the novel coracobrachialis muscle is usually into the medial border of the humerus in a 3-5cm impression at the mid-shaft level. Contrary to this, in the present case, it was seen getting inserted as a sharp slender tendon in the middle of the medial border of the humerus. Variable insertion of coracobrachialis muscle may be responsible for the causation of compression of surrounding structures like median nerve, musculocutaneous nerve, and brachial artery. This article aims to point out a rare case of the unusual tendinous insertion of coracobrachialis and its association with musculocutaneous nerve, providing necessary information to surgeons performing surgical reconstruction using coracobrachialis. [ABSTRACT FROM AUTHOR]

La lesión de los nervios mediano y cubital puede ocasionar daños permanentes y tiene consecuencias devastadoras. Los accidentes con instrumentos cortantes en ambiente laboral o doméstico y las lesiones del plexo braquial, constituyen las causas más frecuentes. En los casos de lesión del nervio mediano, recuperar la sensibilidad de la “pinza” (borde cubital del pulgar y radial del índice), es esencial para la reeducación de la función motora e incluso, puede considerarse un requisito previo. Asimismo, la lesión del nervio cubital, conlleva a déficit de sensibilidad del borde medial de la mano y produce falta de soporte para la manipulación con la pinza. En ambos casos, la mano está expuesta a traumatismos, heridas, quemaduras, etc. En el momento de la lesión y siempre que sea posible, debe realizarse una reparación primaria del nervio. Las avulsiones, las lesiones proximales y los grandes defectos nerviosos, obligan a una reconstrucción secundaria cuando el paciente se ha recuperado de la lesión aguda. Este estudio objetiva una actualización de la literatura.

El lipoma arborescente es un tumor infrecuente, a pesar de ello se trata de un tumor que es más frecuente en la rodilla. Entre los diagnósticos diferenciales se encuentra la sinovitis villonodular, y otra serie de enfermedades articulares. El lipoma arborescente se suele presentar con clínica de derrame articular. En el caso que presentamos, la paciente acudía principalmente por tumoración en el antebrazo y síntomas de parestesias y disestesias en 2° y 3er dedos de la mano. Tras una adecuada exploración física y pruebas complementarias, fue diagnosticada de un Lipoma arborescente en la bursa bicipitoradial que generaba una compresión del N mediano a ese nivel. Tras la resección de la tumoración la paciente mejoró de su clínica.

Copyright of Revista Española de Cirugía Ortopédica y Traumatologia (English Edition) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and objective. In our daily practice we find anatomical variations that will have a diagnostic and therapeutic repercussion. With this article we emphasize the importance of vascular anatomical variations presenting an anatomical case of a persistent median artery which alters the vascularization of the fingers, and that is frequently associated with the presence of a bifid median nerve. Following this finding, a literature review and a clinical study were conducted to highlight the association of this malformation with carpal tunnel syndrome (STC) Methods. Our study is divided into two parts: anatomical and clinical. The anatomical study of a forearm showed us as a persistent median palmar artery which is responsible for vascularization of the 1st and 2nd fingers, associated with a bifid median nerve. Then, we conducted a literature review and a prospective study in order to know the percentage of medium arteries found in the STC surgery, chosen in a random way based on their incorporation to the waiting list of our hospital for a 4 months period. Results. A total of 128 STC patients were operated, finding a persistent median artery in 3 patients, which corresponds to 2.34% of the total valued. Discussion. The percentage of presentation of persistent medium artery in our study is coincident with the various studies reviewed in adult patients. We agree on the importance of the knowledge of anatomical variations by themselves and their implication in the symptomatology of STC. It is also important to keep in mind the existence of these anatomical variations when faced with a traumatic injury or when we dissect a flap. [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of the study was to evaluate the anatomical characteristics and variations of the palmaris longus nerve branch and define the feasibility of transferring this branch to the posterior interosseous nerve without tension. Thirty arms from 15 adult male cadavers were dissected after preparation with 20 % glycerin and formaldehyde intra-arterial injection. The palmaris longus muscle (PL) received exclusive innervation of the median nerve in all limbs. In most it was the second muscle of the forearm to be innervated by the median nerve. In 5 limbs the PL muscle was absent. In 5 limbs we identified a branch without sharing branches with other muscles. In 4 limbs it shared origin with the pronator teres (PT), in 8 with the flexor carpi radialis (FCR), in 2 with flexor digitorum superficialis (FDS), in 4 shared branches for the PT and FCR and in two with PT, FCR, FDS. The mean length was (4.0 ± 1.2) and the thickness (1.4 ± 0.6). We investigated whether the branch for PL was long enough to be transferred to the posterior interosseous nerve (PIN). The branch diameter for PL corresponds to 46 % of the PIN. The PL muscle branch presented great variability. The PL branch could be transferred to the PIN proximally to the Froshe arcade without tension in all specimens even with full range of motion of the forearm. In 13 limbs was possible the tensionless transfer to PIN distal to the branches of the supinator muscle. [ABSTRACT FROM AUTHOR]

To know the nerve variations of brachial plexus and its branches is very important in the management of upper limb nerve injuries. Variations of the brachial plexus are not uncommon, but types of variations are diverse. The unusual communication branches between the musculocutaneous nerve (MCN) and the median nerve (MN) in course were found during routine dissection on the two different left arms of formalin fixed male cadavers. Depending on the position related to the coracobrachial muscle (CBM), one MCN pierced the CBM, the other did not in the two cases. The branches of MCN emerged interior to the coracoid process to innervate the CBM. The present case reports of anatomical variations of nerves can help to manage nerve injuries and plan surgical approaches during surgical procedures. [ABSTRACT FROM AUTHOR]

La inyección local con corticoide es una de las opciones de tratamiento conservador para el Síndrome del Túnel Carpiano (STC) leve a moderado, son pocos los reportes de lesión del nervio mediano por inyección intraneural. Se presenta un caso de neuritis química del nervio mediano posterior a infiltración con corticoide local en un paciente de masculino de 42 años con (STC). Se le realizo neurolisis, epineurotomía y desbridamiento del material inyectado. En la literatura han sido descriptas varias técnicas de infiltración a nivel del túnel del carpo. En este reporte se discute los límites anatómicos del túnel del carpo, las técnicas de infiltración y opciones de tratamiento en caso de esta complicación. Se recomienda aplicar la inyección cubital al tendón del palmaris longus 1,5 cm proximal al pliegue de flexión de la muñeca. Colocada la aguja se pregunta al paciente si siente parestesias o dolor en el territorio del nervio mediano, si la respuesta es afirmativa, el procedimiento debe detenerse y redireccionar la aguja.

Antecedentes. En la liberación del síndrome de túnel del carpo (STC) los estudios electrodiagnósticos pueden cuantificar la gravedad de la enfermedad. Hasta la fecha, los reportes de estudios que evalúan la evolución electrofisiológica como resultado objetivo de la cirugía de descompresión son controvertidos, de hecho la correlación entre estas pruebas y la percepción clínica de mejoría ha sido descrita como modesta. Objetivos. Evaluar el comportamiento de los parámetros electrofisiológicos en una serie de pacientes operados del síndrome de túnel del carpo y determinar las variables electrofisiológicas de mejor rendimiento. Materiales y métodos. Estudio observacional analítico retrospectivo de pacientes operados ambulatoriamente por síndrome de túnel del carpo y evaluados con estudios electrodiagnósticos antes y después de la cirugía. Resultados. Se analizaron 48 pacientes con edad promedio de 48 años. El 52% de pacientes mejoraron según la escala de Padua. Las latencias distales motoras y sensitivas y el delta sensitivo del nervio mediano mejoraron después de cirugía con resultados estadísticamente significativos. Las latencias del nervio cubital no variaron. Conclusiones. La mejoría de los parámetros electrofisiológicos después de una liberación de síndrome de túnel del carpo es controversial: algunos reportes muestran mejoría desde el primer mes, especialmente en la velocidad de conducción sensitiva. Otros estudios muestran mejoría significativa entre las semanas 18 y 42 postoperatorias, siendo la recuperación motora más rápida que la sensitiva. En el presente estudio el 52% de los pacientes mejoraron en las escalas por disminución del grado de severidad. Las latencias distales motoras y sensitivas y el delta sensitivo del nervio mediano evidenciaron una mejoría. Estos resultados sugieren que los estudios electrodiagnóstico son efectivos en la evaluación objetiva de pacientes con síndrome de túnel del carpo y es el único examen que puede demostrar mejoría luego de una liberación del STC.

La evidencia y las pautas para el uso de intervenciones específicas después de la liberación del túnel carpiano son limitadas. El objetivo principal de este estudio fue determinar los diferentes enfoques terapéuticos empleados en la práctica clínica habitual entre los profesionales de diferentes países tras la liberación del nervio mediano en la muñeca. Se diseñó una encuesta de 15 ítems en lengua inglesa, que fue distribuida por correo electrónico y a través de las redes sociales a profesionales de diferentes países. En nuestro estudio identificamos una gran variedad en el abordaje posquirúrgico del síndrome del túnel del carpo en 23 países diferentes. No hay criterios comunes en las técnicas de tratamiento empleadas tras la liberación del nervio mediano en la muñeca. Evidence and specific interventions after carpal tunnel release are limited. The main purpose of this study was to elucidate the current practice patterns of professionals from around the world after carpal tunnel release. A 15-item English survey was designed and distributed via email and through social networks to professionals from different countries. A descriptive study of the items was carried out comparing them with the published evidence. In our study, we identified a great variety in the post-surgical approach of carpal tunnel syndrome in 23 different countries. There are no common criteria in the techniques used after surgical decompression of the median nerve. [ABSTRACT FROM AUTHOR]

The anatomical relationship of the median nerve and its innervation pattern are variable and may have direct implications in surgical procedures such as distal nerve transfers. The objective of this study was to evaluate the anatomical variations of pronator teres muscle (PTM) innervation and its clinical significance in nerve transfers. Data were collected regarding the number of median nerve branches, site of their origin, contribution with branches of other muscles and the possibility of transferring expendable branches of PTM to the anterior interosseous nerve (AIN) and radial nerve. The most common origin of the branches was proximal to the humeral intercondylar line. The presence of only one PTM branch was identified in 9 limbs, in which 6 was exclusive for this muscle. The majority of specimens presented more than one branch to the PTM, with two branches in 19, although only 6 of these did not share branches with other muscles. The proximal branch of the PTM was long enough to be transferred to the AIN in 23 limbs and branches of the radial nerve in all. These transfers were possible even during the forearm prone-supination and flexion-extension of the elbow. The use of the PTM branch may be considered for transfers in C7-T1 root injuries of the brachial plexus, with care regarding the availability of multiple PTM branches and tension to the AIN and radial nerve branches. [ABSTRACT FROM AUTHOR]

Innervation of the flexor digitorum superficialis muscle (FDS) is controversial. Several authors describe that the branches of this muscle arise independently or from a common trunk that comes from the median nerve, within the ulnar region. Other descriptions indicate the presence of additional branches in the middle and distal third of the forearm. These differences are also reflected when describing the motor points. The aim was to determine the number, location and distribution patterns of the branches for the FDS. 30 forearms of Brazilian adults were used. About the number of branches, 26% presented a single branch (R1). 57% presented two branches (R1 and R2) and 17% presented 3 branches (R1, R2 and R3). Regarding the format of origin, 87% of the R1 emerged independently, while 13% emerged from a common trunk. In the case of R2 and R3, 100% emerged independently. About the points of origin, 90% of the R1 were originated in the proximal third of the forearm, while 60% of the R2 emerged from the middle third, and of the 5 R3, 60% were originated in the middle third and the remaining two emerged in the distal third. This same variability was present in the motor points distribution. Regarding the distribution patterns of these motor branches, two types were identified. Pattern I was present in 85% and was characterized by all branches arising at a point distal to the origin of the anterior interosseous nerve (AIN), however, in the type II pattern (15% of the sample), the first branch was originated proximal to the origin of the AIN. [ABSTRACT FROM AUTHOR]

The most frequent anatomic variations of the musculocutaneous nerve could be divided in two main groups: communicating branches with the median nerve and variations in relation to the origin, which in turn can be subdivided into absence of the nerve and non-perforation of the coracobrachialis muscle. Unusual clinical symptoms and/or unusual physical examination in patients with motor disorders, could be explained by anatomic variations of the musculocutaneous nerve. A total of 106 arms were evaluated, corresponding to 53 fresh male cadavers who were undergoing necropsy. The presence or absence of the musculocutaneous nerve was evaluated and whether it pierced the coracobrachialis muscle or not. The lengths of the motor branches and the distances from its origins to the coracoid process were measured. In 10 cases (9.5%) an unusual origin pattern was observed, of which six (5.7%) correspond to non-perforation of the coracobrachialis muscle and four (3.8%) correspond to absence of the nerve. The length of the branch for the brachialis muscle was 37.7±15.4 mm and for the short and long heads of the biceps 27.6±11.7 mm and 33.2±10.1 mm respectively. The study showed that our population has similar prevalence of absence of the musculocutaneous nerve and non-perforation of the coracobrachialis muscle compared to previous reports in different populations. Moreover, there was no statistical correlation between the sides and the evaluated variables. [ABSTRACT FROM AUTHOR]

The aim of this paper was to report the incidences of the anastomosis between deep branch of ulnar nerve and a branch of the median nerve commonly named Cannieu-Riché anastomosis (CRA) and thenar muscles innervation. The anatomical dissection of 80 limbs from 40 fresh adult cadavers were performed in the Department of Anatomy at the Medical School of the Catholic University of São Paulo. The incidence of CRA and thenar muscle innervation were studied. The CRA was found in all of the dissected hands (100%). The abdutor pollicis brevis and the opponens pollicis muscle are innervated exclusively by median nerve in all dissected hands. The superficial head of flexor pollicis brevis was innervated by the median nerve in of 56 the hands (70%), in 24 (30%) it had double innervation (median nerve and deep branch of ulnar nerve). The deep head of flexor pollicis brevis were absent in 11 hands (14%), in 52 hands (65%), a double innervation was observed. In 14 (17.5%) exclusively by deep branch of ulnar nerve and in 3 hands (3.6%) exclusively by a branch of median nerve. The oblique head of adductor pollicis muscle was innervated only by deep branch of ulnar nerve in 66 hands (82%) of dissected hands, 14 (17.5%) had a double innervation. The transverse head of adductor pollicis was innervated exclusively by deep branch of ulnar nerve in 77 hands (96.4%), and in 3 (3.6%) had a double innervation. According to our study the pattern of innervation was more frequent in relation to the flexor pollicis brevis muscle and should be considered as a normal pattern, in that the superficial head receives innervation of branches of median nerve, and the deep head receives innervation of deep branch of ulnar nerve and branches of median nerve (dual innervation). The abductor pollicis brevis and opponens pollicis received innervation exclusively by median nerve. Both the oblique and transverse head of adductor pollicis exclusively by ulnar nerve. The RCA was found in all of the dissected hands (100%). [ABSTRACT FROM AUTHOR]

Objetivo: Conocer la incidencia posoperatoria de DG en pacientes con STC en una cohorte de pacientes. Materiales y métodos: Cohorte de pacientes intervenidos por STC moderado, avanzado o extremo, entre octubre de 2012 a octubre de 2013.Resultados: Cuarenta y tres pacientes cumplieron con los criterios de inclusión. El 48.8 % eran operarios de máquinas y el 34.9 % trabajaban en servicios generales. El tiempo de evolución del STC fue de 4.1 años. La mano más comprometida y operada fue la derecha (62.8 %). El tiempo de seguimiento mínimo fue en promedio 10 meses (5-20).Diez pacientes (23 %) desarrollaron dedo en gatillo, referido por el paciente y corroborado por el examen físico.Discusión: El STC es a menudo asociado con el dedo en gatillo. La aparición del DG después de cirugía tiene una alta incidencia en los primeros 3 a 4 meses. Nosotros tuvimos una incidencia de 23 % en 43 pacientes operados con la misma técnica de mínima incisión, con seguimiento mínimo de 5 meses. Casi todos los DG aparecieron entre el 4 y 6º mes después de cirugía.El edema posquirúrgico y la fricción que se genera entre el tendón flexor y la polea A1 al seccionar el retináculo palmar son factores en la génesis del DG.El pulgar y el dedo medio desarrollaron con más frecuencia el gatillo (80 %).

Resumen El desarrollo de un neuroma es una temida complicación tras la cirugía de los nervios periféricos. El tratamiento es de gran complejidad, especialmente cuando afecta a los principales nervios a nivel de la muñeca. Presentamos un caso de neuroma en continuidad del nervio mediano tratado mediante neurolisis y cobertura mediante un colgajo sinovial.

Variations of the peripheral nerve formation, communication and distribution are clinically important because such knowledge can be used for proper planning of surgeries and evaluating effects of nerve injuries and clinical imaging. Median nerve is known to have several such variations. However studies done on median nerve in Sri Lankan subjects are spars. The objective of this study was to find out anatomical variations of the median nerve with regards to its variations in roots and relations to the arteries in the axilla and arm. The study was done using 98 upper limbs of 49 formalin fixed cadavers. They were dissected and anatomy of the median nerve formations was studied focusing its variations of the roots and relation to the arteries. Anatomical variations of MN formation were observed in 33 (33.67%) upper limbs with 4 bilateral and 25 unilateral variations. These variations were classified broadly in to two groups, variations of roots (15.3%) and variation of arterial relations (18.37%). There were three types of numerical variations (9.18%) and three types of morphological variations (6.12%) of roots. The median nerve was found to form in relation to the 2nd part of the axillary artery in 6.12%, abnormal relation to the 3rd part of the axillary artery in 2.04%, normal relation to the 3rd part of the axillary artery in 81.63%, and brachial artery in 10.2% of the specimens. The current study highlights the presence of different anatomical variations at median nerve formation with regards to its roots and arterial relations and describes three rare forms of anomalies which were not found on literature survey. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the incidence of unusual formation of the median nerve in Thai cadavers. Two hundred and ninety-two upper limbs were dissected and observed. The results showed that 5 out of 292 (1.71%) arms had unusual splitting of median nerve that supplied the flexor arm muscles. Concomitantly, the musculocutaneous nerve was absent. In 4 out of 5 variant arms (80% or 1.37% of total upper limbs), each median nerve was unusually formed by 3 roots; the first and second roots were from lateral cord and the third one from medial cord. The union of the second lateral and medial roots to become a median nerve distantly extended in the arm. The second lateral roots gave off small muscular branches to the upper part of flexor arm muscles. Knowledge of such anatomical variations is helpful for surgeons in performing of brachial plexus surgery. [ABSTRACT FROM AUTHOR]

El cordón lateral y el nervio mediano se asocian a variaciones. Observamos variaciones simultáneas en la formación del cordón lateral y nervio mediano en treinta y dos cadáveres fijados en formol. En 29,6% de extremidades superiores el cordón lateral se formó por la división anterior del tronco superior solamente. En el 21,8% de estos casos la división anterior del tronco medio formó dos raíces adicionales para el nervio mediano y en 7,8% de los casos la división anterior del tronco medio se unió con la raíz medial del nervio mediano. En el 14% de las extremidades superiores no se formó la parte superior del tronco y el cordón lateral se formó por la unión de la división anterior de las raíces C5, C6 y C7. En 6.2% de esos casos donde no se formó la parte superior del tronco, el nervio mediano recibió una raíz adicional del cordón lateral. Creemos que el conocimiento previo de estas variaciones anatómicas es de interés para el anatomista y médico por igual. Los cirujanos que realizan procedimientos que implican neoplasias o reparar traumatismos necesitan ser conscientes de estas variaciones. Lateral cord and median nerve are associated with variations. We observed concurrent variations in the formation of lateral cord and median nerve in thirty two formalin fixed cadavers. In 29.6% upper limbs Lateral cord was formed by anterior division of upper trunk only. In 21.8% of these cases the anterior division of middle trunk formed two additional roots for the median nerve and in 7.8% cases anterior division of middle trunk joined with medial root of median nerve. In 14% upper limbs the upper trunk was not formed and the lateral cord was formed by union of anterior division of C5, C6 and C7 roots. In 6.2% of such cases where upper trunk was not formed, the median nerve received an additional root from lateral cord. We believe that prior knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasms or repairing trauma need to be aware of these variations.

El hamartoma de nervio mediano es una neoplasia beniga poco frecuente, que afecta predominantemente al nervio mediano de pacientes jóvenes, y se manifiesta generalmente por sintomatología compresiva distal a nivel del mismo, acompañado o no de macrodactilia.

La anastomosis de Martin Gruber (AMG) es una de las variaciones anatómicas más frecuentes que consiste en la contribución de axones motores desde el nervio mediano hacia el ulnar en el antebrazo. Factores filogenéticos y genéticos se asocian con la aparición de la AMG. Entre tanto, otros factores como género, raza o lateralidad no parecen tener importancia en la aparición de la rama comunicante. Las clasificaciones de la AMG han sido establecidas según los hallazgos anatómicos, electrofisiológicos e histológicos y también según el lugar de origen y destino de la anastomosis. El objetivo de este artículo es revisar los factores asociados a la presencia de la AMG, así como las descripciones y clasificaciones anatómicas y electrofisiológicas. Esta revisión aporta información relevante para el reconocimiento de los patrones clásico y variante de inervación de la musculatura intrínseca de la mano. Dicho reconocimiento permite diagnosticar e intervenir apropiadamente las alteraciones de los nervios periféricos de la extremidad superior. Salud UIS 2009; 41: 157-168The Martin Gruber Anastomosis (MGA) is one of the most common anatomical variants of the upper limb, which consists of motor axons crossing through the forearm from the median nerve to the ulnar nerve. Phylogenetic and hereditary factors have been associated whit the MGA. However, gender, race, or laterality, do not seem to have importance in the appearance of the communicating branch. The MGA has been categorized according to findings in anatomy, electrophysiology and histology, in relation to the source and destination of the communicating branch. The aim of this article is to review the factors related to the presence of MGA, as well as the descriptions and classifications according to anatomy and electrophysiology. This revision contributes with important information relevant to the recognition of differences between the classic pattern and the variant pattern of the innervations of the intrinsic muscles of the hand. Such recognition allows a more appropriate diagnostic and intervention of disorders of the peripheral nerves in the upper limb. Salud UIS 2009; 41: 157-168

The aim of this study was to examine the change in median nerve location according to forearm movement. Thirty fresh specimens from 15 adult Korean cadavers (10 males and five females; age range, 53-91 years) were examined. We measured the motor entry point according to normal and pronated positions of the forearm. The x and y coordinates of the first motor entry point (MEP) in the normal position were 1.6±0.6 cm and 2.8±1.3 cm, respectively. The depth of the MEP was 1.5±0.3 cm. The x and y coordinates of the second MEP were 1.3±0.3 cm and 4.7±1.7 cm, respectively. The depth of the MEP was 1.4±0.2 cm. The x and y coordinates of first MEP with the forearm in the pronated position were 1.9±0.7 cm and 2.3±0.8 cm. respectively. The depth of the MEP was 1.7±0.4 cm. The x and y coordinates of the second MEP were 1.6±0.7 cm and 4.4±1.7 cm, respectively. The depth of the MEP was 1.6±0.3 cm. The differences in locations according to movement of the nerve branch were 0.3 cm, and depths were 0.2 cm. The pronated position results of this study will be clinically helpful. [ABSTRACT FROM AUTHOR]

The median nerve is responsible for the innervation of the muscles of the superficial layer of the anterior compartment of the forearm, it originates along its course in the arm and forearm, branches to these muscles. Some branches originated from common trunks (Ct). We studied 30 upper limbs of Brazilian adults corpses, fixed in 10 % formaldehyde in order to obtain an anatomical and biometric description of the origin and distribution of the branches of the median nerve in the superficial muscles of the forearm: pronator teres (Pt), palmaris longus (PL), flexor carpi radialis (FCR), flexor digitorum superficialis (FDS) and classify these branches (Br) according to their origin. We performed dissections and recorded origins in relation to the biepicondilar line (BEL). With the results we obtained a classification of the branches to the muscles of the superficial layer of the anterior compartment in 4 patterns (I, II, III, IV; the I classified in IA and IB), including the origin of anterior interosseous nerve (AIN). In the pattern IA (29 %), branches originated from proximal to distal in the following sequence: CtPT, PL, FCR, AIN, Br1FDS, Br2FDS; in pattern IB (41 %) showed CtPt, TcFCR and PL, AIN, Br1FDS, Br2FDS; in pattern II (4 %) was CtPt and FCR, PL, AIN, Br1FDS, Br2FDS, Br3FDS; in pattern III (11 %) it was CtPt, Ct FCR and PL, AIN, Br1FDS, Br2FDS, Br3FDS and in pattern IV (15 %) was Br1Pt, Br2Pt, CtFCR and PL, Br1FDS, AIN, Br2FDS. In type pattern IB, the first muscle to receive branches from the median nerve in the forearm was the PT, which in 53 % of cases originated from a common trunk. The PL was the second to be innervated, leaving third place to FCR, which 50 % were supplied by a common trunk. The latest to be innervated muscle was the FDS, which received two branches in 57 % of cases. The results are a contribution to the knowledge of the innervation of the muscles of the superficial layer of the anterior compartment of the forearm. [ABSTRACT FROM AUTHOR]

Anomalous muscle slips of pectoralis major have been reported on several cases in the literature. Among these, chondroepitroclearis muscle is an extremely rare aberrant muscular slip originating from the pectoral region. During an educational dissection, chondroepitroclearis muscle was found on the right side in a Korean cadaver. Tendinous muscular slip originated from pectoralis major muscle, crossing the neurovascular bundle in the arm, and inserted onto medial epicondyle of the humerus. Clinical significance of these anomalous slip can cause median nerve entrapment and functionally limited movement of the humerus. We report a case of tendinous chondroepitroclearis muscle and discuss its clinical and embryological significance. [ABSTRACT FROM AUTHOR]

Se realizó estudio de conducción nerviosa periférica a 12 pacientes con sospecha clínica de polineurorradiculopatía desmielinizante inflamatoria crónica, con tiempo de evolución entre 21 d y 1 año. Se estudiaron los nervios medianos, peroneos profundos, y surales, con el objetivo de contribuir a la caracterización electrofisiológica del estudio de conducción nerviosa en esta patología y demostrar la utilidad de nuevas variables como el porcentaje de caída de amplitud, área y dispersión en el diagnóstico electrofisiológico. Se demostró que las variables más sensibles en esta patología son: la latencia al inicio tanto proximal como distal, latencia al pico proximal y distal, duración proximal, duración de la fase negativa proximal, velocidad de conducción nerviosa al pico, porcentaje de caída de amplitud, de área y dispersión en el estudio motor, la latencia al inicio y al pico, duración, velocidad de conducción nerviosa al inicio y al pico en el estudio sensitivo que evidenció su grado de alteraciónA peripheral nerve conduction study was conducted among 12 patients clinically suspected of chronic inflammatory demyelinating polyradiculoneuropahty with a time of evolution from 21 days to 1 year. The median, deep peroneal and sural nerves were studied aimed at contributing to the electrophysiological characterization of the nerve conduction study in this pathology and at demonstrating the usefulness of new variables, such as the percentage of the falling of amplitude, area and dispersion in the electrophysiological diagnosis. It was proved that the most sensitive variables in this pathology are: latency at the proximal and distal beginning, proximal duration, duration of the proximal negative phase, nerve conduction velocity at the peak, percentage of the decrease of amplitude, area and dispersion in the motor study, latency at the beginning and at the peak, duration, and nerve conduction velocity at the beginning and at the peak in the sensitive study that showed the degree of alteration

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Intense muscle activity of the forearm generates the need to describe the possible sites of compression of the peripheral nerves of the upper limb. For the median nerve one of the most prevalent sites of nerve entrapment is when the nerve travels within the carpal tunnel. To this we must add the potential compression of the nerve when it passes through the heads of the pronator teres muscle (PT). This compression is characterized by paresis of the wrist flexor muscles or some of the thenar, signs which can add to numbness and pain in the hand. The aim of this study was to describe the relation of the median nerve with the PT muscle. Thirty formolized forearms of adult Brazilian individuals were used. It was found that in 40% of cases the median nerve crossed the ulnar head PT muscle. In one case the ulnar head was absent. Due to this, the median nerve passed posterior to the humeral head of this muscle. The clinic that develops from compression syndrome at this level is directly linked to the distribution of the branches that the nerve presents proximal to the site of compression. Associated with these findings, it is vital for optimal diagnosis of the compression of median nerve to rule out compression of this nerve in proximal sites to the carpal tunnel. [ABSTRACT FROM AUTHOR]