Arteria ulnar superficial, bilateral y antebraquial: similitudes y diferencias / Superficial ulnar artery, bilateral and antebrachial: similarities and differences

Describimos un hallazgo infrecuente de arteria ulnar superficial en ambos antebrazos de un cadáver, con origen en la arteria braquial, a nivel de la fosa cubital. Las arterias presentan un trayecto que dividimos en cuatro segmentos, a causa de sus flexuosidades. Ambos antebrazos presentan ausencia del músculo palmaris longus. Se resumen las principales teorías sobre su desarrollo y las complicaciones que pueden ser ocasionadas por su presencia y el eventual beneficio de la misma. Hasta el momento, no hemos encontrado en la literatura, una disposición morfológica de arterias ulnares superficiales como las aquí descritas.

We describe an infrequent finding of a superficial ulnar artery in both cadaver forearms, which originates in the brachial artery at cubital fossa level. The arteries have a path that we divided into four segments, because of their flexuosities. Both forearms showed an absence of the palmaris longus muscle. This summarizes the main theories about its development and the complications and eventual benefits that can be caused by its presence. So far, we have not found in the literature, a morphological disposition of superficial ulnar arteries such as those described here.

Anomalies of radial and ulnar arteries / Anomalias nas artérias radial e ulnar

Abstract During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

Resumo Durante dissecção de membro superior direito de um cadáver de 70 anos, do sexo masculino, conduzida em um departamento de anatomia, foram observadas anomalias tanto na origem quanto no curso das artérias radial e ulnar. Após descer 5,5 cm desde a borda inferior do músculo redondo maior, a artéria braquial anomalamente se bifurcava em uma artéria radial medialmente, e em uma artéria ulnar lateralmente. No braço, a artéria ulnar se encontrava ao lado do nervo mediano, e seguia um curso normal no antebraço. A artéria radial se encontrava medialmente ao nervo mediano no braço e, então, no nível do epicôndilo medial, ela cruzava do lado medial para o lado lateral do antebraço, na superfície dos músculos flexores. O curso da artéria radial era superficial e tortuoso em todo o braço e antebraço. As variações das artérias radial e ulnar aqui descritas foram associadas a formação e curso anômalos do nervo mediano no braço. Conhecimento sobre anomalias neurovasculares são importantes para cirurgiões vasculares e radiologistas.

Case report of high origin of radial, ulnar, and profunda brachii arteries, its clinical implications and review of the literature / Relato de caso de origem alta das artérias radial, ulnar e braquial profunda, suas implicações clínicas e revisão de literatura

Arterial variations in the arm are of potential clinical implications as it is a frequent site of injury and also involved in many surgical and invasive procedures. During a dissection of the right upper extremity, an abnormal high origin of the radial and ulnar arteries was found. The brachial artery had a very short segment without any branches, divided into the radial and ulnar arteries at the upper third of the arm. The course and branching pattern of these radial and ulnar arteries in the arm are discussed. It was also observed that the profunda brachii artery was represented by two separate branches arising from the posterior circumflex humeral artery. Accurate knowledge of these variation patterns is of considerable clinical importance in the conduct of reparative surgeries around the shoulder and fracture management of the humerus. These additional data of arterial anomalies to contemporary anatomical literature are of interest to clinicians, in particular vascular and plastic surgeons and radiologists.

As variações arteriais no braço têm potenciais implicações clínicas já que o braço é um sítio de lesões frequentes, além de estar envolvido em muitos procedimentos cirúrgicos e invasivos. Durante a dissecção da extremidade superior direita, uma origem alta anormal das artérias radial e ulnar foi encontrada. A artéria braquial apresentava um segmento muito curto sem quaisquer ramos, dividindo-se nas artérias radial e ulnar no terço superior do braço. O curso e o padrão de ramificação das artérias radial e ulnar no braço são discutidos. Também se observou que a artéria braquial profunda estava representada por dois ramos separados, surgindo da artéria umeral circunflexa posterior. O conhecimento preciso sobre esses padrões de variação é de considerável importância na realização de cirurgias reparadoras na região do ombro e no manejo de fraturas de úmero. Estes dados adicionais sobre as anomalias arteriais para a literatura anatômica contemporânea são de grande interesse para os médicos, especialmente para cirurgiões plásticos e vasculares e radiologistas.

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.

role of ulnar variance in kienbock's disease

The etiology of Kienbock's disease is not clear definitely. Lunate blood supply, its shape and ulnar variance have been counted as the etiologies of this disease. For years, ulnar variance supposed to be an important predisposing factor for Kienbock's disease. There are controversies on the role of ulnar variance in Kienbock's disease and it has recently been stated that negative ulnar variance is not a risk factor for Kienbock's disease. The aim of this study was to elucidate the role of the negative ulnar variance in Kienbock's disease in Iranian patients. In this study, ulnar variance was measured in standardized condition in 90 normal wrists and in 67 patients with Kienbock's disease who had undergone surgery over the past 15 years. The correlation between age, sex and ulnar variance was assessed. We tried to determine the role of ulnar variance in the development of Kienbock's disease. Mean ulnar variance in the control group was 0.477 millimeter and in the group with Kienbock's disease, it was -0.995 millimeter. Regarding age, both groups were similar and after stratification by sex, we found that sex had no role in the development of disease. The correlations between age and ulnar variance, and sex and ulnar variance in the control group were not statistically significant. However, comparing case and control groups, we found statistically significant correlation between negative ulnar variance and Kienbock's disease. In spite of recent reports, negative ulnar variance is a predisposing risk factor for the development of Kienbock's disease