A Case of Kampo Medicine Treatment for Acute Antebrachial Compartment Syndrome in the Arm Caused with Percutaneous Coronary Intervention Via Radial Artery / 日本東洋医学雑誌

After percutaneous coronary intervention (PCI), the patient developed symptoms of pain, sensory impairment, paralysis, pallor of the skin, and pain during passive extension, and was diagnosed with PCI-induced antebrachial compartment syndrome. Since it was considered to be blood stasis and water stasis in Oriental medicine, we administered jidabokuippo and keishibukuryogan to the patient. Then the subjective and objective symptoms improved promptly, and the symptoms disappeared by the 10th day after the operation. The patient was able to discontinue jidabokuippo 14 days after the operation. It was suggested that the symptomatic treatment with Kampo medicine is effective for compartment syndrome.

Isolated musculocutaneous nerve injury following a pedestrian-automobile collision: A case report

@#Isolated musculocutaneous nerve (MCN) lesion is rare and usually associated with direct trauma. Along with the rarity of this condition, other muscles involved in elbow flexion, such as brachioradialis and pronator teres, can mask the weakness induced by the MCN injury and make it difficult to identify it. Here, we report a 17-year-old patient with isolated MCN palsy following a single episode of anterior shoulder contusion. A lack of suspicion for this rare condition delayed diagnosis until 7 months post injury, when atrophy of muscles in the left upper arm became prominent and weakness of the elbow flexors persisted. After 6 months of rehabilitation therapy rather than undergoing surgical exploration, elbow flexor strength was nearly fully recovered but sensory symptoms remained. The mechanism of injury is speculated to be a sudden overloading of the anterior shoulder with extension and external rotation, which overstretched and compressed the MCN within the coracobrachialis muscle where the nerve is relatively fixed. Although isolated peripheral nerve injury is rare, it can be caused by a single episode of vigorous impact. Therefore, even in patients without any external wounds, careful physical examination with suspicion of peripheral nerve injury as one of the differential diagnoses is needed.

Unusual bilateral sensory innervation of the dorsum of hand by lateral antebrachial cutaneous nerve: a case report / 대한해부학회지

A 68-year-old male cadaver showed bilateral variation in the sensory innervation of the dorsum of hand. On the dorsum of right hand, first digit and lateral half of second digit were supplied by lateral antebrachial cutaneous nerve (LABCN); medial side of second digit and lateral side of third digit were supplied by superficial branch of radial nerve (SBRN) and medial side of third digit, the fourth and fifth digits were supplied by dorsal cutaneous branch of ulnar nerve (DBUN). On the dorsum of the left hand, lateral side of first digit was supplied by LABCN, medial side of first digit, the second and third digits as well as the lateral side of fourth digit were supplied by SBRN; medial side of fourth digit and fifth digit were supplied by DBUN. These variations would be helpful in understanding peripheral neuropathy, in interpretation of conduction velocity studies and in reconstructive surgery of hand.

Ultrasonographic Study of the Anatomical Relationship Between the Lateral Antebrachial Cutaneous Nerve and the Cephalic Vein

OBJECTIVE: To define the anatomy of the lateral antebrachial cutaneous nerve (LABCN) and the cephalic vein (CV) in the anterior forearm region of living humans using ultrasonography for preventing LABCN injury during cephalic venipuncture. METHODS: Thirty forearms of 15 healthy volunteers were evaluated using ultrasonography to identify the point where the LABCN begins to contact with the CV, and the point where the LABCN separates from the CV. The LABCN pathway in the forearm in relation to a nerve conduction study was also evaluated. RESULTS: The LABCNs came in contact with the CV at a mean of 0.6±1.6 cm distal to the elbow crease, and separated from the CV at a mean of 7.0±3.4 cm distal to the elbow crease. The mean distance between the conventionally used recording points (point R) for the LABCN conduction study and the actual sonographic measured LABCN was 2.4±2.4 mm. LABCN usually presented laterally at the point R (83.3%). CONCLUSION: The LABCN had close proximity to the CV in the proximal first quarter of the forearm. Cephalic venipuncture in this area should be avoided, and performed with caution if needed.

Anatomy of osterior antebrachial cutaneous nerve related to the lateral epicondyle and interepicondylar line / Anatomía del nervio cutáneo posterior del antebrazo relacionado con el epicóndilo lateral y la línea interepicondilar

Posterior antebrachial cutaneous nerve (PACN) is a branch of radial nerve supplying the skin of posterior forearm. Data regarding its anatomy remain insufficient especially the origin and number of branches. We dissected 101 upper extremities from 32 male and 20 female cadavers to expose the PACN. In all specimens, the nerve emerged from the deep fascia at the hiatus proximal to the interepicondylar line (IEL) with mean distances of 7.24 and 7.44 cm in males and females, respectively. Percentage of this distance to the arm length was 23.2 % and 26.1 % in males and females, respectively. After penetrating the deep fascia, the PACN coursed in the subcutaneous layer and crossed the IEL anterior to the lateral epicondyle (LE) in all cases. The mean distances from the crossing point to the LE along the IEL were 1.52 cm in males and 1.34 cm in females. Regarding the branches of PACN, at least 50 % of the specimens had up to 3 or 4 branches originating either proximal or distal to the hiatus. In two arms, one of these branches passed posterior to the LE. Moreover, there were communicating branches between the PACN and the lateral antebrachial cutaneous nerve in 9 specimens. Gender and side differences were found in some measurement parameters. These data are crucial for avoiding the PACN injury during surgical procedures around the elbow.

El nervio cutáneo posterior del antebrazo (NCPA) es un ramo del nervio radial que inerva la piel del antebrazo. Los datos acerca de su anatomía siguen siendo insuficientes en especial en cuanto a su origen y el número de ramos. Disecamos 101 miembros superiores de cadáveres pertenecientes a 32 hombres y 20 mujeres para exponer el NCPA. En todas las muestras, el nervio surgió de la fascia profunda en el hiato proximal a la línea interepicondilar (LIE) con distancias medias de 7,24 y 7,44 cm en hombres y mujeres, respectivamente. El porcentaje de esta distancia a la longitud del brazo fue 23,2 % y 26,1 % en hombres y mujeres, respectivamente. Después de penetrar la fascia profunda, el NCPA continuaba en el tejido subcutáneo y cruzaba la LIE anterior al epicóndilo lateral (EL) en todos los casos. Las distancias medias desde el punto de cruce del EL a lo largo de la LIE fueron 1,52 cm en hombres y 1,34 cm en mujeres. Con respecto a las ramos del NCPA, al menos 50 % de las muestras tenían hasta 3 o 4 ramos, ya fuesen proximales o distales al hiato. En dos de los brazos, uno de estos ramos pasó posterior al EL. Por otra parte, en 9 de las muestras se observó comunicación entre los ramos del NCPA y el nervio cutáneo antebraquial lateral. No se encontraron diferencias secundarias o de sexo en algunos parámetros de medición. Estos datos son esenciales para evitar las lesiones durante los procedimientos quirúrgicos alrededor del codo que involucren el NCPA.

Descriptive anatomy of lateral digital extensor muscles of the hand of the white-footed tamarin (Saguinus leucopus Günther, 1876) / Anatomía descriptiva de los músculos extensores digitales laterales de la mano del tití gris (Saguinus leucopus Günther, 1876)

The Saguinus leucopus is an endemic and monotypic primate of Colombia with quadrupedal arboreal locomotion, but the study of its morphological adaptations are still scarce, therefore the specific knowledge of its muscles will allow to understand these adaptations and to establish better medical and surgical procedures in order to preserve this species. For this purposes, the two forearms of 10 S. leucopus specimens were dissected, they were fixed within a formaldehyde solution, phenic acid and mineral oil mixture. Among the craniolateral muscles of the forearm two muscles were independent for digits IV and V. They presented form, origin and insertion suitable for individual extension of each digit, with innervation and irrigation by the cranial interosseous nerve and the homonymous artery respectively; they show similarities and differences with other primates, it allows to conclude that the development of these muscles could enable a particular anatomical and functional individualization in these digits extension, this feature makes possible its quadrupedal arboreal locomotion.

El Saguinus leucopus es un primate endémico y monotípico de Colombia con la locomoción cuadrúpeda arbórea, sin embargo los estudios de sus adaptaciones morfológicas aún son escasos, por lo tanto, el conocimiento específico de sus músculos permitirá conocer estas adaptaciones y establecer mejores procedimientos médicos y quirúrgicos con el fin de preservar esta especie. Para estos fines, se disecaron los dos antebrazos de 10 especímenes de S. leucopus, los cuales fueron fijados con una solución en mezcla de formaldehído, aceite mineral y ácido fénico. Entre los músculos cráneo laterales del antebrazo se encontraron dos músculos independientes para los dígitos IV y V. La forma, el origen y la inserción eran adecuadas para la extensión individual de cada dígito, con la inervación e irrigación por el nervio interóseo craneal y la arteria del mismo nombre respectivamente, presentando similitudes y diferencias con otros primates, lo que permite llegar a la conclusión que el desarrollo de estos músculos podría permitir una individualización anatómica y funcional particular en la extensión de estos dígitos, haciendo posible su locomoción cuadrúpeda arbórea.

Neurolymphomatosis Involving Antebrachial Cutaneous Nerve / 대한정형외과학회잡지

The term neurolymphomatosis has included infiltration of the peripheral nervous system by lymphoma. In generally, direct invasion of the peripheral nervous system is rare. The difficulty in treatment of neurolymphomatosis is due to unclassified characteristic symptoms and diagnosis. We performed excision of mass on the antebrachial cutaneous nerve with no specific symptoms. After diagnosis of diffuse large B cell lymphoma, further treatment and observation were followed. However, recurrence of the lymphoma was found in the ipsilateral forearm ulnar nerve, therefore we described a case of neurolymphomatosis with a brief review of the literature.

Descripción anatómica del músculo extensor del I y II dedo de la mano del zorro perruno (Cerdocyon thous Linnaeus, 1766) / Anatomical description of crab-eating fox' (Cerdocyon thous Linnaeus, 1766) extensor of digit i and ii muscle

El zorro perruno (Cerdocyon thous) es el cánido silvestre más común en América del Sur, con una relativa estabilidad poblacional, pero susceptible de ser atropellado y caer en trampas, pudiendo sufrir traumas en sus miembros torácicos, por lo tanto se requiere un conocimiento anatómico específico de sus músculos para intervenciones médicas y quirúrgicas. El objetivo principal de esta investigación fue realizar una descripción anatómica del músculo extensor del I y II dedo del C thous, en la cual, se reporta forma, origen, inserción, inervación e irrigación. Se diseccionaron de superficial a profundo los dos antebrazos de seis especímenes muertos donados por CORPOCALDAS a la Universidad de Caldas. El músculo extensor del I y II dedo en este estudio presentó características anatómicas similares a las reportadas a otras especies pero con una distribución tendinosa variante formando desde tres a cuatro ramas que se distribuyen del I al III dedo, incluso faltando a veces para el III dedo, pero de igual forma presenta una distribución que debe ser conocida para procedimientos que requieran de su conocimiento.

The crab-eating fox (Cerdocyon thous) is the most common wild canid in South America. With a relative demographic stability, this animal is susceptible of being hit and falling into traps, and can suffer trauma in its thoracic limbs; therefore a specific anatomical knowledge about its muscles is necessary for medical and surgical procedures. The main aim of this research was to describe the anatomy of the extensor muscle of digit I and II of the C. thous reporting form, origin, insertion, innervation and irrigation. The forearms of six donated dead specimens from CORPOCALDAS to Caldas University were dissected from superficial to deep. In this research, the extensor muscle of digit I and II showed similar anatomical features to those reported for other species but with a variant tendinous distribution that forms from three to four branches distributed from digit I to III. Although sometimes this distribution does not exist for the digit III; this similar distribution must be reported for procedures which require this knowledge.

Descripción anatómica del músculo braquiorradial del tití gris (Saguinus leucopus Günther, 1877) y el hallazgo de una cabeza accesoria como variante anatómica / Anatomical description of white-footed tamarin (Saguinus leucopus Günther, 1877) brachioradialis muscle, and the finding of an accessory head as an anatomical variant

El Saguinus leucopus es un primate neotropical, endémico y monotípico de Colombia, con escasos estudios sobre su anatomía, en especial de sus músculos, siendo estos un elemento fundamental para la locomoción activa de este primate en los árboles. El objetivo del presente estudio fue describir la anatomía macroscópica del músculo braquiorradial del tití gris (Saguinus leucopus), tomando como base del estudio diez especímenes fijados con formalina al 10%, y a cada uno de ellos se les disecó los dos miembros torácicos de superficial a profundo, describiendo la forma, el origen, la inserción, la inervación y la irrigación del músculo braquiorradial. Se concluye que es un músculo que presenta una morfología, que debe contribuir a los movimientos flexores y supinadores del codo, y puede llegar a tener una cabeza accesoria en esta especie.

The Saguinus leucopus is a neotropical, endemic, and monotypic Colombian primate; few studies have been reported about its anatomy, specially about its muscles, this being a fundamental element for the active motion of this primate in the trees. The aim of this study was to describe the gross anatomy of the brachioradialis muscle on the white-footed tamarin (Saguinus leucopus). Ten specimens were included in the study, fixed with formalin at 10% and their thoracic limbs dissected, from the superficial to the deep plane, describing the form, origin, insertion, innervation and irrigation of the Brachioradialis muscle. The conclusion we made is that this muscle represents a morphology and in this way it must contribute to the flexor and supinator elbow movements, and would have an accessory head in this species.

Medial antebrachial cutaneous nerve: anatomical relationship with the medial epicondyle, basilic vein and brachial artery / Nervio cutáneo antebraquial medial: relación anatómica con el epicóndilo medial, vena basílica y arteria braquial

Medial antebrachial cutaneous nerve (MACN) courses in the medial arm to provide sensory innervation to the medial forearm. Its anatomy has been partly described since data regarding its branching pattern and distances to adjacent landmarks are still lacking. The purpose of this study was to provide morphometric anatomy of the MACN with comparisons between sides and sexes. Ninety-six upper extremities from 26 males and 22 females were dissected. We found that up to 5 branches of MACN pierced the deep fascia with the maximum of 4 reaching the interepicondylar line (IEL). Presence of 2 and 3 branches was found in the majority of cases (> 80%). The distances from these branches to the landmarks varied considerably. In case of no branch, the mean distances to the medial epicondyle (ME) and brachial artery (BA) were approximately 1.5 cm while those to the basilic vein (BV) were 0.7 cm in both sexes. Regardless of the branching pattern, the MACN could pass over or close (within 0.5 cm) to the ME, BV and BA. Asymmetry in the branching pattern was found in 50% of specimens. Sex but not side differences were observed in some measurement parameters. These data are crucial for not only localizing the MACN during nerve block and graft harvest but also avoiding the nerve injury during surgical procedures.

El recorrido del nervio cutáneo antebraquial medial (NCAM) proporciona la inervación sensorial medial del antebrazo. Su anatomía se ha descrito en parte, porque los datos relativos a su patrón de ramificación y distancias a puntos de referencia adyacentes son insuficientes. El propósito de este estudio fue proporcionar datos morfométricos sobre la anatomía del NCAM, comparando entre lados y sexos. Se disecaron 96 miembros superiores de 26 hombres y 22 mujeres. Se encontró que 5 ramos del NCAM traspasaron la fascia profunda y llegaron 4 hasta la línea interepicondilar (LIE). Presencia de 2 y 3 ramos se encontró en la mayoría de los casos (>80%). Las distancias de estos ramos a los puntos anatómicos variaron considerablemente. En caso de ausencia de ramos, la distancia medial al epicóndilo medial (EM) y arteria braquial (AB) fueron de aproximadamente 1,5 cm, mientras que a la vena basílica (VB) fueron 0,7 cm en ambos sexos. Independientemente del patrón de ramificación, el NCAM podría pasar sobre o cerca (a menos de 0,5 cm ) del EM, VB y AB. Asimetría en el patrón de ramificación se encontró en 50% de las muestras. Diferencias en algunos de los parámetros de medición se observaron según sexo, pero no por lado. Estos datos son relevantes para localizar el NCAM durante el bloqueo del nervio y la toma de injertos, sino también para evitar la lesión del nervio durante los procedimientos quirúrgicos.

Determination of an Ideal Stimulation Site of the Medial Antebrachial Cutaneous Nerve Using Ultrasound and Investigation of the Efficiency

OBJECTIVE: To determine an ideal stimulation site of the medial antebrachial cutaneous nerve (MACN) using ultrasound measurement and to compare the efficiency of the new stimulation site with the conventional stimulation site on the nerve conduction study. METHODS: Both arms of 15 healthy participants were measured using ultrasound. The MACN was identified in the transverse view at each 0, 2, 4, 6, and 8 cm proximal sites from the medial epicondyle, and the distances to the median nerve and to the skin from the MACN were measured. The ideal stimulation site should be located at the level which can give the shortest distance from the skin and the longest distance from the median nerve in terms of volume conduction. To confirm the efficiency of the ideal site, we measured the amplitude of the MACN conduction study at the ideal site against one at the 4 cm proximal to the medial epicondyle (conventional site). RESULTS: The ultrasound showed the ideal stimulation site for the MACN could be the elbow crease line. However, the nerve conduction study revealed that the amplitudes of the MACN were significantly larger at the 4 cm proximal to the medial epicondyle compared with ones at the ideal site. CONCLUSION: The ideal stimulation site based on the ultrasound did not permit better stimulation site for the nerve conduction study of the MACN compared with the conventional site. Careful adjustment of the stimulation site on the basis of this study would contribute to an accurate conduction study of the MACN.

Anatomical Distribution of Branches of the Medial Antebrachial Cutaneous Nerve during Cubital Tunnel Surgery

PURPOSE: The purpose of this prospective study is to examine the anatomical variations of the branches of the medial antebrachial cutaneous nerve in Koreans encountered during cubital tunnel surgery. METHODS: Ninety two patients with cubital tunnel syndrome were treated with a standard approach from December 2008 to July 2012. The position of the branches of medial antebrachial cutaneous nerve was evaluated based on the medial humeral epicondyle with the elbows fully extended. RESULTS: At least one medial antebrachial cutaneous nerve branch was found during the surgeries in all patients. The average number of crossing medial antebrachial cutaneous nerve branches per patient was 1.6. Thirty-eight percent of the cases showed that the medial cutaneous nerve branches cross proximal to the medial humeral epicondyle within 1 cm. Eighty-two percent showed that the medial antebrachial cutaneous nerve branches cross distal to the medial humeral epicondyle within 1.9 cm. CONCLUSION: When using standard approach during cubital tunnel surgery, more than one medial forearm cutaneous nerve is found. Therefore, understanding the general position of medial antebrachial cutaneous nerve branches helps avoid iatrogenic damage to this nerve during cubital tunnel surgery.

Normal conduction values for the posterior antebrachial cutaneous nerve / 中华物理医学与康复杂志

Objective To determine normal reference values for conduction in the posterior antebrachial cutaneous nerve.Methods Antidromic sensory conduction examinations of the bilateral posterior antebrachial cutaneous nerve were conducted with fifty-eight healthy subjects.The onset latency,peak latency,peak-to-peak amplitude and conduction velocity of the sensory nerve action potentials (SNAPs) were recorded and the inter-side ratios of the peak-to-peak amplitudes were calculated.Results The observed means (and standard deviations) of the onset time,the peak latency,the amplitude and the conduction velocity were 1.96 (0.12) ms,2.48 (0.14) ms,7.39 (2.36) μV and 61.39 (3.69) m/s,respectively.The side-to-side amplitude ratio (smaller/larger) was 0.88 ± 0.09,and no significant difference was observed between the left and right side.The average peak latency and amplitude were significantly different for different age groups.There was no statistically significant difference among the age groups with regard to onset latency or conduction velocity.Conclusion Conduction in the posterior antebrachial cutaneous nerve is easy to study.The peak latency is prolonged and the amplitude decreases with age,suggesting that different normal reference values should be established for different age groups.

A case report on variant ulnar artery.

During routine dissection for 1st MBBS students on 65 year old donated embalmed male cadaver in the Department of Anatomy, K.J.Somaiya Medical College, Sion, Mumbai, India, we observed an unusual branch of the brachial artery. The brachial artery terminated in the cubital fossa into radial and common interosseous arteries. The radial artery had normal course and branches. The common interosseous artery was deeper and gave anterior and posterior ulnar recurrent arteries, and terminated into anterior and posterior interosseous arteries. The unusual large branch from the brachial artery was a variant of ulnar artery, arose from the lateral side of the brachial artery, descended on the lateral side upto the cubital fossa and crossed the fossa from lateral to medial, superficial to median nerve. It then descended superficial to the muscles arising from medial epicondyle of the humerus and was covered by the deep fascia of the forearm, pierced the deep fascia proximal to the wrist, crossed the flexor retinaculum, and formed the superficial palmar arch. Throughout its course, this artery gave no branch. There was no associated altered anatomy of the nerves observed in the specimen. The left upper limb of the same cadaver was normal. The photographs of the variations were taken for proper documentation and for ready reference. The embryological basis of the variation is presented.

Isolated Musculocutaneous Nerve Palsy

No abstract available.

Anatomical basis of lateral antebrachial neurocutaneous flap pedicled with inferior cubital artery perforator / 中华显微外科杂志

Objective To provide anatomical basis for lateral antebrachial neurocutaneous flap pedi-cled with inferior cubital artery perforator in repairing tissue defects around elbow joint. Methods Thirty embalmed upper limbs of adult cadavers perfused with red latex were used for this study, and followings were observed:①The course and distribution of lateral antebrachial cutaneous nerve; ②Anastomoses between inferior cubital artery and nutrient vessels of lateral antebrachial cutaneous nerve. Mimic operation was performed on other side of fresh specimen. Results ①The main trunk of lateral antebrachial cutaneous nerve (LACN) lined in the radial forearm and distributed in the 1/3 region of lateral forearm. ①The nutritional vessels of the flap were plurisegmental and polyphyletic. The inferior cubital artery which was relatively constant reached to skin through "V"-shaped peak formed by communicating branches of cephalic vein and deep venous system. They also gave off large number of small veins, which closely aligned with perineural branches and neural stem vascular chain of lateral antebrachial cutaneous nerve. Conclusion The lateral antebrachial neurocutaneos flap pedicled with inferior cubital artery perforator can be formed to repaire tissue defects around elbow joint.

Anatomical Considerations of Lateral and Medial Antebrachial Cutaneous Nerves

OBJECTIVE: To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. METHOD: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. RESULTS: BT_L and L12 were 1.4+/-3.7 mm and 4.4+/-3.7 mm respectively. ME_M, M8 and M10 were 28.6+/-6.9 mm, 18.9+/-8.9 mm and 18.3+/-8.2 mm respectively. The thickness of LABCN and MABCN was 19.1+/-4.9 mm and 13.2+/-4.2 mm respectively. CONCLUSION: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm.