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.

Surgical Technique for Repairing Foveal Tear of the Triangular Fibrocartilage Complex: Arthroscopic Knotless Repair

Knotless repair of triangular fibrocartilage complex has several advantages. All procedures for triangular fibrocartilage complex repair could be done under arthroscopy in this technique. In addition, this technique allows for repair of deep layers of triangular fibrocartilage complex down to fovea of the ulnar head. This article describes arthroscopic repair of the Palmer type 1B triangular fibrocartilage complex tear using arthroscopic knotless technique.

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.

Management of the Comminuted Fractures of the Ulnar Head and Neck Combined with Distal Radius Fractures by Darrach Procedure and Tenodesis of Extensor Carpi Ulnaris

PURPOSE: To evaluate the surgical results of distal radioulnar fractures managed by open reduction and internal fixation for the fractures of the distal radius and excision of the fractured fragments and ECU tenodesis for the comminuted fractures of ulnar head and neck. METHODS: Six cases of combined fractures of the distal radius and ulna were enrolled. Distal radius fractures were fixed by ORIF with AO locking plate without bone graft. The comminuted fragments of distal ulnar head and neck were excised and the tenodesis using half strip of ECU was added to stabilize the proximal ulnar stumps. After immobilization for 6 weeks, active ROM exercise started. The change of radial inclination and volar tilt, the ulnar shift and collapse of carpal bone and ulnar impingement were investigated with simple X-ray. Patients were assessed with residual subjective symptoms and modified Mayo wrist score (MMWS). All were female and average age was 68(58~75) years. Average follow up was 23(10~50) months. RESULTS: Resting pain was absent in all patients but heavy lift made them feel weakness and discomfort intermittently. All patients returned to the normal daily activities except one patient handicapped by hemiplegia. The average range of motion and grip power was 89% and 85% compared to the contralateral side respectively. The average MMWS was 87(75~95). The postoperative loss of the reduction of the distal radius was not observed in follow up X-ray. CONCLUSION: ORIF of distal radius fractures associated with the excision of the distal ulnar fragments and stabilization procedure using half strip of ECU may be one good method for the treatment of the fractures of the distal radius combined with the comminuted distal ulnar fractures difficult to be managed by ORIF. The intermittent weakness felt in this method made it not suitable in young active patient doing heavy work. AO locking plate was strong enough to maintain reduction until bone union.