Surgical Management of Pisiform Bone Deformity Associated with Tendonitis of Flexor Carpi Ulnaris

PURPOSE: This study was performed to investigate the degree of symptom improvement after removal of bone fragment in patients with deformed pisiform bone associated with tendonitis of flexor carpi ulnaris. METHODS: Pisiform bone fragment removal was performed in 12 patients who had failed conservative treatment from January 2008 to December 2011. They were followed up at 2 weeks, 1 month, 2 months, 6 months, and 12 months after surgery. Their symptoms were assessed with Green score. RESULTS: Eleven of 12 patients who underwent bone fragment removal showed symptom improvement. Symptoms worsened in 1 patient due to pain and restricted range of motion caused by postoperative scar. CONCLUSION: The results of this study suggest that removal of bone fragment may be an effective treatment in patients with tendonitis of flexor carpi ulnaris accompanied by pisiform bone deformity whose pain does not improve with conservative management.

Accessory flexor carpi ulnaris muscle: a case report of a rare variation in human

This study describes a rare case of the accessory muscle originated from the flexor carpi ulnaris muscle. Anunusual variation of the flexor muscle was observed during the male cadaver dissection. The presence of ananatomical variation muscle was verified in the forearm on the left side of a 59 year old corpse settled in formol10%. Morphological variability and clinical significance are reviewed.

Accessory muscle in the forearm: a clinical and embryological approach / 대한해부학회지

Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.

Surgical Treatment of Chronic Flexor Carpi Ulnaris Tendinopathy

PURPOSE: The purpose of this study was to evaluate the results of surgical treatment in patients with chronic flexor carpi ulnaris tendinopathy. MATERIALS AND METHODS: Five patients with 7 wrists underwent surgical treatment for chronic flexor carpi ulnaris tendinopathy. The degenerative tissue inside the tendon over the pisiform was debrided and partial release of the tendon was performed. The clinical outcome was evaluated using pre and postoperative visual analogue scale (VAS) pain score and modified Mayo wrist score at the final follow-up. RESULTS: The mean VAS score was 7.3 preoperatively, which was significantly improved to 3.6 at postoperative 2 weeks, 1.9 at 6 weeks, 1.1 at 3 months, 0.7 at 6 months, and 0.7 at the final visit. Modified Mayo wrist score showed 3 excellent, 3 good, and one fair result. Biopsy showed degenerative tissue findings in all cases. CONCLUSION: Chronic flexor carpi ulnaris tendinopathy is a degenerative disease and surgical treatment of refractory cases can decrease clinical symptoms in the early postoperative period and enable patients to return to activities of daily-living.

Ulnar and humeral heads forming separate bellies: a rare case of digastric flexor carpi ulnaris muscle / Cabezas ulnar y humeral formando vientres separados: un caso raro del músculo flexor ulnar del carpo digástri

Proper knowledge of muscular variations is essential for both anatomists and surgeons. Variations of the flexor carpi ulnaris (FCU) are not very common. We are reporting an unusual case of FCU muscle with two bellies. The two heads (ulnar and humeral) of the muscle continued as two separate bellies and the tendons of which joined each other slightly proximal to the wrist before getting inserted to pisiform bone. Further, detailed literature review of variations of FCU muscle is done and the developmental basis for the variation and its surgical importance are discussed.

El correcto conocimiento de las variaciones musculares es esencial para anatomistas y cirujanos. Variaciones del músculo flexor ulnar del carpo (MFUC) no son muy comunes. Se reporta un caso inusual del MFUC con dos vientres. Las dos cabezas (ulnar y humeral) del músculo continuaron como dos vientres separados. Los tendones se unieron entre sí, ligeramente proximal a la muñeca, antes de llegar a su inserción en el hueso pisiforme. Se hace una detallada revisión de la literatura de las variaciones del MFUC y son discutidas las bases del desarrollo de las variaciones, destacándose además su importancia quirúrgica.

Anatomical Relation of Ulnar Nerve and Flexor Carpi Ulnaris Muscle at the Wrist

OBJECTIVE: To verify proper stimulation point of ulnar nerve at the wrist by investigating anatomical relation of ulnar nerve and flexor carpi ulnaris (FCU) muscle. METHOD: Cadaver dissection of 9 wrists was done to identify gross anatomical relation of ulnar nerve and FCU muscle. Ultrasonography of 17 healthy volunteers was done for the measurement of distance from lateral border of FCU muscle to ulnar nerve at three sites. Ratios of these distances to total width of FCU muscle and FCU tendon were calculated. RESULTS: FCU muscle was composed of lateral tendinous and medial muscular portion, and all ulnar nerves were located under the tendinous portion of FCU muscle on cadaver dissection. Ultrasonographic distances from lateral border of FCU muscle to ulnar nerve were 4.6+/-3.3 mm, 4.8+/-4.0 mm and 5.9+/-3.1 mm from distal to proximal sites. The ratios to total width of FCU muscle were 31.02+/- 23.31%, 24.30+/-26.12% and 24.48+/-13.01%, which showed that the ulnar nerve was closer to the lateral border than the medial border. The ratios to total width of FCU tendon were 49.63+/-41.35%, 51.30+/-50.46% and 64.59+/-36.79%, which showed progressive increment from distal to proximal sites. CONCLUSION: Proper stimulation point of ulnar nerve at the wrist is the lateral border of FCU muscle than the medial border. However, the proximity of ulnar nerve to the medial or lateral border was not conclusive, because the ratio to FCU tendon was not consistent in three sites of the wrist. Further electrophysiologic study is necessary for the comparison of proper stimulation point based on FCU tendon.

Additional muscle slip of flexor carpi ulnaris associated with anomalous ulnar nerve and ulnar artery in the distal forearm / Fascículo adicional del músculo flexor ulnar del carpo asociado con una variación del nervio ulnar y arteria ulnar en la parte distal del antebrazo

During routine dissection classes to under graduate medical students, we observed an anomalous flexor carpi ulnaris muscle associated with abnormal ulnar nerve and ulnar artery in the distal part of forearm. There was an additional belly arising from the lower part of the flexor carpi ulnaris muscle and crossed ulnar nerve and vessels, median nerve and ended in a broad aponeurosis which crossed the tendons of flexor digitorum superficialis and merged with the deep fascia and flexor retinaculum. The ulnar nerve and ulnar artery divided into their terminal branches in the lower part of the forearm. However, the distribution of the terminal branches of both ulnar nerve and artery were normal. An understanding of these unusual findings may be clinically relevant in describing the anterior compartment of the forearm.

Durante una disección de rutina en clases para estudiantes de Medicina, se observó una anomalía del músculo flexor ulnar del carpo asociado con una variación del nervio y arteria ulnar, en la parte distal del antebrazo. Un vientre adicional derivado de la parte inferior del músculo flexor ulnar del carpo cruzaba el nervio ulnar y vasos ulnares, nervio mediano y terminaba en una amplia aponeurosis la cual cruzaba los tendones del músculo flexor superficial de los dedos y se fusionaba con la fascia profunda y el retináculo flexor. El nervio ulnar y la arteria ulnar se dividían en sus ramas terminales, en la parte inferior del antebrazo. Sin embargo, la distribución de las ramas terminales tanto del nervio ulnar como de la arteria ulnar eran normales. La comprensión de estos inusuales hallazgos pueden ser clínicamente relevantes para describir el compartimiento anterior del antebrazo.

Ulnar nerve Compression Syndrome due to anomalous Branch of the Ulnar Nerve Piercing the Flexor Carpi Ulnaris: Report of one case / 대한정형외과학회잡지

Compression ulnar neuropathy was predicted by Guyon in 1961,following his anatomical studies of the ulnar tunnel. Nearly a half century later Ramsey Hunt first reported isolated ulnar motor paralysis in the hand, due to chronic occupational trauma. Many authors has tried to describe the etiology of the ulnar nerve compression syndrome at or around the wrist. That is most frequently caused by ganglion, occupational neuritis, thrombosis of the ulnar artery, thickening of volar ligament or different kinds of trauma (e.g. fractures of the carpal bones). Now we experienced a case of the ulnar nerve compression syndrome at distal forearm by an anomalous branch of the ulnar nerve by piercing the distal tendon of the flexor carpi ulnaris.

Mivacurium Chloride in Patients with Chronic Renal Failure / 대한마취과학회지

Mivacurium chloride(BW B1090U, mivacurium) was the second bis-benzylisoquinolinium diester compound in clinical deveopment. Short duration of action was emphasized as the most important clinical feature of this new drug, mainly due to its rapid hydrolysis by butyryl cholinesterase. Its hydrolysis rate in vitro by purified plasma cholinesterase approximated 88% of that of succinylcholine. The widespread use today of atracurium and vecuronium as the muscle relaxants of choice of patients with renal failure reflected their relatively larger systemic clearance rate and short duration of action. I have determined the neuromuscular blocking aetion of a bolus dose of mivacurium(0.2 mg/ kg) during 1-1.5% isoflurane and 50% nitrous oxide anesthesia in ten healthy patients and thirteen patients with chronic renal failure undergoing kidney transplantation. Neuromuscular block was assessed by measuring the electromyographic evoked response of the flexor carpi ulnaris muscle to train-of-four stimulation of the ulnar nerve with DATEX ABM. The results were as follows; 1) I found one of facial erythema, but did not find hypotension and taehycardia after the injection of mivacurium. 2) The onset, clinical duration(25%), 95% recovery time and recovery index(25-75%) after mivacurium was 2.28+/-0.35 min., 10.93+/-1.64 min., 25.72+/-3.42 min. and 6.77+/-1.75 min. in group 1, 2.41+/-0.22 min, 16.21+/-2.52 min., 35.17+/-3.68 min. and 9.09+/-3.29 min. in group 2(mean+/-SEM). There were no significance between two groups, but slightly inerease of clinical duration in group 2 was found. With the above results the author concluded that mivacurium was a reliable relaxant for outpatient and the patient with chronic renal failure due to short clinical duration, no cardiovascular effects and no changes in the patient with chronic renal failure.