Examination of the accessory tendons of extensor hallucis longus muscle in fetuses

There are various data about the incidence of accessory tendons (AT) of extensor hallucis longus (EHL) muscle; however, their function is unknown. This study aimed to determine the incidence and morphometric features of the AT of EHL muscle in fetuses in order to provide more information to discuss its possible function. Forty-five fetuses (26 female and 19 male) were used in this study. Fetuses were grouped as Group A (16-21 weeks), Group B (22-27 weeks), and Group C (28-34 weeks) according to their age. In 23 (51%) out of 45 fetuses, there were AT. These were bilateral in 15 fetuses (65%) and unilateral in eight fetuses (35%). Fifty-two percent of the fetuses in group A, 43% in group B, and 67% in group C had AT. AT were observed in 14 female (54%) and 9 male (47%) fetuses. In all cases, the AT were always diverging to the medial side of the main EHL tendons and attached to the metatarsophalangeal joint capsule distal to the joint space. Significant correlations were observed in this study between EHL and AT widths as well as between EHL width and EHL-AT distance on both sides. The present study is the first to provide morphometric data about the AT of EHL muscle in fetuses which will be of use in understanding their function, particularly in biomechanics of the great toe.     

长伸肌腱移位治疗外翻的应用解剖学

目的:探讨长伸肌腱移位治疗外翻的解剖学入路及手术的要点。方法:(1)100例正常足及100例外翻足,测量长伸屈肌腱的位置;(2)对20具尸体40足解剖,观察长伸肌腱、长屈肌腱、短伸肌腱、腓浅神经、腓深神经、隐神经及周围血管走行特点,并测量上述结构与解剖标志的相对位置。结果:正常长伸肌腱的位置在踝横纹处位于胫骨前肌外侧(9.44±4.26)m m,在跖附关节中点外侧(2.00±2.22)m m,跖趾关节中点外侧(1.32±1.46)m m,止点位于末节趾骨基底中点(2.22±2.42)m m范围内,长屈肌腱在跖趾关节中点外侧(0.44±2.42)m m。在外翻的患者中,长伸肌腱在踝横纹处位于胫骨前肌外侧(9.32±3.46)m m,在跗跖关节中点外侧(3.00±2.22)m m,跖趾关节中点外侧(4.22±2.26)m m,止点位于末节趾骨基底中点(2.02±2.32)m m范围内,长屈肌腱在跖趾关节中点外侧(3.24±2.32)m m。趾背侧皮肤由隐神经、腓浅及腓深神经支配。结论:(1)正常与外翻足的比较中,伸肌腱的位置在足横纹及止点处无明显的差异,在跖附关节及跖趾关节处,外翻足的伸肌腱明显外移(P<0.05)。长屈肌腱也明显外移(P<0.05)。(2)手术中隐神经终末支易受损伤。(3)伸肌腱内移并止点重建可矫正外翻。     

小腿前外侧群肌瓣的应用解剖

目的：为小腿下１／３的骨髓炎和其它创伤性修复提供满意的肌瓣。材料和方法：用３０具成人的尸体,采用连续层次解剖法,调查了小腿前群和外侧群各肌,用游标卡尺测量有关的数据。结果;转动胫骨前肌、拇长伸肌、趾长伸肌、腓骨长肌、腓骨短肌和第３腓骨肌瓣能覆盖胫骨前内侧下１／３的面积分别为８．７ｃｍ＾２、１２．４ｃｍ＾２、１２．７ｃｍ＾２１３．６ｃｍ＾２、１９．０ｃｍ＾２、１６．７ｃｍ＾２。结论：除胫骨前肌和腓骨     

、趾短伸肌应用解剖及去神经游离移植的临床应用

目的：旨在为、趾短伸肌去神经游离移植修复腭裂、腭咽闭合不全、面瘫等提供形态学基础。方法：①对２２只足标本的、趾短伸肌的形态变异及神经支配进行解剖观察；②在１０９例手术中以神经刺激仪确认、趾短伸肌的神经，并测肌的长度，体积及重量。结果：①、趾短伸肌与长腱合并机会分别为５５．７％、６２．８％；趾短伸肌发出腱至第５趾的占７６．９％；②肌的神经支配三种类型比率分别是２４．４％、３２．８％、４２．７％；③肌的长度在８．３～１３．１ｃｍ，体积１．８～３．１ｃｍ３，重量１．９～３．２ｇ。结论：、趾短伸肌肌腱有与长腱合并的变异，趾短伸肌腱常有发出第五趾者；神经支配有三型；肌的长度、重量、体积适合肌肉游离移植的成活，是腭裂、腭咽闭合不全、尿道上裂及面瘫等外科治疗可靠的组织移植材料。     

Unusual variant of the extensor carpi radialis brevis muscle: a case report

A variation of the extensor carpi radialis brevis muscle (ECRB) origin was discovered during a cadaveric dissection. The identified ECRB originated from the fascia/tendon of the extensor digitorum communis (EDC), without any of its origin at the usual location on the lateral epicondyle. The ECRB tendon inserted onto the third metacarpal base. A branch of the posterior interosseous nerve innervated the ERCB. This is the first report of an ECRB originating from the EDC fascia/tendon. This unique variation of the ECRB origin may be of clinical interest, especially in the treatment of lateral epicondylitis (tennis elbow).     

Anatomical variations of the flexor hallucis longus muscle and the consequences for tendon transfer. A cadaver study

The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus muscle. Eighty cadaver specimens preserved according to Thiels method were assessed. Following careful dissection, the distance between the musculotendinous junction and the bone–cartilage border of the distal tibia was determined. Three typical anatomical variations were found: (1) a long lateral and shorter medial muscle belly; (2) equal-length medial and lateral muscle bellies; (3) a long medial and shorter lateral muscle belly. As a special variation in two cases only one lateral muscle belly was found. When planning a flexor hallucis longus transfer, preoperative magnetic resonance tomography (MRT) should be carried out in order to guarantee sufficient coverage of an existing soft tissue defect. These anatomical characteristics have also to be considered when interpreting ultrasonic or MRT findings in this region.     

趾长伸肌腱及其滑液囊血管的应用解剖

用40例新鲜成人尸体足标本,作巨微解剖.透明标本和组织切片方法,测量了趾长伸肌腱各项数据,详细报道了其系膜的分支及位置.趾长伸肌腱囊外近侧段的血供为肌血管的延伸;滑液囊及肌腱囊内段血供主要来自胫前动脉、跗上外侧动脉和足背动脉;肌腱囊外远侧段血供来自跖骨背侧动脉。临床切取不同部位带血管蒂趾长伸肌腱时可以此为据.本文还特别强调了跗上外侧动脉在切取滑液囊肌腱复合瓣中的作用.     

Morphology of peroneus tertius muscle

Peroneus tertius (PT) muscle is peculiar to man, and man is the only member among the primates in whom this muscle occurs. The muscle is variable in its development and attachment. Because of functional demands of bipedal gait and plantigrade foot, part of extensor digitorum brevis (EDB) has migrated upwards into the leg from the dorsum of foot. PT is a muscle that evolution is rendering more important. In a total of 110 cadavers, extensor compartment of leg and dorsum of foot were dissected in both the lower limbs and extensor digitorum longus (EDL), and PT muscles were dissected and displayed. PT was found to be absent in 10.5% limbs, the incidence being greater on the right side. The remaining limbs in which the PT muscle was present had a very extensive origin from lower 3/4th of extensor surface of fibula (20% on right and in 17% on left), and the EDL was very much reduced in size. In approximately 12%, the tendon of PT was thick or even thicker than the tendon of EDL. In 4%, the tendon extended beyond fifth metatarsal up to metatarsophalangeal joint of fifth toe, and in 1.5%, it extended up to the proximal phalanx of little toe. In two cases (both on the right side), where PT was absent, it was replaced by a slip from lateral margin of EDL. We conclude that PT, which is preeminently human, is extending its purchase both proximally and distally.     

小腿有关肌腱转位修复跟腱的生物力学评价

目的：为临床选用自体肌腱转位修复跟腱提供生物力学依据。方法：选用防腐固定成年和新鲜青年下肢各７例。制备拉伸试件，在ＳＷＤ－１０型材料试验机上，进行单向拉伸破坏实验。结果：跟腱、腓骨长肌腱、腓骨短肌腱、胫骨后肌腱及展肌腱固定组分别为２２９２．６Ｎ、１０２０．５Ｎ、７５２．０Ｎ、９３８．９Ｎ和７２１．３Ｎ，新鲜组分别为１９２７．１Ｎ、８１９．５Ｎ、３４６．７Ｎ、６９９．７Ｎ、３０３．８Ｎ。结论：腓骨长肌腱是跟腱缺损修复术较理想的自体材料。     

尺侧腕伸肌-拇短伸肌腱移位重建拇对掌功能的应用解剖

目的:研究拇对掌肌、拇短展肌的解剖学特点,探讨符合人体生物力学的拇对掌功能重建的方法。方法:对20侧新鲜成人上肢标本,解剖拇对掌肌、拇短展肌,并建立尺侧腕伸肌-拇短伸肌移位重建拇对掌功能的手术模型。结果:拇短展肌肌纤维方向沿第1掌骨纵轴方向,拇对掌肌肌纤维方向与第1掌骨成一定角度。尺侧腕伸肌-拇短伸肌移位后,测量拇指远侧横纹中点到第3掌骨长轴与掌远侧横纹交点之间的最大距离可达(5.9±0.7)cm。结论(:1)尺侧腕伸肌长度、肌力足以重建拇对掌功能,拇短伸肌腱止点恒定,联合移位后其作用方向与拇短展肌方向一致,且旋前角度足够。(2)以尺侧腕伸肌-拇短伸肌移位重建拇对掌功能是一种符合拇对掌功能生物力学的简单有效的方法。     

Anatomic variation of the 5th extensor tendon compartment and extensor digiti minimi tendon

Anatomic variation within the 5th extensor compartment may contribute to the development of tenosynovitis and limit the usefulness of the extensor digiti minimi (EDM) for tendon transfer. The purpose of this study was to assess the anatomic variation of the EDM tendon and its surrounding retinaculum, with particular attention to anatomical variation between specimens. Forty-one fresh cadaver hands were dissected. The length of the 5th compartment retinaculum was noted. The incidence of an intercompartmental septum was noted in each specimen as well as the type of tendinous attachments present between the EDM and extensor digitorum communis (EDC) tendons. The presence and length of any accessory retinacular bands distal to the edge of proper extensor retinaculum was also noted. Only one specimen contained a single EDM tendon, while 71% (n = 29) of specimens contained two slips and 23% (n = 9) had three slips; 24% (n = 10) of EDC tendons had no slip to the small finger, while 61% (n = 25) of specimens had a single slip to the small finger. The EDC's contribution to the small finger was found to be an independent tendon in 42% of cases (n = 17), while 34% (n = 14) of specimens were found to have a common EDC slip, which branched to both the ring and small finger. Three EDM tendons divided distal to the extensor retinaculum, while the remaining EDM tendons divided beneath or proximal to the extensor retinaculum. Seventy-three percent (n = 30) of the specimens had an accessory retinacular band surrounding the EDM tendon identified at the base of the 5th metacarpal. Eighty-eight percent (n = 36) of hands had a septum between the EDM slips. The surgeon should be aware of variability within the 5th dorsal compartment in cases of trauma and in cases of tendon transfer. In our series 30 of 41 specimens were noted to contain an accessory dorsal retinacular band surrounding the EDM and 36 specimens were noted to contain a septum within the 5th compartment. The presence of an accessory retinacular band surrounding the EDM at the level of the 5th metacarpal base is an anatomic finding that requires further investigation.     

长伸肌瓣的解剖学基础

在30个成人下肢标本上观察了长伸肌的形态、血供和神经支配。测得肌长23.1cm。该肌由7-17支胫前动脉横向分支供应,肌下份有腓动脉穿支发出补充,动脉主要从肌的内侧入肌。腓深神经约发出2支分支分布该肌,也是从肌内侧进入肌内。根据观察结果我们认为长仲肌瓣倒置治疗小腿中下份慢性骨髓炎及开放性胫骨骨折,似为较理想的供肌。     

Spannungsrückgewinn menschlicher Sehnen nach Entlastung (mechanische Erholungseigenschaft)

Zusammenfassung Wird eine gespannte Sehne auf eine bestimmte Restspannung entlastet, so ist bei Konstanthaltung der Länge ein zeitabhängiger Spannungsrückgewinn zu registrieren (mechanische Erholungseigenschaft). An einer elektronischen Zugprüfmaschine wurden 127 menschliche Sehnen (M. extensor hallucis longus) bei verschiedenen Entdehnungsgeschwindigkeiten (2, 4 und 8 mm/min) und Ausgangskräften (8, 16 und 32 kp) untersucht. Die zugehörigen Entdehnungsniveaus betrugen jeweils 25% der Ausgangskraft. — Die Kurve des Spannungsrückgewinns entspricht additiv superponierten e-Funktionen der Zeit. Der prozentuale Spannungsrückgewinn ist (im untersuchten Bereich) nahezu unabhängig von der Ausgangsspannung, steigt jedoch mit zunehmender Entdehnungsgeschwindigkeit etwas an. Nach 30 s beträgt der Spannungsrückgewinn etwa 1,4 bis 2%, nach 3 min 2 bis 3% der Ausgangsspannung. Der Spannugsrückgewinn ist bei männlichen Sehnen signifikant größer als bei weiblichen und fällt mit zunehmendem Alter signifikant ab (0,2 bis 0,3% pro Jahr). Der Alterseinfluß ist bei weiblichen Sehnen ausgeprägter als bei männlichen. Bei rechtsseitigen Sehnen ist der Spannungsrückgewinn signifikant größer als bei linksseitigen. Alters-, Geschlechts- und Seitendifferenzen sind durch. Unterschiede des makroskopischen Sehnenquerschnitts allein nicht zu erklären.Mit Unterstützung der Stiftung Volkswagenwerk.     

指伸肌腱止点形态特点与损伤分型及治疗方法

目的　根据指伸肌腱止点的形态特点探讨其损伤分型与手术修复方法。 方法　依据将28例指伸肌腱止点区损伤情况分为带较大骨折块手指伸肌腱止点损伤、撕脱骨片小或骨折块粉碎无法固定及不带骨片的伸肌腱止点撕脱伤、靠近末节指骨基底背侧指伸肌腱腱性损伤3种类型。按损伤分型分别采骨块固定,末节指骨基底钻孔缝合固定及直接缝合修补等手术方法进行修复。 结果　28例无一例再度撕脱或断裂,其中3例远侧指间关节僵硬,其余25例远侧指间关节主动伸直受限度0°~10°,主动屈曲度30°~70°。 结论　根据伸肌腱止点损伤的分型,分别采用骨折块固定,末节指骨基底钻孔缝合固定及直接修补缝合手术方法进行修复,方法简便,疗效可靠。     

Anatomical study of the symmetry of lateral extensor compartment of the wrist

The anatomy of the lateral extensor compartment of the wrist has been extensively studied, since it is the site of stenosing tenosynovitis of the tendons of abductor pollicis longus and extensor pollicis brevis (de Quervain's disease). Septation of the compartment and multiplicity of the tendons within it have been thought, by some surgeons, to cause overcrowding and thus contribute to the pathogenesis of the condition. This anatomical study of ten pairs of cadaveric hands has shown that these variations are common, confirming previous reports in the literature, and, more importantly, that they are frequently bilaterally symmetrical. Since de Quervain's disease tends to occur unilaterally, it seems unlikely that anatomical variations are important in its pathogenesis. Appreciation of these variations is, however, important in surgical treatment. Adequate exposure is necessary to recognize the anatomical structures, so that all subcompartments within the fibroosseous tunnel may be decompressed. © 1993 Wiley-Liss, Inc.     

The twisted structure of the rat Achilles tendon

The rat is frequently used as a model to study the characteristics, aetiology and pathology of the Achilles tendon. However, though the structure of the human Achilles tendon has been extensively investigated, the anatomical structure of the rat Achilles tendon remains unclear, which impedes the ability to use rats to study Achilles tendinopathy. The purpose of this study was to reveal the structure of the rat Achilles tendon and to explore its similarities with the human Achilles tendon through an anatomical dissection of 80 rat Achilles tendons (40 female, 40 male). This study found that the subtendons of the rat Achilles tendon originating from the triceps surae muscle were twisted, and each subtendon also had its own torsion. The extent of these two types of torsion could be very different between rats. Alterations in this torsion may result in distinct stress fields in the Achilles tendon, which may play a critical role in the pathogenesis of Achilles tendinopathy. This study provides an important basis to support the use of rats as model animals to investigate the characteristics of the human Achilles tendon and Achilles tendinopathy.     

The clinical surface anatomy anomalies of the palmaris longus muscle in the Black African population of Zimbabwe and a proposed new testing technique

The presence of the palmaris longus muscle (PLM) is highly variable. Rates of absence vary from 0.6% in the Korean population to as high as 63.9% in the Turkish population. The tendon of PLM may be absent on one or both forearms, may have duplicated tendons on one forearm or may be laterally shifted to the extent that the tendon of the PLM lies superficial to that of flexor carpi radialis muscle. Among Black American populations, in which there is usually mixed ancestry, rates of absence are 3.5%. Only two studies have been performed on Black African populations: in Republic of Congo and Uganda, and each showed widely differing rates of absence of 3.0% and 14.6%, respectively. In this study, a total of 890 Black Zimbabwean subjects in Harare aged between 8 and 13 years, were examined for clinical surface anatomy anomalies of the tendon of PLM. The results showed that the tendon of the PLM was absent unilaterally in 0.9% of the population, and bilaterally absent in 0.6% with an overall rate of absence of 1.5%. Other variations noted were a laterally shifted PLM in 1.1% of subjects and duplicated tendons on one forearm, which was the least prevalent anomaly, in 0.2% of subjects. The author proposes a new technique to test the tendon of PLM, which combines resisted thumb abduction and resisted wrist flexion. The proposed technique capitalizes on the role of the PLM as an important abductor of the thumb. Clin. Anat. 22:230–235, 2009. © 2009 Wiley‐Liss, Inc.     

Physiological properties and pattern of innervation of regenerated muscles in the rat

The regeneration of fast and slow muscles was compared following "mincing" and replacement into their own or alien muscle bed. At intervals varying from 2 to 9 weeks the tension developed by the regenerated muscles was assessed and compared to that developed by the muscles from the contralateral unoperated side. This parameter was then taken as an indication of recovery. The regenerated muscles never developed more than half of the tension of the control muscles. Muscles regenerated in the bed of extensor digitorum longus became fast-twitch muscles and muscles regenerated in the bed of soleus became slow-twitch muscles, no matter whether they originated from an extensor digitorum longus or soleus "mince". The regeneration of the muscle tissue in the place of extensor digitorum longus developed better than in the place of soleus. The pattern of innervation of the regenerated muscles was analysed using a combined cholinesterase silver stain. Many of the regenerated fibres had more than one end plate and some end plates more than one axon terminal. These results show that in adult animals muscle redevelopment can occur, but only to a limited extent. Moreover, on reinnervation of regenerated muscle fibres the axons do not assume their original pattern of innervation.     

Epifascial accessory palmaris longus muscle

In hand reconstructive surgery the palmaris longus muscle is one of the most utilized donor site for tendon reconstruction procedures. However, its anatomic position is variable and anatomic variations may be responsible for median nerve compression. We report the case of a 40-year-old, right-handed woman, who presented with numbness and paresthesias in the palm and in the flexor aspect of the first, second, and third fingers of her right hand for the preceding 5 months, coinciding with increase of office work (typing). The clinical examination and radiological investigations (ultrasound and magnetic resonance) revealed a subcutaneous mass (15 mm x 2.3 mm x 6 cm), with a lenticular shape and definite edges at the level of the volar aspect of the distal third of the forearm. The fine-needle aspiration biopsy revealed the presence of striated muscle fibers. During surgery, a muscle belly was found in the epifascial plane. This muscle originated from subcutaneous septa in the middle forearm and inserted on to the superficial palmar aponeurosis with fine short tendon fibers. Exposure of the antebrachial fascia did not reveal any area of weakness or muscle herniation. The palmaris longus tendon, flexor digitorum superficialis tendons, and flexor carpi radialis tendon showed usual topography under the antebrachial fascia. The accessory muscle was excised and histology revealed unremarkable striated muscle fibers, limited by a thin connective sheath. The presence of an accessory palmaris longus (APL) located in the epifascial plane could be ascribed to an unusual migration of myoblasts during the morphogenesis. Although extremely rare, APL is worth bearing in mind as a possible cause of median nerve compression and etiology of a volar mass in the distal forearm.