Inervación del músculo extensor radial corto del carpo en individuos brasileños: biometría de su origen y distribución / Innervation of the extensor carpi radialis brevis muscle in Brazilian individuals: biometry of its origin and distribution

El ramo de inervación para el músculo extensor radial corto del carpo (MERCC) ha sido utilizado para restablecer funciones de la musculatura del miembro superior en pacientes con lesiones medulares, del plexo braquial o de sus ramos terminales. El origen del nervio para el MERCC es variable, pudiendo originarse desde el tronco del nervio radial (NR), del ramo profundo de este nervio (RPNR) o del ramo superficial del mismo (RSNR). Con el propósito de complementar la anatomía sobre el origen y distribución del ramo para el MERCC, se utilizaron 30 miembros superiores, formolizados, de cadáveres de individuos Brasileños, localizados en los laboratorios de Anatomía de la Universidad Estadual de Ciencias da Saude, Maceió, Brasil. A través de disección se localizó el músculo y su inervación, determinando su origen, así como su distribución. Para efectuar la biometría, se consideró como referencia una línea transversal que pasaba entre las partes más prominentes de los epicóndilos lateral y medial del húmero (LBE), registrando la distancia entre esta línea y el punto de origen de este ramo muscular, así como la distancia entre la LBE y los puntos motores. El nervio para el MERCC se originó del RPNR en 50 % de los casos; desde el tronco principal del NR en 26, 7 % y desde el RSNR en 23, 3 %. La distancia entre el origen del ramo en estudio y la LBE fue en promedio de 23 ± 12 mm; la distancia entre el 1º, 2º y 3º punto motor respecto a la LBE fue de 55 ± 17 mm, 66 ± 17 mm y 79 ± 11 mm, respectivamente. La distribución de la inervación fue clasificada en 4 tipos en relación a sus puntos motores. Los resultados obtenidos son un importante aporte al conocimiento anatómico, así como a la neurocirugía en las transferencias nerviosas con propósitos de restauración de las funciones de músculos lesionados en el miembro superior.

The branch of the innervation for the extensor carpi radialis brevis muscle (ECRBm), has been used to reestablish muscle functions in the upper limbs of patients who have spinal cord injury, of the brachial plexus or its terminal branches. The origin of the ECRBm varies, and can originate from the trunk of the radial nerve (RN), from the deep branch of the radial nerve (DBRN), or from the superficial branch of the radial nerve (SBRN). In order to further complement the anatomy related to the origin and distribution of the ECRBm branch, 30 formolized upper limbs from Brazilian individuals, from the Universidad Estadual de Ciencias da Saude, Maiceió, Brazil were used. Through dissection, the muscle and its innervations was located, determining the origin of the branch as well as distribution. To determine biometry, a transversal reference line, which passed through the most prominent areas of the epicondyles of the humerus (BEL) was considered. The nerve for ECRBm originated from DBRN in 50 % of cases; from the main trunk of RN in 26.7 % and from SBRN in 23.3 %. The distance from the origin of the branch studied and the BEL was an average of 23 ± 12 mm; the distance from the first, second and third motor point to the BEL was 55 ± 17 mm, 66 ± 17 mm and 79±11 mm, respectively. The distribution of the innervation was classified in four types in relation to the motor points. The results are an important contribution to anatomical knowledge, as well as neurosurgery during nerve transfers to restore functions of damaged muscles in the upper limb.

What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy?

BACKGROUND: A variety of treatment options suggest that the optimal treatment strategy for lateral elbow tendinopathy (LET) is not known, and further research is needed to discover the most effective treatment for LET. The purpose of the present study was to verify the most effective position of eccentric stretching for the extensor carpi radialis brevis (ECRB) in vivo using ultrasonic shear wave elastography. METHODS: A total of 20 healthy males participated in this study. Resting position was defined as 90° elbow flexion and neutral position of the forearm and wrist. Elongation of the ECRB was measured for four stretching maneuvers (forearm supination/pronation and wrist extension/flexion) at two elbow angles (90° flexion and full extension). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the eight aforementioned stretching maneuverangle combinations. RESULTS: The shear elastic modulus was the highest in elbow extension, forearm pronation, and wrist flexion. The shear elastic moduli of wrist flexion with any forearm and elbow position were significantly higher than the resting position. There was no significant difference associated with elbow and forearm positions except for elbow extension, forearm pronation, and wrist flexion positions. CONCLUSIONS: This study determined that elbow extension, forearm pronation, and wrist flexion was the most effective eccentric stretching for the ECRB in vivo.

Extensor carpi radialis brevis transfer to extensor pollicis longus :an anatomical study / 中华显微外科杂志

Objective To investigate the anatomical basic of extensor carpi radialis brevis (ECRB) tendon transferring to extensor pollicis longus (EPL) tendon.Methods Twelve sides of ECRB and EPL in fresh adult cadaver's forearms were collected,and the anatomical model of ECRB transferring to EPL was set up in all the forearms.The anatomical parameters of EPL were measured before and after anatomical model established.Results The effective transferring length of ECRB was (3.5±0.8)cm;the maximum circumferential of ECRB and EPL were (8.5±0.8)cm and (3.6±0.3)cm (P ＞0.05),the ratio of muscle cross-sectional area was 5.57;After the anatomical model setting up,anatomic angles of EPL was (30±7)°,which was a decrease of (20±5) ° comparing with the preoperative angel of (50±9) ° (P ＞0.05);Thumb extension angle was (50± 12) °,which was a decrease of (8±3) ° comparing with the preoperative angel of (58 ± 16) ° (P＜0.05);The dorsal extension angle of first metacarpal was (12±5)o,which was a decrease of (3± 2) o comparing with the preoperative angle (15±8)° (P＞0.05);Thumb tip lifting height was (2.3±0.9) c m,which was a decrease of (1.2±0.6)cm comparing with the preoperative height (3.5±1.2)cm (P ＞0.05).Conclusion Based on the measurement of the anatomic parameters of ECRB and EPL,the ECRB has enough length and muscle force to reconstruct the function of EPL.The thumb had a good extension appearance and accorded with the rule of biomechanics after setting up the anatomical model of ECRB transferring to EPL.This study will provide the anatomical evidence for further clinical application

Morphology and morphometry of the tendons of the palmaris longus and radial carpal extensor muscles in humans / Morfología y morfometría de los tendones de los músculos palmar largo y extensores radiales del carpo en el hombre

The tendons of the palmaris longus (PL) and radial carpal extensor (RCE) muscles have extensive applications in surgery, yet despite their constant use, information about their morphological and morphometric characteristics remains limited. The aim of this study was to describe the morphological and morphometric characteristics of the PL and RCE muscle tendons and compare them to each other in 30 upper limbs of adult individuals with no apparent deformations from anatomy units at four universities in Chile. The anterior side and lateral margin of the forearm and the back of the hand as far as the tendon plane were dissected. The average length, width at origin level and at the level of the radiocarpal joint line of the PL muscle tendon were 125.48 mm ± 8.93, 4.76 mm ± 1.35 and 3.76 mm ± 0.91, respectively. The average length, width at the levels of origin and insertion of the extensor carpi radialis longus muscle tendon were 180.46 mm ± 15.03, 14.69 mm ± 3.72 and 7.76 mm ± 1.44 respectively, whereas for the extensor carpi radialis brevis muscle they were 115.23 mm ± 11.81, 9.53 mm ± 2.58 and 7.33 mm ±1.17, respectively. The most common origin of the tendons of the PL and extensor carpi radialis longus muscles was at the level of the middle third of the forearm, whereas the most common origin of the extensor carpi radialis brevis muscle tendon was at distal third level. The shape of the tendons of the PL and RCE muscles was broad and flat along their entire length. Simulating the longitudinal division of the tendons of the RCE muscles in two halves, the radial half of the tendons of both muscles has morphological and morphometric characteristics similar to the PL muscle tendon, such that it could be used as a graft in the case of agenesis of the PL muscle, or for tendon transfer where elongation of a tendon in the region is required.

Los tendones de los músculos palmar largo (PL) y extensores radiales del carpo (ERC) tienen extensas aplicaciones en cirugía, pero a pesar de su constante uso, es escasa la información respecto a sus características morfológicas y morfométricas. El objetivo de este estudio fue describir las características morfológicas y morfométricas de los tendones de los músculos PL y ERC y compararlas entre sí, en 30 miembros superiores de individuos adultos, sin deformaciones aparentes, pertenecientes a unidades de anatomía de cuatro universidades de Chile. Se disecó la cara anterior y el margen lateral del antebrazo, y el dorso de la mano, hasta llegar al plano de los tendones. Los promedios de longitud, anchos a nivel del origen y a nivel de la línea articular radiocarpiana del tendón del músculo PL fueron de 125,48 mm ± 8,93, 4,76 mm ± 1,35 y 3,76 mm ± 0,91, respectivamente. Los promedios de longitud, anchos a nivel de origen y a nivel de la inserción del tendón del músculo extensor radial largo del carpo fueron de 180,46 mm ± 15,03, 14,69 mm ± 3,72 y 7,76 mm ± 1,44, mientras que para el tendón del músculo extensor radial corto del carpo fueron de 115,23 mm ± 11,81, 9,53 mm ± 2,58 y 7,33 mm ±1,17, respectivamente. El origen más común de los tendones de los músculos PL y extensor radial largo del carpo fue a nivel del tercio medio del antebrazo, mientras que el origen más común del tendón del músculo extensor radial corto del carpo fue a nivel del tercio distal del antebrazo. La forma de los tendones de los músculos PL y ERC era ancha y plana durante toda su extensión. Al simular la división longitudinal de los tendones de los músculos ERC en dos mitades, la mitad radial de los tendones de ambos músculos presenta características morfológicas y morfométricas similares al tendón del músculo PL, por tanto, eventualmente podrían ser utilizadas para injerto en caso de agenesia del músculo PL, o para transferencia tendinosa, en caso de que se requiera un alargamiento de algún tendón de la región.

Spontaneous Rupture of the Extensor Carpi Radialis Brevis and Radial Collateral Ligament of the Elbow in a Recreational Golfer: Surgical Experience of Repair of a Chronic Retracted Tendon and Ligament

Lateral epicondylitis with rupture of the radial collateral ligament of the elbow has not been reported in the literature. We report on a case of a recreational golfer who had not received steroid injection and had no trauma history. The patient was treated with open surgical repair. At 2 years follow-up, satisfactory clinical and radiological outcomes were observed with return to pre-injury level. The authors report this case and review the literature.

Spontaneous Rupture of the Extensor Carpi Radialis Brevis and Radial Collateral Ligament of the Elbow in a Recreational Golfer: Surgical Experience of Repair of a Chronic Retracted Tendon and Ligament

Lateral epicondylitis with rupture of the radial collateral ligament of the elbow has not been reported in the literature. We report on a case of a recreational golfer who had not received steroid injection and had no trauma history. The patient was treated with open surgical repair. At 2 years follow-up, satisfactory clinical and radiological outcomes were observed with return to pre-injury level. The authors report this case and review the literature.

Los músculos extensores radiales del carpo y su importancia clínica: una revisión de la literatura / The radial carpal extensor muscles and their clinical significance: a review of the literature

Los extensores radiales del carpo son dos músculos de la parte lateral del compartimento posterior del antebrazo, que se utilizan con frecuencia en cirugías de transferencia de tendón. Las variaciones anatómicas de estos músculos son bastante comunes y su conocimiento es clínicamente significativo, ya que se pueden utilizar para corregir deformidades de la mano. El objetivo de este estudio es conocer la anatomía de los músculos extensores radiales, su embriología, sus variaciones anatómicas y su importancia clínica.

Extensor carpi radialis are two lateral muscles of the posterior compartment of the forearm which are often used in tendon-transfer surgery. The anatomical variations of these muscles are quite common and knowledge about these variations is clinically significant, as it is useful to correct deformities of the hand. The aim of this study is to know the anatomy of the extensor radial muscles, embryology, anatomical variations and their clinical significance.

An anomalous pattern of superficial branch of radial nerve - a cadaveric case report / Patrón anómalo del ramo superficial del nervio radial - reporte de caso en un cadaver

In the present case study, there is an anomalous pattern of superficial branch of radial nerve (SBRN) that can be recognized as an anatomical variant of the left upper limb of a 60 years old donated embalmed male cadaver in the Department of Human Anatomy, Universiti Putra Malaysia, in which the superficial branch of radial nerve supplies the extensor carpi radialis longus and extensor carpi radialis brevis muscle. The superficial branch of radial nerve gave off branch to supply the proximal fusion part of extensor carpi radialis longus and extensor carpi radialis brevis muscles immediately after bifurcation of the radial nerve into the superficial branch of radial nerve and deep branch of radial nerve. This variation is very important to the surgeon as the presence of the variant will make them more careful in dealing with nerve entrapment surgery, reconstructive surgery and in the pain management services, the variation giving indications for treatment.

En el presente estudio se observó un caso de un patrón anómalo del ramo superficial del nervio radial (RSNR) reconocido como una variante anatómica del miembro superior izquierdo en un cadáver de sexo masculino de 60 años perteneciente al Departamento de Anatomía Humana de la Universidad Putra, Malasia. En este caso el ramo superficial del nervio radial inervaba a los músculos extensores radial largo y corto del carpo. El ramo superficial del nervio radial otorgaba un ramo a nivel del origen fusionado de los músculos extensores radiales del carpo, inmediatamente después de la división en ramos superficial y profundo del nervio radial. Esta variación es de importancia para el cirujano debido a que requiere un mayor cuidado en el tratamiento quirúrgico de atrapamiento del nervio o cirugía reconstructiva para el manejo del dolor.

Anatomical variation of radial wrist extensor muscles: a study in cadavers

OBJECTIVE: The tendons of the extensor carpi radialis longus and brevis muscles are quite useful in tendon transfer, such as in correction of finger clawing and restoration of thumb opposition. Knowledge of additional radial wrist extensor muscle bellies with independent tendons is useful in the above-mentioned surgical procedures. METHODS: The skin, subcutaneous tissue, and antebrachial fascia of 48 (24 on the right side and 24 on left side) male upper limb forearms were dissected. The following aspects were then analyzed: (a) the presence of additional muscle bellies of radial wrist extensors, (b) the origin and insertion of the additional muscle, and (c) measurements of the muscle bellies and their tendons. RESULTS: Five out of 48 upper limbs (10.41 percent) had additional radial wrist extensors; this occurred in 3 out of 24 left upper limbs (12.5 percent) and 2 out of 24 right upper limbs (8.3 percent). In one of the right upper limbs, two additional muscles were found. The length and width of each additional muscle belly and its tendon ranged between 2 - 15cm by 0.35 - 6.4cm and 2.8 - 20.8cm by 0.2 0.5cm, respectively. The additional radial wrist extensor tendons in our study basically originated either from the extensor carpi radialis longus or brevis muscles and were inserted at the base of the 2nd or 3rd metacarpal bone. CONCLUSION: The present study will inform surgeons about the different varieties of additional radial wrist extensors and the frequency of their occurrence.