Flexor carpi ulnaris herniation after cubital tunnel release: A case report.

Muscle herniation in the upper extremity is a rare but recognized phenomenon with a paucity of reports in the current literature. In the majority of cases, the herniation is secondary to trauma, with some of the cases due to muscle hypertrophy and increased intra-compartmental pressure from the forced exertion. Treatment for this condition ranges from nonsurgical, repair, or reconstruction to fasciotomy of the flexor carpi ulnaris fascia. Here, we present a case of flexor carpi ulnaris herniation after an open in situ cubital tunnel release in a 57-year-old male 6 years after initial surgery. The patient's symptoms did not improve with conservative management, and the patient subsequently underwent endoscopic fasciotomy with resolution of his symptoms and maintenance of his wrist and grip strength. The rationale for the treatment chosen is discussed.

Innervation of the Proximal Interphalangeal Joint: An Anatomical Study.

PURPOSE: To describe the innervation of the proximal interphalangeal (PIP) joint of the fingers as well as the anatomical relations of the articular branches. METHODS: In this anatomical study, 52 fresh-frozen index, long, ring, and little fingers of 6 male and 4 female cadavers were dissected after injection of a colored latex composite. The anatomical dissections were performed under ×3.5 and ×6.0 magnifications. The numbers of articular nerve branches that penetrated the PIP joint on both sides of the fingers were quantified and patterns of innervation were established. We also measured the origin of the branches regarding the PIP articular line, the angle of emergence, and the diameter of the nerves. RESULTS: The PIP joint was innervated by one articular branch of the proper palmar digital nerve at each side of the finger (pattern 1). Less frequently, an additional distal branch from the same proper palmar digital nerve was found (pattern 2). Dorsal articular branches were identified innervating only the little finger. CONCLUSIONS: The findings suggest that PIP joints of the fingers have a consistent articular nerve anatomy predominantly provided at the palmar aspect of the joint. These findings provide an anatomical basis for procedures to denervate the PIP joint. CLINICAL RELEVANCE: An accurate understanding of peripheral nerve anatomy of the PIP joint is essential to improve outcomes in denervation techniques.

Innervation of the interphalangeal joint of the thumb: anatomical study.

We dissected 30 cadaveric thumb interphalangeal joints to delineate the sensory nerve anatomy of its capsule. Four articular branches supplying the interphalangeal joint capsule of the thumb were found in all specimens. Ulnar and radial proper digital nerves provide one palmar capsular nerve branch on their respective sides. Of the two dorsal branches of the radial nerve at the dorsum of the thumb, we observed that each nerve provided one branch to the interphalangeal dorsal capsule. Our findings demonstrate a consistent pattern of innervation and may provide the anatomical basis to the treating surgeon for an effective and safe denervation of the interphalangeal joint of the thumb.