Lateromedial and dorsoplantar borders among supplying areas of the nerves innervating the intrinsic muscles of the foot

The branching patterns of nerves supplying the intrinsic muscles of the foot were analyzed as a basis to confirm the muscle layer structure. Thirty‐eight feet of 20 Japanese cadavers were examined in detail in this study. The first dorsal interosseus was innervated by a branch from the deep peroneal nerve as well as a branch of the lateral plantar nerve in 92.1%, the second dorsal interosseus in 10.5% and the third dorsal interosseus in 2.6%. In three specimens, branches from the deep peroneal nerve innervated the oblique head of the adductor hallucis or the lateral head the flexor hallucis brevis. In addition, branches from the medial and lateral plantar nerves and the deep peroneal nerve formed communication loops in three specimens. The first dorsal interosseus, the oblique head of the adductor hallucis and the lateral head of the flexor hallucis and their innervating nerve branches are closely related within the first intermetatarsal space. Since the tibial part of the first interosseus muscle primordium is occupied in the space during development, the variations of innervation patterns and formation of the communicating nerve loops may be explained by various combinations of the part and the other muscle primordia. Anat Rec 255:465–470, 1999. © 1999 Wiley‐Liss, Inc.     

拇展肌与拇收肌移位吻接术前、后黏弹性实验研究

研究了正常拇展肌、拇收肌拉伸黏弹性力学性质和模拟拇外翻拇展肌、拇收肌移位吻接术后拇展肌和拇收肌的拉伸黏弹性力学性质.取20个足标本,解剖后暴露拇展肌与拇收肌,得出拉伸应力松弛、蠕变等数据.对断裂后的拇收肌和拇展肌模拟临床手术进行移位吻接,对10个拇展肌和10个拇收肌标本做腱与腱吻接,另各取10个拇收肌、拇展肌标本做了腱与骨膜吻接.对吻接后的标本进行拉伸实验,得出了吻接术后各组拉伸应力松弛、蠕变曲线.以回归分析的方法处理实验数据,得出了归一化应力松弛、蠕变曲线及归一化应力松弛函数和归一换化蠕变函数.     

腹前外侧群肌的肌内神经分布模式

目的 揭示腹前外侧群肌的肌内神经分布模式,探讨其临床意义。 方法 取经甲醛固定的12具24侧中国成年尸体的腹前外侧群肌,行改良的Sihler染色。 结果 腹前外侧群肌的神经绝大多数源于节段性分布的胸神经。腹外斜肌各肌齿有独立的神经支配,在髂前上棘和髂结节之间的髂嵴上方有一纵向神经密集带。腹内斜肌腹股沟韧带中点上方有一纵向神经密集带,髂嵴上方有一横向神经密集带。腹横肌髂前上棘与第8、9肋软骨连结处之间有一弧形的神经密集带。腹直肌各肌腹中部有一横向神经密集带,上3个肌腹有独立神经支配。 结论 腹外斜肌和腹直肌可分出神经肌肉亚部;各肌内的神经密集带应被考虑为肉毒毒素A注射和局部麻醉的最佳靶点部位,不宜设为腹壁手术的切口部位。     

Pseudoganglion on the connecting branch between the deep branch of the lateral plantar nerve and medial plantar nerve

The connecting branch between the deep branch of the lateral plantar nerve and medial plantar nerve often has an enlarged site. We investigated these enlarged sites of the connecting branches. We observed the 22 human feet of 20 Japanese cadavers. We investigated the connecting branch macroscopically and histologically. We found the connecting branches between the deep branch of the lateral plantar nerve and medial plantar nerve in 19 feet out of 22 feet. This connecting nerve branch was interposed between the tendon of the flexor hallucis longus and the flexor hallucis brevis, and there enlarged in the anteroposterior direction. After penetration, numbers of fascicles of this connecting branch were increased at the enlarged site. In this region, the connective tissues surrounding the nerve fascicles and vessels were more developed compared with the adjoining sides of this branch. A few fascicles at this enlarged site innervated the first metatarsophalangeal joint capsule. Other nerve fascicles arose from the connecting branch and branched off muscular branches to the flexor hallucis brevis. This branch possibly receives the physical exertion or friction during gait due to its position. Deformity and overload of the foot can cause sensory disorders of the foot, but the anatomical basis for the relationship between the deformity/overload and sensory disorders of the foot is unclear. We discussed that this connecting branch can be a potential cause of pressure neuropathies in the human foot.     

Ramification pattern of the deep branch of the lateral plantar nerve in the human foot

To understand how the oblique and transverse heads of the adductor hallucis muscle of the human foot are phylogenitically and ontogenetically developed, it is essential to know nerve supplies of these two heads of the muscle. In the present study, we dissected seven feet of five Japanese cadavers in detail to clarify the ramification patterns of the deep branch of the lateral plantar nerve by peeling off its epineurium (the nerve fascicle analysis method). We found that the muscular branch to the oblique head of the adductor hallucis muscle directly separated from nerve fascicles constituting the deep branch of the lateral plantar nerve, whereas the muscular branch to the transverse head arose in common with branches which innervated other intrinsic muscles of the foot, i.e., the 2nd and 3rd lumbrical muscles and the 1st and 2nd dorsal interossei muscles. The present study revealed that two heads of the adductor hallucis muscle, the oblique and transverse, had different innervating patterns, suggesting that two heads of the human adductor hallucis muscle develop from different primordia, and not from common ancestors.     

展肌游离移植的应用解剖学

对20侧新鲜成年尸足解剖,观测展肌的形态、血供和神经支配。该肌血供和神经支配分别来自足底内侧动静脉和足底内侧神经.可设计以足底内侧血管和足底内侧神经为蒂的展肌瓣,以期游离移植修复和重建面瘫等功能缺失。     

Anatomical study of human adductor hallucis muscle with respect to its origin and insertion

The adductor hallucis muscle (ADH) is evolutionally and functionally important, but no detailed morphological data about this muscle in the human body is available. In the present study, we examined the origin and insertion of the oblique and transverse heads of the ADH. Forty-five feet (20 right, 25 left) of 34 cadavers (13 men, 21 women, average age of 80 years old) were used in the present study. The origin, insertion and nerve supplies of the oblique and transverse heads of the ADH were macroscopically examined in detail. Most commonly, the oblique head of the ADH arose from the bases of the 2nd, 3rd and 4th metatarsal bones, the plantar metatarsal ligaments spanned between the bases of the 2nd, 3rd and 4th metatarsal bones, the lateral cuneiform bone, the fibrous sheath of the tendon of the peroneus longus muscle and the long plantar ligament, and inserted into the lateral sesamoid bone of the great toe and the capsule of the 1st metatarsophalangeal joint. Most commonly, the transverse head of the ADH originated from the capsules of the 3rd and 4th (and occasionally 5th) metatarsophalangeal joint and the deep transverse metatarsal ligaments, and inserted into the lateral sesamoid bone of the great toe, the capsule of the 1st metatarsophalangeal joint and lateral surface of the base of the 1st proximal phalanx. This muscle was classified into four types based on the origin of its oblique head and was classified into three types based on the origin of its transverse head. The percent ratio of the weight of the oblique head to the total weight of all the intrinsic muscles of the foot was 9.4% ± 1.5, and the transverse head was 1.5% ± 0.6 (n = 14). The transverse head of ADH tends to be reduced in size in the human, but the oblique head is well developed with no sign of reduction.     

踝跖部神经显微断层解剖及其临床意义

目的：为不同部位断足再植提供理论基础和有关数据。方法：用体视学方法对６６例成人踝跖部胫神经及其重要分支进行观测。结果：胫神经的平均横径和面积分别为：第１断层５．８ｍｍ，１４．１ｍｍ２，足底内侧神经的平均横径和面积分别为：第１断层４．０ｍｍ，７．２ｍｍ２，第２断层４．１ｍｍ，６．８ｍｍ２；第３断层４．３ｍｍ，６．５ｍｍ２；第４断层３．７ｍｍ，５．４ｍｍ２；第５断层３．１ｍｍ，４．４ｍｍ２；第６断层３．２ｍｍ，４．４ｍｍ２；第７断层２．９ｍｍ，４．７ｍｍ２。足底外侧神经的平均横径和面积分别为：第１断层３．０ｍｍ，４．８ｍｍ２；第２断层３．１ｍｍ，４．５ｍｍ２；第３断层３．５ｍｍ，４．７ｍｍ２；第４断层４．０ｍｍ，４．４ｍｍ２；第５断层４．５ｍｍ，４．６ｍｍ２。结论：提出了“三段”断足分型法。不同断层平面断足再植吻接神经时要首选吻接主干，但断层１１和１２应根据足部感觉功能需要首选吻接胫侧神经。     

Variations in sural nerve formation pattern and distribution on the dorsum of the foot

The sural nerve, a cutaneous nerve, is clinically important because it is frequently for nerve conduction testing, biopsy, and harvesting for nerve grafts. This nerve exhibits a wide variety of variation in formation, distribution on the dorsum of the foot, and so on, depending on the population observed. In this study, we examined the variation in the sural nerve in 110 Korean cadavers. Of these cadavers, 86.1% of the sural nerves corresponded to type A, where tibial and peroneal components were united to form the sural nerve. These two components most frequently united (65.9%) in the third quarter of the calf, and when the union position was expressed as a ratio to calf length, it corresponded to 0.408 in men and 0.346 in women, with a statistically significant difference. Due to this sexual dimorphism in addition to shorter calf length in females, the length of the sural nerve was shorter in females (male average length: 14.5 ± 4.8 cm; female average length: 11.4 ± 2.9 cm). In terms of distribution of the lateral dorsal cutaneous nerve, the distal continuation of the sural nerve on the dorsum of the foot, it showed variation in association with the superficial peroneal nerve. The innervation of the sural nerve extended most frequently up to the lateral two and a half toes, solely or in conjunction with the superficial peroneal nerve. Obtaining further information regarding sural nerve variation will be useful for various clinical procedures and interpretation of sural nerve conduction results. Clin. Anat. 30:525–532, 2017. © 2017 Wiley Periodicals, Inc.     

The effects of the communicating branch between medial and lateral plantar nerves on the innervations of the foot lumbrical muscles

Introduction

The communicating branches between the medial (MPN) and lateral (LPN) plantar nerves aren’t frequently observed in relation to the innervation of the foot muscles in previous studies. In this study, the number and localization of the communicating branch on the innervations of foot muscles were evaluated to open a new sight considering the innervations of lumbrical muscles.

展肌转位修复跟腱的应用解剖

在30侧成人下肢标本上,观测了拇展肌形态和血供。设计了以足底内侧动脉或其深支为蒂的拇展肌或肌皮瓣转位修复跟腱和皮肤缺损的术式。并作了拇展肌肌腱和跟腱的拉伸破坏试验:拇展肌肌腱载荷平均为66.4kg,跟腱载荷平均为235.2kg。两者载荷之比为1∶3.5.     

Variations in the facial muscles at the angle of the mouth

The Latin term modiolus literally means “the nave of a wheel” and in dentistry refers to the point lateral to the angle of the mouth where several facial muscles converge. It has been described as coinciding with a muscular or tendinous node in the cheek and is considered to be important clinically. The facial muscles that insert in the vicinity of the mouth angle are the levator anguli oris, zygomaticus major, risorius, buccinator, and depressor anguli oris. The arrangement of these muscles in relation to the angle of the mouth was studied in 147 cadavers (279 sides) of the Mongoloid (Japanese) and Caucasian races. Considerable variation in the pattern of convergence was found. The variations were classified into three types as follows. Type A: location of the muscle convergence was lateral to the angle of the mouth. Type B: convergent area was located above the angle. Type C: convergent area was located below the angle. When the two races were considered together type C occurred most frequently (42.3%) followed closely by type B (41.2%). The arrangement described in textbooks (type A) occurred least frequently (16.5%). The frequency of appearance of convergent types according to race also is given. The gross observations do not support the existence of a nodular modiolus. In addition, the muscles that are supposed to contribute to the nodule usually do not converge lateral to the mouth angle but rather converge either above or below the angle.     

足底内侧和外侧群肌的肌内神经整体分布模式及临床意义

目的 揭示足底内侧和外侧群肌的肌内神经整体分布模式,探讨其临床意义.方法 24具成年尸体,完整取下足底内侧和外侧群肌,采用改良Sihler染色显示肌内神经分布模式.结果 (足母)收肌的神经支从肌止端的深面入肌,而(足母)展肌、(足母)短屈肌、小趾展肌和小趾短屈肌的神经支常从肌起端的深面入肌.(足母)展肌中有1个半月形和...     

Formation and distribution of the sural nerve based on nerve fascicle and nerve fiber analyses

The formation and distribution of the sural nerve are presented on the basis of an investigation of 31 legs of Japanese cadavers using nerve fascicle and fiber analyses. Nerve fibers constituting the medial sural cutaneous nerve were designated as 'T', whereas those constituting the peroneal communicating branch were designated as 'F'. In 74.2% of cases (23/31), the T and F fibers joined each other in the leg, whereas in 9.7% of cases (3/31) they descended separately. In 16.1% of cases (5/31), the sural nerve was formed of only the T fibers. The sural nerve gave off lateral calcaneal branches and medial and lateral branches at the ankle. The lateral calcaneal branches always contained T fibers. The medial branches consisted of only T fibers, whereas most of the lateral branches consisted of only F fibers (71.0%; 22/31). In addition to the T and F fibers, P fibers, which derived from the superficial and deep peroneal nerves, formed the dorsal digital nerves. The P fibers were entirely supplied to the medial four and one-half toes. However, they were gradually replaced by the T and F fibers in the lateral direction. The 10th proper dorsal digital nerve consisted of T fibers only (38.7%; 12/31), of F fibers only (19.4%; 6/31) or of both T and F fibers (38.7%; 12/31). These findings suggest that the T fibers are essential nerve components for the skin and deep structures of the ankle and heel rather than the skin of the lateral side of the fifth toe. The designation of the medial sural cutaneous nerve should be avoided and only the T fibers are appropriate components for naming as the sural nerve.     

Nerve communication between the glossopharyngeal nerve,external carotid plexus and the superficial cervical ansa: human autopsy case

The authors encountered a very rare human autopsy case in which the supernumerary branch of the glossopharyngeal nerve and a nerve branch arising from the external carotid plexus communicated with the superficial cervical ansa. This anomaly was observed on the left side of a 71-year-old male cadaver during the gross anatomical seminar at Niigata University in 2004. The nerve fascicle and fiber analyses indicated that the supernumerary branch of the glossopharyngeal nerve separated cranial to the branches to the pharyngeal constrictor muscles, carotid sinus and stylopharyngeal muscle and sent the nerve fibers to the muscular branches to the platysma and the cutaneous branches to the cervical region. Additionally, it was shown that the branch arising from the external carotid plexus sent the nerve fibers to the cutaneous branch to the cervical region. Although the external carotid plexus is primarily postganglionic sympathetic fibers originating from the superior cervical ganglion, the vagus and glossopharyngeal nerves gave off branches connecting to the plexus, and therefore it was not possible to determine the origins of this branch of the external carotid plexus. The present nerve fascicle analysis demonstrates that the supernumerary branch of the glossopharyngeal nerve, which innervated the platysma, did not share any nerve components with the branches to the pharyngeal constrictor muscles, carotid sinus and stylopharyngeal muscle, suggesting that this supernumerary branch may be categorized into the different group from these well-known branches.     

Gross anatomic evidence of partitioning in the human fibularis longus and brevis muscles

Evidence from a variety of studies suggests that many mammalian muscles are partitioned with respect to their architecture and innervation. Each of these specific muscle subvolumes is innervated by an individual muscle nerve branch, contains motor unit territories with a unique array of physiological attributes and has been known as a neuromuscular compartment or segment. This gross anatomic study investigated for evidence of neuromuscular segmentation in human fibularis (peroneus) longus and brevis muscles. Forty-three legs (24 left, 19 right) from embalmed adult cadavers were dissected. Any architectural segments within these muscles were identified. The specific innervation patterns of these muscles were also described. The fibularis longus muscle was consistently found to have connective tissue partitions that separated it into four parts: anterior superficial, anterior deep, posterior superficial, and posterior deep. The innervation pattern of this muscle was consistent with the segments defined by the connective tissue partitions. There were consistently four primary motor branches, each supplying a specific portion of the fibularis longus muscle. While a typical branching pattern was recognized, there was some variability as to the order of these branches as they originated. The fibularis brevis muscle was consistently found to have a central connective tissue partition that separated it into two portions: anterior and posterior. In 91% of the fibularis brevis muscles, there were two primary motor branches, one for each of the two segments of the muscle. In the other 9%, only one primary motor branch supplying the muscle could be identified. © 1996 Wiley-Liss, Inc.     

Fascicular analysis at perineurial level of the branching pattern of the human common peroneal nerve

The macroscopic branching pattern of the peripheral nerves is usually provided by the epineurial connective tissue, whereas the removal of the epineurium discloses component fascicles covered by a perineurial sheath comprising a fine network with a peculiar branching pattern. In order to compare both patterns, the common peroneal nerve (PC) was dissected minutely in 10 human legs. At the epineurial level the branching pattern into tributary bundles was variable in respect to both the origin of the superficial peroneal nerve and that of the muscular branches (Rr. m. peroneus longus, RPL) to the peroneus longus. At the perineurial level the fascicles formed intricate tiny plexuses without a discrete branching pattern, but as a whole consisted of a regular arrangement divided into four crural streams for the deep peroneal (PP), the accessory deep peroneal (PPA) and two dorsal cutaneous nerves. The RPL fascicles were derived substantially from the PPA stream. The findings on the fascicular branching pattern in the present study show that the PC consists of two muscular and two sensory streams that were ensheathed by the epineurium to form the PP containing a single muscular stream, and the superficial peroneal nerve with the three remaining streams. Thus the extensor and peroneal muscles of the leg have their own nerve supply from the PP and PPA, respectively. The branching pattern of the fascicles of muscular branches at the perineurial level may be a useful estimator of muscle grouping, for which the branching pattern at the epineurial level is hardly of any use due to its variability.     

The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves

The hip adductor group, innervated predominantly by the obturator nerve, occupies a large volume of the lower limb. However, case reports of patients with obturator nerve palsy or denervation have described no more than minimal gait disturbance. Those facts are surprising, given the architectural characteristics of the hip adductors. Our aim was to investigate which regions of the adductor magnus are innervated by the obturator nerve and by which sciatic nerve and to consider the clinical implications. Twenty‐one lower limbs were examined from 21 formalin‐fixed cadavers, 18 males and 3 females. The adductor magnus was dissected and was divided into four parts (AM1‐AM4) based on the locations of the perforating arteries and the adductor hiatus. AM1 was supplied solely by the obturator nerve. AM2, AM3, and AM4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 (9.5%), 20 (95.2%), and 6 (28.6%) of the cadavers, respectively. The double innervation in more than 90% of the AM3s is especially noteworthy. Generally, AM1–AM3 corresponds to the adductor part, traditionally characterized as innervated by the obturator nerve, and AM4 corresponds to the hamstrings part, innervated by the sciatic nerve. Here, we showed that the sciatic nerve supplies not only the hamstrings part but also the adductor part. These two nerves spread more widely than has generally been believed, which could have practical implications for the assessment and treatment of motor disability. Clin. Anat. 27:778–782, 2014. © 2013 Wiley Periodicals, Inc.     

Arborization of the inferior laryngeal nerve and internal nerve on the posterior surface of the larynx

The morphological patterns of the inferior laryngeal nerve and internal laryngeal nerve display complex arborizations. This paper attempts to identify and clarify these patterns. Dissections were performed on 105 adult Japanese cadavers, and observations were made on 201 sides. Results showed that the communications between the inferior laryngeal nerve (ILN) and internal laryngeal nerve (ITLN) could be classified into two types and three subtypes. Also, the ITLN displayed three characteristic patterns at the arytenoid cartilage. These communications produce complex arborizations of the ILN as it enters the larynx. This may explain the variety of potential clinical symptoms observed after thyroid surgery or neck dissections. © 1995 WiIey-Liss, Inc.     

Interfascicular septum of the calcaneal tunnel and its relationship with the plantar nerves: A cadaveric study

The relationship between the plantar nerves and internal fascial structure of the calcaneal tunnel is clinically important to alleviate pain of the sole. The study aimed to investigate the three‐dimensional (3D) anatomy of the calcaneal tunnel and its internal fascial septal structure by using microcomputed tomography (mCT) with a phosphotungstic acid preparation, histologic examination, and ultrasound‐guided simulation. Twenty‐one fixed cadavers and three fresh‐frozen cadavers (13 men and 11 women, mean age 82.1 years at death) were used in this study. The 3D images of the calcaneal tunnel harvested by mCT were analyzed in detail. Modified Masson trichrome staining and serial sectional dissection after ultrasound‐guided injection were conducted to verify the 3D anatomy. Within the calcaneal tunnel, the interfascicular septum (IFS) commenced proximal to the malleolar‐calcaneal line and distal to the bifurcation of the tibial nerve into the plantar nerves. The medial and lateral plantar nerves were separated by the IFS, which divided the calcaneal tunnel into two compartments. The plantar nerves were ramified into two or three branches within each compartment. The IFS terminated around the talocalcaneonavicular joint, and the plantar nerves traveled into the sole. Clinical manipulation of the plantar nerves should be performed in consideration of the fact that they are clearly separated by the IFS. Clin. Anat. 32:877–882, 2019. © 2019 Wiley Periodicals, Inc.