Morphological And Morphometric Study Of Dry Scaphoid Bone In The North Indian Population

Background: A review of the relevant literature showed that previous descriptions of scaphoid were not detailedenough to match our present clinical knowledge or the requirements of modern imaging especially in the NorthIndian population. With this in mind a study was conducted on 50 dry cadaveric scaphoids of North Indianorigin.Material and Methods: The study was performed on 50 dry human scaphoid bones of the North Indian population.Various morphological and morphometric parameters were observed and measured using vernier callipers, anon-stretchable thread, centimetre scales and a protractor.Results: All the morphological parameters studied were present in all the 50 bones except the sulcus for flexorcarpi radialis that was absent in 12 and the ridge for the scapho-capitate interosseous ligament that was absentin 13 bones. The tubercle was conical in 36, pyramidal in 13 and round in the remaining 1 bone. The maximallength of scaphoid and the thickness of waist were significantly higher on the right side. 30 bones had equallydeveloped, 10 bones had under developed proximal while the remaining 10 bones had under developed distalpole. The average value of anteroposterior intra scaphoid angle of 50 scaphoid was found to be 39.20+6.420.Clinical significance: The data obtained in the present study will be helpful for the hand surgeons, radiologists,morphologists and clinical anatomists

Flexor Carpi Radialis Tendon Rupture due to Repetitive Golf Swing

Flexor carpi radialis (FCR) muscle is located in the forearm anteriorly that runs through a synovial fibro-osseous tunnel in the forearm. We described a case of FCR tendon rupture due to repetitive overuse injury. A 55-year-old man, right-hand dominant, presented with right forearm pain and swelling which started 3 days ago while playing amateur golf. Focal tenderness and bruising over volo-ulnar region of the right forearm were examined. Plain radiographs showed soft tissue edema around lesion area and no detectable fracture. Ultrasonography showed multiple hypoechoic lesions suspected as hematoma of the flexor muscle group. After done magnetic resonance imaging, he was diagnosed with rupture of FCR tendon at proximal origin and strain of flexor digitorum superficialis and palmaris longus muscle. He received compressive dressing and restriction of wrist range of motion for three weeks. Two months later, remaining traces of lesions were observed at the follow-up ultrasonography and the pain disappeared.

Flexor Carpi Radialis Brevis: An Unusual Anomalous Muscle of the Wrist

During imaging studies or surgical procedures, anomalous forearm and wrist muscles are occasionally encountered. Among them, the flexor carpi radialis brevis is very rare. Because the trend is growing toward treating distal radius fractures with volar plating, the flexor carpi radialis brevis is worth knowing. Here, we report two cases with a review of the literature.

Imaging in the Diagnosis of Symptomatic Forearm Muscle Herniation.

Symptomatic muscle herniations are an unusual cause of upper extremity pain that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion6. Dynamic ultrasound and Dynamic MRI test are the very good tool for diagnosis of muscle herniation, FNAC and biopsy are rarely needed. This article describes a successful repair of a 22yr old manual worker’s ventral forearm herniation with polypropylene mesh. Prevalence Muscle herniation in an extremity is a well-known cause of pain, even though there have been extremely few documented cases. In a 2009 report published by the “Journal of Hand and Microsurgery,” only 200 cases of herniated muscles of the extremities had been reported since the mid-1800s, and only 17 cases of muscle herniation in the upper limb have been described10. Characteristics A herniated muscle in the forearm can cause mild to severe localized pain, affect grip, cause nerve pain or have no physical symptoms at all. Causes of documented cases include sporting or occupational activities, or an unrelated primary medical condition. Patients usually have a swollen mass that increases in size when the affected muscle is engaged and decreases when the muscles are relaxed. One differential diagnosis for a herniated forearm muscle is a tumor. Muscle herniation in the forearm typically affects males in their adolescent or young-adult years1. We report a case of a disappearing forearm nodule that appeared with muscle contraction. This is characteristic of a transfascial muscle hernia. Ultrasound and MRI are the key to identifying an area of fascial alteration. Treatment alternatives of this unusual condition are discussed.

Different frequency of the absence of the palmaris longus according to assessment methods in a Korean population / 대한해부학회지

The palmaris longus (PL) is a slender, spindle-shaped weak flexor of the wrist. Congenital absence of the PL is estimated to occur in 15% among individuals worldwide. However, the frequency of its absence varies considerably among different population groups and with different detection techniques. In the present study, the presence of the PL tendon was examined in a Korean population (n=269) using three clinical tests, namely the Traditional Test, Mishra's Test II, and the Gangata Test. We classified subjects into six types based on whether inspection or palpation was required to determine the presence of the PL and flexor carpi radialis. The most reliable test was determined using Kendall's coefficient of concordance. Our results showed that the PL tendon was absent in 4.1% of the subjects in our study, and bilateral and unilateral absences were 2.2% and 1.8%, respectively. Statistical analysis revealed that these tests had similar reliability for assessing the PL tendon, and the Traditional Test showed the highest effectiveness, at 93%. Therefore the Traditional Test was found to be the most effective for revealing the PL in this Korean population.

Clinical Utility of Flexor Carpi Radialis H-Reflex in the 7th Cervical Radiculopathy

OBJECTIVE: To determine the clinical utility of flexor carpi radialis (FCR) H-reflex with and without facilitation in the diagnosis of 7th cervical radiculopathy. METHOD: Thirty-four subjects (27 men, 7 women) participated in this study showed symptoms and signs suggesitive of cervical radiculopathy and every subject had single herniated cervical disc on MRI study. All participants underwent electrophysiologic study including routine nerve conduction study (NCS), electromyography (EMG), FCR H-reflexes with and without facilitation in both arms. Abnormal parameters for FCR H-reflex were 1) side to side latency difference more than 1.0 msec, 2) absence of FCR H-reflex in one side, 3) side to side amplitude ratio below 33% for without facilitation and 22% for facilitation. If the subjects had at least one of the three abnormal parameters, we concluded as having abnormal FCR H-reflex. RESULTS: In the FCR H-reflex without facilitation group, we were not able to elicit FCR H-reflex in both arms in 17 subjects. Among the 17 subjects with elicited FCR H-reflex, 7 had abnormal FCR H-reflex (C7 root; 4, other roots; 3). In the FCR H-reflex with facilitation group, FCR H-reflex was obtained in 32 subjects, 13 out of the 32 showed abnormal FCR H-reflex (C7 root; 6, other roots; 7). The sensitivity and specificity of FCR H-reflex without facilitation in the diagnosis of 7th cervical radiculopathy were 67%, 73%, with facilitation it were 50%, 65%. CONCLUSION: Even though FCR H-reflex without facilitation is superior in its sensitivity and specificity, low elicitabiliy is the factor that limits its clinical utility. FCR H-reflex with facilitation with its good elicitability, seems to be a useful adjunctive method to routine NCS and EMG examination in the diagnosis of 7th cervical radiculopathy.

H-reflexes in the Flexor Carpi Radialis with Facilitation and with Facilitation & Averaging: Normative Data

OBJECTIVE: To determine the normal values of flexor carpi radialis (FCR) H-reflex without facilitation, with facilitation and with facilitation & averaging. And to compare the three methods. METHOD: The FCR H-reflex was tested in 60 healthy people. 1) H-reflexes was recorded in the FCR muscle without facilitation. 2) H-reflexes was recorded in the FCR muscle with facilitation and facilitation was carried out by contracting the FCR muscle with 1 kg of weight. 3) FCR H-reflex was tested by repetitive stimulation with facilitation and the multiple responses were averaged. RESULTS: Without facilitation, FCR H-reflexes were elicited only in 24 people out of 60 people and with facilitation, FCR H-reflexes were elicited in all 60 people. The mean latencies and amplitudes of the three methods were measured and normal limits of latency difference and amplitude ratio were calculated. In the FCR H-reflex without facilitation, with facilitation and with facilitation & averaging, the normal limits of latency difference were 1.0 msec, 1.0 msec, 1.1 msec and normal limits of amplitude ration were 0.37, 0.22, 0.57. CONCLUSION: FCR H-reflex with facilitation and with facilitation & averaging might be useful in the clinical diagnosis.

Clinical Experience of Local Steroid Injections through the Flexor Carpi Radialis for Treating Carpal Tunnel Syndrome / 대한마취과학회지

BACKGROUND: Local steroid injections for the treatment of carpal tunnel syndrome have become common, but median nerve injuries after the injections have rarely been reported. In our study, we checked the occurrence of a severe pain during local steroid injections through the flexor carpi radialis, and we evaluated the efficacy of injections for several short-term period. METHODS: A total of 24 patients with 32 affected hands were studied. The patients who presented with known medical causes or thenar muscle atrophy or a previous trauma history at the affected wrist were excluded from the study. The diagnosis was made both clinically and electrophysiologically, and then the injections were performed through the flexor carpi radialis with the hand in the supine position. Triamcinolone Acetonide (TA) 40 mg was injected first, and TA 20 mg was reinjected when the recovery rate on a 100 mm visual analog scale (VAS) score was below 50% 1 week after the injection. The patients were reevaluated with the VAS score before and 1, 3 and 6 months after the injections. RESULTS: In our study, no patients reported severe pain indicating there was median nerve injury during the injections. The mean VAS scores were 64.9, 9.5, 31.1 and 47.3 before and 1, 3 and 6 months after the injections respectively. As a result, the injections were deemed for the short-term period (P < 0.05). CONCLUSIONS: In our study, we concluded that local steroid injection through the flexor carpi radialis for treating carpal tunnel syndrome is a safe and effective method.

H-reflex in flexor carpi radialis of normal subjects.

The H-Reflex of flexor carpi radialis muscle was studied in 100 normal Thai subjects 62 females and 38 males) with the average age of 29.10+7.75. The average body mass index was 20.53+2.57 Kg/m2. The FCR H-reflex can be recorded from both upper limbs in 52 subjects, one sided response in 22 subject and no response at all in 26 subjects. The average latency of FCR H-reflex was 12.41+1.48 ms. The average amplitude, duration and intensity were 0.77+0.54 mV, 10.17+2.72 ms and 87.30+28.30 V respectively. There was no statistic difference between the right and the left H-reflex value. The reproducible H-reflex didn’t correlate with age, sex and body mass index. This study presented the additional method for studying proximal medium nerve and C6-7 root pathology.