1.Higher and Bulkier Origin of the Lumbricals and their Clinical Relevance
Sushma RK ; Chandni G ; Bhat KMR
Journal of Surgical Academia 2013;3(1):22-24
Lumbricals are important small intrinsic muscles of the hand, which arise from the tendons of the flexor digitorum
profundus in the palm distal to the flexor retinaculum and are inserted on to the dorsal digital expansion. Variations
in the unipinnate/bipinnate pattern of lumbricals, absence of one or more muscles, origin from the superficial flexor
tendons and flexor retinaculum have been reported earlier. In the present case, all four lumbricals were arising from
the tendons of the flexor digitorum profundus, proximal to the flexor retinaculum in the anterior part of the forearm
and extending into the palm through the carpal tunnel. However, there was no variation found with regard to their
normal unipinnate (first two) and bipinnate (last two) pattern of origin. In the palm all the four lumbricals were
found to be bulkier than their normal size, first one being the bulkiest. The bulky and high origin of lumbricals
within the carpal tunnel makes the tunnel a compact space. Therefore, such variation is one of the predisposing
factors for the carpal tunnel syndrome. Thus, the knowledge of such variant origin of lumbricals is helpful not only
during carpal tunnel release but also during the magnetic resonance imaging (MRI) and ultrasound based diagnosis
of carpal tunnel and during the flexor tendon repair and reconstruction.
2.A Rare Case of Bilateral High Origin of the Testicular Artery with Variations in the Course and Branches
Prasanna LC ; Babu A ; D'Souza AS ; Bhat KMR
Journal of Surgical Academia 2014;4(1):45-48
In general, testicular artery (TA) usually arises from the antero-lateral part of the abdominal aorta below the origin of
the renal arteries at second lumbar vertebrae level. Very rarely variations in the origin of the testicular arteries are
observed. We here report a rare case of bilateral unusual origin and course of the testicular artery. On the right side,
testicular artery aroused from the aorta about 0.5cm above the origin of the renal artery and gave off inferior
suprarenal artery. In contrast, left testicular artery springs from the pre-hilar branch of the left renal artery, 2cm
before reaching the hilum of kidney. On both sides, testicular arteries descended in front of the hilar structures of the
kidney. Since, the origin and course of the testicular artery is important to consider during surgical and diagnostic
interventions, knowledge of such variation may be helpful in avoiding diagnostic and surgical errors and adverse
consequences especially during laparoscopic approaches.