Accessory flexor carpi ulnaris muscle: a case report of a rare variation in human

This study describes a rare case of the accessory muscle originated from the flexor carpi ulnaris muscle. Anunusual variation of the flexor muscle was observed during the male cadaver dissection. The presence of ananatomical variation muscle was verified in the forearm on the left side of a 59 year old corpse settled in formol10%. Morphological variability and clinical significance are reviewed.

Accessory muscle in the forearm: a clinical and embryological approach / 대한해부학회지

Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.

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.

Anatomical Relation of Ulnar Nerve and Flexor Carpi Ulnaris Muscle at the Wrist

OBJECTIVE: To verify proper stimulation point of ulnar nerve at the wrist by investigating anatomical relation of ulnar nerve and flexor carpi ulnaris (FCU) muscle. METHOD: Cadaver dissection of 9 wrists was done to identify gross anatomical relation of ulnar nerve and FCU muscle. Ultrasonography of 17 healthy volunteers was done for the measurement of distance from lateral border of FCU muscle to ulnar nerve at three sites. Ratios of these distances to total width of FCU muscle and FCU tendon were calculated. RESULTS: FCU muscle was composed of lateral tendinous and medial muscular portion, and all ulnar nerves were located under the tendinous portion of FCU muscle on cadaver dissection. Ultrasonographic distances from lateral border of FCU muscle to ulnar nerve were 4.6+/-3.3 mm, 4.8+/-4.0 mm and 5.9+/-3.1 mm from distal to proximal sites. The ratios to total width of FCU muscle were 31.02+/- 23.31%, 24.30+/-26.12% and 24.48+/-13.01%, which showed that the ulnar nerve was closer to the lateral border than the medial border. The ratios to total width of FCU tendon were 49.63+/-41.35%, 51.30+/-50.46% and 64.59+/-36.79%, which showed progressive increment from distal to proximal sites. CONCLUSION: Proper stimulation point of ulnar nerve at the wrist is the lateral border of FCU muscle than the medial border. However, the proximity of ulnar nerve to the medial or lateral border was not conclusive, because the ratio to FCU tendon was not consistent in three sites of the wrist. Further electrophysiologic study is necessary for the comparison of proper stimulation point based on FCU tendon.

Mivacurium Chloride in Patients with Chronic Renal Failure / 대한마취과학회지

Mivacurium chloride(BW B1090U, mivacurium) was the second bis-benzylisoquinolinium diester compound in clinical deveopment. Short duration of action was emphasized as the most important clinical feature of this new drug, mainly due to its rapid hydrolysis by butyryl cholinesterase. Its hydrolysis rate in vitro by purified plasma cholinesterase approximated 88% of that of succinylcholine. The widespread use today of atracurium and vecuronium as the muscle relaxants of choice of patients with renal failure reflected their relatively larger systemic clearance rate and short duration of action. I have determined the neuromuscular blocking aetion of a bolus dose of mivacurium(0.2 mg/ kg) during 1-1.5% isoflurane and 50% nitrous oxide anesthesia in ten healthy patients and thirteen patients with chronic renal failure undergoing kidney transplantation. Neuromuscular block was assessed by measuring the electromyographic evoked response of the flexor carpi ulnaris muscle to train-of-four stimulation of the ulnar nerve with DATEX ABM. The results were as follows; 1) I found one of facial erythema, but did not find hypotension and taehycardia after the injection of mivacurium. 2) The onset, clinical duration(25%), 95% recovery time and recovery index(25-75%) after mivacurium was 2.28+/-0.35 min., 10.93+/-1.64 min., 25.72+/-3.42 min. and 6.77+/-1.75 min. in group 1, 2.41+/-0.22 min, 16.21+/-2.52 min., 35.17+/-3.68 min. and 9.09+/-3.29 min. in group 2(mean+/-SEM). There were no significance between two groups, but slightly inerease of clinical duration in group 2 was found. With the above results the author concluded that mivacurium was a reliable relaxant for outpatient and the patient with chronic renal failure due to short clinical duration, no cardiovascular effects and no changes in the patient with chronic renal failure.