Osseous vascular anatomy in the hand and wrist

The design and the realization of vascularized osseous grafts at the hand and the wrist require a precise knowledge of the general and regional anatomy. This article gives first a progress report on current knowledge about the general organization of arterial and venous vascularization, of the long bones (number and localization of the nutrient foramina, communication between the epiphyseo-metaphyseal and diaphyseal networks) and of the short bones, in the adult and the child, before the closing of the growth plate. The general organization of arterial vascularization of the hand and the wrist is pointed out, with the current nomenclature and the contribution of the recent publications, in particular in these, which relate to the distal extremity of the radius. The vascularization of each bone (radius and ulna, carpal bones, metacarpals and phalanges) is then described; making way, the anatomical bases of each vascularized bone graft, which can be harvested there, are described. The last technical projections are included, in particular the realization of the reverse flow vascularized bone grafts harvested from the metacarpals. This article still gives a progress report on the osseous vascularization of the short bones, in particular of those which are exposed the most to the osteonecrosis (scaphoid, lunatum). It has the ambition to light the reader and to prepare him (her) with the reading of the following chapters.     

Injection-corrosion-lavage. Techniques for study and description of vascular anatomy in the hand

The venous anatomy of the human hand has not been accurately described. Two main reasons for this deficiency in our knowledge are apparent: technical difficulties involved with dissection and imaging of the vessels, and the seemingly limitless number of topographic patterns in this field. This paper introduces firstly, a method for injection and corrosion of hand specimens, and secondly, a routine for describing the venous anatomy, primarily based on their function, and only secondarily on their position or topography.     

Anatomy and function of lumbrical muscles

The lumbrical muscles are unique in having their origin and insertion on tendons. The lumbricals assist in metacarpophalangeal joint flexion; they contribute to interphalangeal joint extension by acting as deflexors of the proximal interphalangeal joint. Anatomically, they are highly specialized in terms of their architectural properties, with a small physiologic cross-sectional area but long fiber length. Their unique properties indicate that they are probably important in fast, alternating movements and fine-tuning digit motion.     

White finger and hypertrophy of the lumbrical muscles

Within the digital vascularization diseases, we found a compression of the radial and ulnar collateral arteries of a finger by hypertrophy of the lumbrical muscles which was presented clinically in the form of a chronic sub-ischemia. A surgical release made it possible to recover a vascularized and sensitive finger.     

The treatment of carpal tunnel syndrome caused by hypertrophied lumbrical muscles. Case reports

Three cases of manual workers suffering from carpal tunnel syndrome caused by a hypertrophied lumbrical muscle are presented. Results of auxiliary diagnostic tests are presented and the differential diagnosis is discussed. We conclude that release of the transverse carpal ligament should be accompanied by release or excision of the muscle belly to obtain permanent cure.     

The vascular anatomy of the abductor digiti minimi and the flexor digiti minimi brevis muscles

PURPOSE: The abductor digiti minimi (ADM) and the flexor digiti minimi (FDM) brevis muscles could be used as flaps with their low functional morbidity, especially in severe crushed injuries of the hand. The vascular anatomy of both of the muscles were investigated to classify the muscles according to the Mathes-Nahai classification. METHODS: Nine cadavers embalmed with formaline were dissected under loupe magnification (x4) from the wrist proximally to the proximal phalanx of the small finger distally, delineating the branches of the ulnar artery along the ADM and FDM muscles. RESULTS: The dissections and the microangiography of the muscles revealed 1 major and 2 minor pedicles. Both of the muscles could be classified as type II muscles according to the Mathes-Nahai classification. CONCLUSIONS: The vascular pattern of the ADM muscle has been described previously, this study explored the vascular anatomy of the FDM muscle. The information regarding the vascular supplies of these muscles could be of help to the clinician when manipulating the muscles. The FDM muscle could be a suitable alternative for the ADM muscle in opponensplasty. When the pedicles are preserved the muscles could be used--based proximally or distally.     

Tear of an anomalous lumbrical muscle as a source of pain in the hand.

Symptoms from adhesions between lumbrical and interosseous muscles at the metacarpophalangeal joint have been described. We report a case in which symptoms were secondary to a tear in an anomalous lumbrical muscle of the ring finger.     

Personal observations on the role of the lumbrical muscles in carpal tunnel syndrome

A case of carpal tunnel syndrome is presented in which an abnormally high origin of a lumbrical muscle seemed to be the cause. Since the patient and author are the same, the symptoms of compression and during the postoperative period are well documented. Evoking the symptoms by exercise or active motion is suggested for future diagnostic tests. A surgical incision more ulnarward is recommended.     

Comparative anatomy of the hand

The pentadactyl scheme is common to all tetrapods, even in case of adaptative phenomenon (five digits are observed during ontogenesis), or in case of functional convergence The carpal organization with two rows is common too, if we take into account the desappearing of the central bones in mature man. The sellar shape of the trapeziometacarpal joint of the thumb, to often attributed to Man and his only thumb, is in fact the regular shape of all carpometacarpal articulations and present in very ancient primitive primate fossils. Some discontinuous caracters in Man (entepicondylar tunnel) are present in all individuals of some species (carnivors). Rarely present in Man, it can exceptionally produce a real pathology.     

Surgical anatomy of the hand

This article discusses the surgical anatomy of the hand highlighting key aspects that are of relevance to its function and to the surgeon.     

Architectural design of the human intrinsic hand muscles.

The architectural features of twenty different muscles (18 intrinsics and 2 thumb extrinsics, n = 180 total muscles) were studied. Muscle length, mass, fiber pennation angle, fiber length, and sarcomere length were determined. From these values, physiologic cross-sectional area and fiber length/muscle length ratio were calculated. Intrinsic muscle lengths were relatively similar to one another, which we interpreted as representing a space constraint within the hand. However, several specialized architectural designs were observed: lumbrical muscles had an extremely high fiber length/muscle length ratio, implying a design toward high excursion. The first dorsal interosseous and adductor pollicis had physiologic cross-sectional areas comparable to those of extrinsic muscles and much greater than those of the other intrinsic muscles. The interosseous muscles had relatively high physiologic cross-sectional areas with low fiber length/muscle length ratios, suggesting their adaptation for high force production and low excursion. Taken together, these observations illustrate the underlying structural basis for the functional capacities of the intrinsic muscles.     

Massive vascular leiomyoma of the hand.

A patient presented with a massive (5.0 x 4.0 x 3.0 cm) vascular leiomyoma (angioleiomyoma) in the hand, which had developed over a 50-year-period without pain. The clinical presentation, microscopic findings, and behaviour of vascular leiomyoma are described.