Application of the sternocleidomastoid intermuscular approach in unilateral parathyroid surgery / 中华内分泌外科杂志

Objective:To investigate the feasibility and advantages of unilateral primary hyperparathyroidism (PHPT) treated by transthyretal interosseous muscle approach surgery.Methods:Clinical data of 7 patients with unilateral PHPT treated by interstitial sternocleidomastoid muscle approach from Jan. 2021 to Feb. 2022 in the thyroid surgery of China-Japan Union Hospital of Jilin University were retrospectively analyzed, including preoperative blood calcium concentration, operation time, incision length, intraoperative parathyroid hormone (PTH) , blood calcium concentration and PTH value in the first month after surgery, abnormal sensation of the skin in the anterior cervical area, etc. The feasibility and advantages of interstitial sternocleidomastoid muscle approach surgery for unilateral PHPT were analyzed.Results:All 7 patients with unilateral PHPT were operated successfully. The PTH was 17.2-63.3 pg/ml on recheck 1 month after surgery, which were all within the normal range. The time from skin opening to resection of the diseased parathyroid gland was 20-35 min, and the length of the surgical incision was 3-4 cm. all patients were given intravenous and oral calcium therapy after surgery, and the blood calcium and PTH levels were within the normal range at 3-12 months of follow-up; the incision recovered well, and there was no significant sensory and functional abnormalities in the anterior neck area.Conclusion:The treatment of unilateral PHPT through the sternocleidomastoid interosseous approach can ensure the safety and efficacy of the operation while better protecting the sensory and motor functions of the anterior cervical region and improving the aesthetics of the surgical incision.

Application of endoscope assisted supraclavicular thyroidectomy and lymph node dissection / 中华内分泌外科杂志

Objective:To evaluate the clinical efficacy of endoscope assisted supraclavicular thyroidectomy and lymph node dissection through the sternocleidomastoid muscular approach (ELDS) .Methods:Clinical data of 40 patients undergoing ELDS and 40 patients who had open surgery (open group) by same team admitted to Ningbo Medical Center Lihuili Hospital from Jan. 2021 to Jan. 2022 were retrospectively analyzed. The intraoperative and postoperative outcomes and follow-up were observed situation. The intraoperative situation, the number of lymph nodes dissected, postoperative outcomes and scar healing satisfaction were observed. SPSS 20.0 software was employed to carry out statistical analysis, the measurement date were compared with t-test, and the counting date were analyzed by χ2 test. Results:There was no significant differences in the two groups with respect to the number of lymph nodes dissected (ELDS group: 30.5±9.8, open group: 29.9±9.0) . The surgical injury in ELDS group were significantly smaller than those in open group, and the operation time was significantly higher in open group (ELDS group: 95.2±12.0min, open group: 82.3±13.9min, P<0.05) . In postoperative follow-up, there were significant differences between the two groups in swallowing impairment, anterior cervical pressure and scar satisfaction (ELDS group: 4.45±1.82, open group: 6.03±1.47, P<0.05) , and the lateral approach group was superior to open group, but there were no significant differences in parathyroidism or recurrent laryngeal nerve injury ( P>0.05) . Conclusions:ELDS has the advantages of good cosmetic effect, less postoperative anterior cervical discomfort, less postoperative complications, and good lymph node dissection effect. The operation is safe and feasible, and has obvious advantages over traditional operation.

Multiple-scale intermuscular coupling network analysis / 生物医学工程学杂志

In order to more accurately and effectively understand the intermuscular coupling of different temporal and spatial levels from the perspective of complex networks, a new multi-scale intermuscular coupling network analysis method was proposed in this paper. The multivariate variational modal decomposition (MVMD) and Copula mutual information (Copula MI) were combined to construct an intermuscular coupling network model based on MVMD-Copula MI, and the characteristics of intermuscular coupling of multiple muscles of upper limbs in different time-frequency scales during reaching exercise in healthy subjects were analyzed by using the network parameters such as node strength and clustering coefficient. The experimental results showed that there are obvious differences in the characteristics of intermuscular coupling in the six time-frequency scales. Specifically, the triceps brachii (TB) had relatively high coupling strength with the middle deltoid (MD) and posterior deltoid (PD), and the intermuscular function was closely connected. However, the biceps brachii (BB) was independent of other muscles. The intermuscular coupling network had scale differences. MVMD-Copula MI can quantitatively describe the relationship of multi-scale intermuscular coupling strength, which has good application prospects.

Different changes of muscle hardness between the rectus femoris and vastus intermedius muscle after maximal knee extension exercise / 体力科学

This study aimed to determine the different changes of muscle hardness between the human rectus femoris (RF) and vastus intermedius muscle (VI) after maximal knee extension exercise. Eight healthy men (23.0±2.6 years) performed maximal isometric contraction (IM), concentric contraction (CC), and eccentric contraction (EC) exercises of the knee extensors. Muscle hardness (i.e., strain ratio, SR) and thickness in the proximal, middle, and distal parts of RF and VI were measured by using strain elastography before and after exercises. The rates of change between the values were calculated as values before exercise 100%. For VI, a significant main effect in “part” was found in IM and EC exercises in SR. Results show that SR in the distal part (IM, 89.0±27.2%; EC, 78.2±26.9%) was significantly lower than that in the middle part (IM, 105.5±34.3%; EC, 91.8±30.4%) for each exercise (p<0.05). However, no significant main effect in “part” was found in SR of RF in any exercise. A significant main effect was found in “part” in muscle thickness of RF in the IM exercise. Also, muscle thickness in the distal part (104.5±7.7%) was significantly higher than that in the proximal part (102.5±4.3%) for each exercise (p<0.05). These results suggest that changes of muscle hardness and thickness in the proximal, middle, and distal parts of the human rectus femoris and vastus intermedius muscle after maximal knee extension exercises are different.

Anaesthesia effect of ropivacaine in different concentrations on intermuscular sulcus brachial plexus block under ultrasound guidance / 中国基层医药

Objective@#To explore the anesthetic effect of different concentrations of ropivacaine in intramuscular sulcus brachial plexus block under ultrasound guidance.@*Methods@#From April 2016 to April 2018, 120 patients with upper limb orthopedic surgery who received muscle under the ditch brachial plexus block guided by ultrasound in Jinhua Hospital of Traditional Chinese Medicine were randomly divided into group A (40 cases, application of 0.375% ropivacaine), group B (40 cases, application of 0.50% ropivacaine), group C (40 cases, application of 0.75% ropivacaine). The anesthetic effect, onset time of sensory block, onset time of motion block, duration of analgesia, recovery time of motion block, serum troponin level, creatine kinase isozyme level and incidence of adverse reactions in the three groups were compared.@*Results@#The excellent and good anesthesia rate of group A, group B and group C was 100.00%, and there was no statistically significant difference among the three groups (P>0.05). The onset time of sensory block[(5.29±1.32)min], the onset time of motion block[(7.42±1.36)min] in group C were shorter than those in group A[(9.32±1.52)min, (13.32±2.46)min] and group B[(7.89±1.63)min, (9.12±2.20)min](F=4.652, 6.365, all P<0.05). The analgesic duration in group C[(10.71±1.52)h] was longer than that in group A[(6.89±2.23)h] and group B[(8.69±2.12)h](F=5.120, P<0.05), but the recovery time of motion block in group C was longer than that in group A and group B (P<0.05). The serum troponin level and creatine kinase isozyme level at 24 h after injection in group C were significantly higher than those in group A and group B(P<0.05), and the serum troponin level and creatine kinase isozyme level in group B were significantly higher than those in group A (P<0.05). With the increase of concentration, the incidence of adverse reactions gradually increased, but there was no statistically significant difference among the three groups (P>0.05).@*Conclusion@#With the increase of ropivacaine concentration, the onset time of anesthesia is shorter and the analgesic time is longer, but the incidence of adverse reactions is also higher.In a comprehensive consideration, 0.50% ropivacaine can be applied to patients with intermuscular sulcus brachial plexus block under ultrasound guidance.

Analysis of multichannel intermuscular coupling characteristics during rehabilitation after stroke / 生物医学工程学杂志

To better analyze the problem of abnormal neuromuscular coupling related to motor dysfunction for stroke patients, the functional coupling of the multichannel electromyography (EMG) were studied and the difference between stroke patients and healthy subjects were further analyzed to explore the pathological mechanism of motor dysfunction after stroke. Firstly, the cross-frequency coherence (CFC) analysis and non-negative matrix factorization (NMF) were combined to construct a CFC-NMF model to study the linear coupling relationship in bands and the nonlinear coupling characteristics in different frequency ratios during elbow flexion and extension movement. Furthermore, the significant coherent area and sum of cross-frequency coherence were respectively calculated to quantitatively describe the intermuscular linear and nonlinear coupling characteristics. The results showed that the linear coupling relationship between multichannel muscles was different in frequency bands and the overall coupling was stronger in low frequency band. The linear coupling strength of the stroke patients was lower than that of the healthy subjects in different frequency bands especially in beta and gamma bands. For the nonlinear coupling, the intermuscular coupling strength of stroke patients in different frequency ratios was significantly lower than that of the healthy subjects, and the coupling strength in the frequency ratio 1∶2 was higher than that in the frequency ratio 1∶3. This method can provide a theoretical basis for exploring the intermuscular coupling mechanism of patients with motor dysfunction.

Acupuncture techniques recorded in the Tianhui bamboo slips of medicine in the tomb of the Han Dynasty / 中国针灸

was nominated after the collection of the bamboo slips of medicine unearthed from the tomb of the Han Dynasty in Tiahui county, Chengdu of Sichuan Province. It is the special chapter on the therapeuticmethods of acupuncture, providing the valuable new historical evidences for the study on the inheritance and evolution of acupuncture in TCM. In the paper, using the cross-proof method among the unearthed literature, the inherited literatures and the unearthed relics, the ancient acupuncture techniques at the early Western Han Dynasty were explored. It was discovered that the manipulations of the different needling techniques, such as pulse needling and intermuscular needling, as well as the forms of the needling tools provided the evidences to the Nine Needles recorded in () and the archaeological discovery. There were many acupuncture prescriptions, reflecting the needling methods recorded in () and () as well as needling chart, the stone portrait of the Han Dynasty. The close combination between the acupuncture needling techniques and the pulse diagnosis indicates the theoretic essence of the meridian medicine at the ancient time.

Rare Form of Schwannoma as a Purely Hemorrhagic Cystic Tumor Located in an Intermuscular Plane

Schwannomas are mostly solid tumors, some of which may contain cystic degenerations or hemorrhages. However, a schwannoma seen as a purely hemorrhagic cystic tumor is very rare. A 63-year-old woman was referred to the hospital due to a slow-growing mass (present for about 5 years) on her right thigh. She complained about vague pain but without neurologic symptoms such as numbness or tingling sensations. MR images showed an oval lesion with defined margins surrounded by the rectus femoris, vastus lateral, and the vastus intermedius. It was characterized as a multilocular cystic lesion composed of hemorrhagic fluid. In addition, the benign hemorrhagic cystic lesion was differentially diagnosed by radiological techniques as a hemorrhagic ganglion cyst. The lesion was surgically excised and, based on pathological features, was diagnosed as being a schwannoma. We report a purely hemorrhagic cystic schwannoma located in an intermuscular plane.

Intermuscular Adipose Tissue Content and Intramyocellular Lipid Fatty Acid Saturation Are Associated with Glucose Homeostasis in Middle-Aged and Older Adults

BACKGROUND: Insulin resistance is associated with the higher content of intermuscular adipose tissue (IMAT) and the saturation of intramyocellular lipid (IMCL), but a paucity of data exist in humans. This study examined associations among IMAT content, IMCL saturation, and fasting glucose concentration in middle-aged and older adults with overweight or obesity. METHODS: Seventy-five subjects (26 males, 49 females) were recruited and thigh muscle and IMAT were assessed using magnetic resonance imaging. Vastus lateralis tissue was acquired from a subset of nine subjects and IMCL content and saturation were assessed using nonlinear dual complex microscopy. RESULTS: The characteristics of the 75 subjects were as follows: age 59±11 years, body mass index 30±5 kg/m², fasting glucose concentration 5.2±0.5 mmol/L, fasting insulin concentration 12.2±7.3 µU/mL, fasting homeostatic model assessment of insulin resistance (HOMA-IR) 2.9±2.0 (mean±SD). IMAT to muscle tissue (MT) volume ratio was positively associated with the saturated fatty acid to unsaturated fatty acid ratio in IMCL. IMAT:MT was positively associated with fasting glucose concentration and HOMA-IR. IMCL saturation was positively associated with fasting glucose concentration while muscle cell area, IMCL area, and % IMCL in muscle cell were not associated with fasting glucose concentration. CONCLUSION: These results indicate that higher intermuscular fat content and IMCL saturation may impact fasting glucose concentration in middle-aged and older adults with overweight or obesity. The centralization of adipose tissue in the appendicular region of the body may promote insulin resistance.

Correlation between the elevation of D-dimer and of deep venous thrombosis progression of the lower extremities after abdominal surgery / 中华普通外科杂志

Objective To investigate the value of D-dimer in predicting the progression of lower extremity deep venous thrombosis (DVT) during perioperative period of gastrointestinal surgery.Methods Color Doppler ultrasound was used to dynamically monitor the formation and changes of perioperative deep venous thrombosis (DVT) in 239 patients receiving abdominal surgery in our department from Nov 2014 to Aug 2016.Changes of plasma D-dimer were measured,and clinical data of malignant tumor,infection,age,BMI were collected.The relationship between D-dimer elevation and DVT progression was analyzed.Results Lower extremity DVT after surgery developed in 97 patients,and thrombosis progression occurred in 16.6％ (16/97).Univariate logistic regression analysis showed that continuous increase of postoperative D-dimer was closely related to the progression of thrombosiss.Multivariate Logistic regression analysis showed that the continuous rise of D-dimer was an independent risk factor for thrombosis.ROC curve analysis showed significantly increased risk of thrombosis progression,when plasma D-dimer polymerization increased ＞0.87 mg/L on the 3rd day.Conclusion The continuous increase of D-dimer ＞ 0.87 mg/L predicts DVT progression of lower extremity DVT.

Clinical significance of lymphatic metastasis between sternocleidomastoid and sternohyoid muscle in papillary thyroid cancer / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical significance of metastasis of lymph nodes between sternocleidomastoid and sternohyoid muscle (LNSS) in papillary thyroid cancer (PTC).@*Methods@#A total of 175 patients with PTC who underwent thyroidectomy with LNSS dissection were retrospectively analyzed. Univariate and multivariate Logistic regression analyses were used to determine the independent risk factors for LNSS metastasis in PTC.@*Results@#The rate of detectable LNSS was 70.9% (124/175) and metastasis rate was 7.4% (13/175). Of 13 cases with LNSS metastasis, 10 with the coexistence of cervical lymph node metastasis. Univariate Logistic regression analysis showed that multiple focal cancer, tumor located in the lower pole of thyroid, belt-shaped muscle invasion, lateral cervical lymph node metastasis, cN+ , the number of cervical lymph nodes with metastasis and the number of lymph nodes with metastasis in level Ⅳwere the risk factors for LNSS metastasis (P<0.05). Multivariate Logistic regression analysis suggested that tumor located in the lower pole of thyroid and the number of cervical lymph nodes with metastasis >6 were the independent risk factors for LNSS metastasis (P<0.05). Given the number of cervical lymph nodes with metastasis as a predictor for the LNSS metastasis, the sensitivity was 92.3%, the specificity was 66.7% and the accuracy rate was 68.6%.@*Conclusions@#LNSS metastasis is commom in PTC, with a metastasis rate of 7.4%. PTC in the lower pole of thyroid and the number of cervical lymph nodes with metastasis > 6 are independent risks for LNSS metastasis.

Ultrasonographic Measurements of the Intramuscular Fluid Collection Using a Phantom: A Preliminary Study / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to check the intermuscular fluid collection in a phantom using ultrasound after comparison with the original injected volume of gel and to evaluate interobserver reliability. MATERIALS AND METHODS: One orthopedic surgeon injected ultrasonographic gel into the muscle of slaughtered cow meat using a syringe and needle, and recorded the injected volume. The injected volume of gel ranged from 1 ml to 5 ml, and total number of trials was 30 times. The volume was calculated using ultrasound by two experienced radiologists. The ultrasonographic measured volme was assessed and interobserver variability was measured. RESULTS: The mean ultrasonographic measured volume was 71.35% of the original injected volume of gel. Thus, the measured volume using ultrasound showed a tendency to underestimate the injected volume into the muscle. For evaluation of interobserver reliability, interclass correlation using SPSS and consistency using Bland and Altman plot were calculated. Interclass correlation was 0.95, and Bland and Altman plot showed that the differences of mean volume measured by two observers were within ±1.96 standard deviation over 95%. Therefore, it showed good interoberver reliability. CONCLUSION: Ultrasonographic measurement of the intramuscular fluid collection in a phantom showed mean 71.35% of the original injected volume of gel, and it tended to be underestimated in proportion to the increased volume of intermuscular gel. This study showed good interobserver reliability.

Analysis of Fibularis Tertius in Terms of Frequency, Morphology, Morphometry and Clinical Significance in North Indian Cadavers.

Introduction: The fibularis tertius muscle has always enjoyed the distinction of being an exclusively human structure and as such it has helped to separate man from the lower animals. Myocutaneous flaps have been progressively used in surgical reconstruction in the lower limb injuries requiring the use of muscles which result in less functional damage as flaps. Aim: Our study is aimed to evaluate frequency, morphology, morphometry and use of the fibularis tertius muscle as flaps in lower limb injuries. Materials and Methods: Sixty lower limbs from formalin preserved cadavers (28 male and 2 female) were dissected and evaluated for the following parameters: origin of muscle, distal insertion, nerve supply, frequency, morphology, morphometry and any variation regarding this muscle. Results: The fibularis tertius muscle was detected in all the cases (60 limbs). Origin of all the cases were found at the interosseous membrane, anterior border of the fibula, and anterior intermuscular septum. Most distal insertions were found at the medial and dorsal sides of base of the 5th metatarsal bone (98.34%). Mean value of muscle belly length was 21 cm and width was 1.9 cm. The mean length of the distal tendon with no muscle fibers up to insertion was 6 cm, and the mean width was 0.5 cm. Conclusions: The fibulari stertius muscle is frequent and has a distinct morphology, making it a feasible option for use as graft. Knowledge of these variations may have useful clinical applications in cases of leg or foot trauma requiring tendoplasty or tendon transfer operations.

Management of a case of Traumatic Lateral Rectus Transection – A Surprise.

A 19-year-old girl, presented with diplopia, bleeding, pain, and tissue hanging out from her right eye after a stick injury. She had uncorrected visual acuity of 20/20 and N6 in both the eyes, right eye esotropia (30 prism diopter), total limitation of abduction (right eye), and diplopia. About 10 mm of lateral rectus (LR) muscle stump was hanging from the insertion over the lid margin. Anterior and posterior segments were normal in both the eyes. The computed tomography (CT) scan showed ruptured and retracted LR. On wound exploration, the proximal part of LR was not retrievable. The cut edge of the muscle stump at the insertion site was sutured to the intermuscular septa and tenons tissue. Post-operatively, diplopia decreased, abduction in right gaze improved dramatically, and eyes were orthophoric 1 year follow-up. Post-operative CT scan was reported to have the presence of intact LR muscle.

Giant intermuscular lipoma of neck and chest: a case report with review of literature.

Intermuscular lipoma is an uncommon benign tumor. In this case report we described a case of a patient with intermuscular lipoma located between sternocleidomastoid, pectoralis and scalene muscles on left side. These typ es of tumors are exceedingly rare in head and neck regions. Intermuscular lipomas are thought to arise from the Intermuscular septa and enlarge between muscle bundles. Clinical data, investigations, Magnetic Resonance Imaging scan confirm the diagnosis. These tumours are more common in males than females. Complete surgical excision of tumor is the treatment of choice. It is crucial for the surgeon to consider deep lipomas when dealing with soft tissue tumors.

Short-term effectiveness of pedicle fixation at the fractured vertebra via paravertebral intermuscular ap-proach for thoracolumbar fractures / 医学研究生学报

Objective Pedode foxatoon at the level of fracture vetebral technology is widely used in rebuilding spnal fracture recently.The purpose of minimally invasive surgery for thoracolumbar fractures is to reduce the injury , fix segments, and rebuild the stability of the spine .This study aimed to investigate the short-term clinical effect of pedicle fixation at the fractured vertebra via the pa-ravertebral intermuscular approach for the treatment of thoracolumbar fractures . Methods We treated 24 cases of thoracolumbar fracture by pedicle fixation at the fractured vertebra via the paravertebral intermuscular approach , rebuilt spinal stability , and corrected kyphotic deformity .We evaluated the improvement of pain symptoms and life quality using The Visual Analogue Scale ( VAS) and The MOS 36-Item Short-Form Health Survey (SF-36), and assessed the corrected status of vertebral height loss and kyphotic deformity by radiographic measurement .All the patients were followed up for over 12 months. Results The VAS score of the patients was signifi-cantly higher while the SF-36 score remarkably lower before surgery than the scores in 12 months which were ([7.65 ±0.13] -[1.54 ±0.07], P<0.05) and ([90.21 ±2.02]-[117.21 ±1.02], P<0.05).Imaging evaluation showed desirable correction of the reduced height of the injured vertebrae and kyphotic deformity . Conclusion Pedicle fixation at the fractured vertebra via the pa-ravertebral intermuscular approach , with its advantages of minimal invasiveness and fewer segments of fixation , can effectively correct vertebral height reduction and kyphotic deformity .

Decreased Intermuscular Adipose Tissue due to Caloric Restriction in Obese Korean Women

BACKGROUND: This study investigated the effects of caloric restriction on thigh intermuscular adipose tissue (IMAT) and the associations of IMAT and metabolic risk factors. METHODS: Thirty-three obese Korean women (BMI 27.2+/-2.5 kg/m2; 32.3+/-8.7 years) were tested before and after 12 weeks of 354.7 kcal/day dietary caloric restriction: waist circumference (WC); %fat according to bioimpedence; subcutaneous adipose tissue (SAT); visceral adipose tissue (VAT); IMAT using single-slice CT scans at the levels of L4/L5 and mid-thigh (midpoint between the anterior iliac crest and patella); fasting levels of leptin, glucose, insulin, triglycerides, total-C, LDL-C, HDL-C, and HOMA-IR. Paired t-test and Spearman correlation analysis were performed. RESULTS: WC, %fat, leptin, glucose, total-C, abdominal SAT and VAT, and mid-thigh IMAT decreased (P<0.05), and %change in mid-thigh IMAT correlated with %change in HOMA-IR (P<0.05). CONCLUSION: Caloric restriction decreased the mid-thigh IMAT in obese Korean women, which may be correlated with reduction of metabolic risk.

Variations of pronator teres muscle. A morphological study.

The muscles of shoulder girdle and elbow act together to position the hand accurately for manipulative functions. The superior extremity of man has undergone various modifications during evolution one of which is the lateral rotation of forelimbs at joints with pectoral girdle. The aim of the present study was to study the variations of pronator teres muscle. The present study was done on 60 upper limbs (56 Males and 4 Females) of embalmed adult human cadavers obtained from Deptt of Anatomy, Govt. Medical College Patiala. The humeral head of PT was found in all the cases, while Ulnar head was present in 52(86.7%) cases. The Humeral head was muscular in all the cases. The Ulnar origin was muscular in 15 cases (28.84%), tendinous in 7 cases (13.46%) & mixed in 30 cases (57.7%). In 2 (3%) cases there was double humeral head and the median nerve was passing between them. In 3cases (5%) there was high origin of humeral head of Pronator teres from medial intermuscular septum. Anatomy instructors and health professionals should be aware of the common variations in muscles and tendons of the forearm, not only for their academic interest but also for their clinical and functional implications.

Intermuscular lipoma of the submandibular space.

Deep lipomas, especially in the head and neck region, are uncommon. This report describes the case of a patient with a large intermuscular lipoma of the submandibular space, which had been present for 10 years and was diagnosed by computed tomography. The clinical, imaging, and histopathological features, as well as the management of the tumor, are described.

Entrapment of the median nerves and brachial arteries in the lower arms bilaterally and additional origin of biceps brachii muscle: case report / Compresión bilateral del nervio mediano y de la arteria braquial en la parte distal del brazo y origen adicional del músculo bíceps braquial: reporte de caso

Neuro-vascular entrapments associated with variations observed in the origins of muscles in the arm are not uncommon. Though additional heads of biceps brachii muscle and extra fibres of brachialis muscles have been demonstrated earlier, bilateral additional heads of the biceps are rarely seen, especially with entrapment of the median nerve and the brachial arteries in both the arms. The present study reports conspicuous heads of the biceps brachii originating extensively from the medial inter-muscular septum, sharing its origin with the brachialis muscle. The extra origins of the muscle formed long musculo-aponeurotic tunnels. The tunnels measured eight centimeters in length extending from the lower arm to the cubital-fossa. Both the median nerve and the brachial arteries passed through the tunnel. The lower aspect of the left tunnel exhibited origins of fibres belonging to the superficial flexors of the forearm. The neuro-vascular structures did not give any branches in the tunnel. Awareness of such variations can aid clinicians in diagnosing and treating such neuropathies and vascular compromise.

No es infrecuente observar atrapamientos neuro-vasculares asociados con variaciones en el origen de los músculos del brazo. A pesar de haberse observado cabezas adicionales del músculo bíceps braquial y fibras extra del músculo braquial raramente estas cabezas adicionales bilaterales han sido causantes de la compresión del nervio mediano y de la arteria braquial. En este trabajo presentamos las cabezas del músculo bíceps braquial originándose en gran parte en el tabique intermuscular medial compartiendo su origen con el músculo braquial. Los orígenes adicionales del músculo forman largos túneles músculo fasciales. Los túneles miden 8 cm de longitud, y se extienden desde la parte inferior del brazo hasta la fosa cubital. Tanto el nervio mediano como la arteria braquial pasan por el túnel. La parte inferior del túnel izquierdo dio origen a fibras pertenecientes al músculo flexor superficial del antebrazo. Las estructuras neurovasculares no otorgaron colaterales en el túnel. El conocimiento de estas variaciones puede ayudar a los clínicos en el diagnóstico y el tratamiento de neuropatías y compromiso vascular.