Objective To investigate the clinical value of high-frequency ultrasound in the diagnosis of pronator teres syndrome (PTS). Methods The high-frequency ultrasound was employed to examine and measure the median nerve of the pronator teres muscle in 30 patients with PTS and 30 healthy volunteers (control group).The long-axis diameter (LA),short-axis diameter (SA) and cross-sectional area (CSA) of the median nerve were measured.The receiver operating characteristic curve of the median nerve ultrasonic measurement results was established,and the area under the curve (AUC) was calculated.The diagnostic efficiency of each index for PTS was compared with the surgical results as a reference. Results The PTS group showed larger LA[(5.02±0.50) mm vs.(3.89±0.41) mm;t=4.38,P=0.013],SA[(2.55±0.46) mm vs.(1.70±0.41) mm;t=5.19,P=0.009],and CSA[(11.13±3.72) mm² vs.(6.88±2.68) mm²;t=8.42,P=0.008] of the median nerve than the control group.The AUC of CSA,SA,and LA was 94.3% (95%CI=0.912-0.972,Z=3.586,P=0.001),77.7% (95%CI=0.734-0.815,Z=2.855, P=0.006),and 78.8% (95%CI=0.752-0.821,Z=3.091,P=0.004),respectively.With 8.63 mm² as the cutoff value,the sensitivity and specificity of CSA in diagnosing PTS were 93.3% and 90.0%,respectively. Conclusion High-frequency ultrasound is a practical method for diagnosing PTS,and the CSA of median nerve has a high diagnostic value.
Humans ; Forearm/innervation* ; Muscle, Skeletal/innervation* ; Median Nerve/diagnostic imaging* ; Ultrasonography/methods* ; Sensitivity and Specificity

Forearm ; innervation ; Ganglion Cysts ; surgery ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; innervation ; surgery ; Tendons ; surgery ; Ulnar Nerve ; surgery

OBJECTIVETo study the distribution of intramuscular nerve and blood vessels in forearm muscles and to discuss the possibility of dividing the forearm muscles into independent functional units.

METHODS(1) The muscles were dissected in 10 forearms from 5 fresh adult human cadavers and stained with the Sihler's nerve staining; (2) The blood vessels were studied in eight forearm muscles from 4 fresh adult human cadavers with irrigation of a mixture of 30% barium sulfate and gelatin from brachial artery and then X-photographed. All pictures were compared to study the intramuscular distribution of nerve and blood vessels.

RESULTSThe intramuscular nerve branches were stained purple-black and visualized clearly. The muscles were classified into three types according to the distribution characters of intramuscular nerve and blood vessels. And the types of muscles could be further subdivided into a and b subtypes.

CONCLUSIONAccording to the neurovascular distribution, the forearm muscles in type II a and type III a can be divided into independent function units for muscle functional transplantation.

Adolescent ; Adult ; Aged ; Female ; Forearm ; blood supply ; innervation ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; blood supply ; innervation ; Young Adult

Anatomical variations are typically more common in the extensor compartment of the forearm, but uncommon in the flexor compartment. The presence of such anatomical anomalies is not usually noticed until the normal functions of an individual become hindered, or when these anomalies become a surgical problem. During routine dissection curriculum, we encountered a rare finding of bilateral Gantzer muscles in a cadaver. We describe the relationship between the Gantzer muscle and anterior interosseous nerve syndrome.
Cadaver ; Diagnosis, Differential ; Dissection ; Forearm ; abnormalities ; anatomy & histology ; innervation ; Humans ; Median Nerve ; anatomy & histology ; Models, Anatomic ; Muscle, Skeletal ; abnormalities ; anatomy & histology ; innervation

BACKGROUNDSural neurofasciocutaneous flap has been popularly used as an excellent option for the coverage of soft tissue defects in the lower third of leg, ankle and foot, but its free transplantation has been rarely reported. The objective of our work was to investigate the operative technique and clinical results of repairing the soft tissue defects of hand and forearm with free peroneal perforator-based sural neurofasciocutaneous flap.

METHODSBetween May 2006 and March 2007, 10 patients including 7 men and 3 women were treated. Their ages ranged from 22 to 51 years. They presented to emergency with large soft tissue defects of 16 cm x 7 cm to 24 cm x 10 cm in size in hand and forearm after injured by motor vehicle accidents (2 cases) or crushed by machine (8 cases). Thorough debridements and primary treatments to associated tendon ruptures or bone fractures were performed on emergency. And free peroneal perforator-based sural neurofasciocutaneous flaps were transplanted when the wound areas were stable at 5 to 7 days after emergency treatment. The flaps were designed along the axis of the sural nerve according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested to repair the recipient sites with the peroneal artery anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephalic vein respectively. The flap sizes ranged from 18 cm x 8 cm to 25 cm x 12 cm. The donor areas were closed by skin grafts.

RESULTSAll of the 10 flaps survived after surgeries. Marginal necrosis occurred in only 2 cases. The skin grafts survived entirely in the donor sites, and no obvious influence on the donor legs was observed. All of the transplanted flaps presented favourable contours and good functions at 9 to 12 months' follow-up.

CONCLUSIONSPeroneal perforator-based sural neurofasciocutaneous flap has favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation, and minimal influence on the donor site. The free transplantation of this flap offers a satisfactory alternative for repairing the large soft tissue defects of forearm and hand.

Adult ; Female ; Forearm Injuries ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Treatment Outcome ; Young Adult

OBJECTIVETo study clinical results of the manual reduction in treatment.

METHODSFrom October 2010 to April 2013,39 children with Monteggia fracture associated with anterior interosseous nerve injury were treated by manual reduction and fixation on buckling rotation backward,including 17 females and 22 males with an average age of 6.3 years old ranging from 3.2 to 11 years old. Among them, 15 cases were on the right side and 24 cases on the left. The course of disease was 40 minutes to 8 days (averaged 1.5 days). There were 7 cases with skateboard injured, 13 cases with stumble injured, 11 cases with falling injured,8 cases with air bed injured. According to Bado classification, 13 cases were type II, 22 cases were type III, 4 cases were type IV.

RESULTSThe distal forefinger showed exercise normally in 34 cases at 3 weeks after treatment, and the patients restored normal activities at 6 weeks after treatment. All patients were follow-up from 54 days to 6 months (averaged 67 days. According to Mayo elbow functional evaluation standard,the scoring result was 19.62±1.35 in activity, 45.00 ± 0.00 in pain, 9.87 ± 0.80 in stability, 25.00±0.00 in strength, 99.49 ±1.92 in total. The outcome of all patients was excellent and good evaluation results.

CONCLUSIONIf the anterior interosseous nerve injury could be identified early and treated timely, patients could gradually restore reasonable function and recover with satisfactory results. Raising understanding of anterior interosseous nerve injury can effectively reduce misdiagnosis.

Arm Bones ; injuries ; innervation ; surgery ; Child ; Child, Preschool ; Female ; Forearm Injuries ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Median Nerve ; injuries ; Monteggia's Fracture ; surgery

This study was designed to investigate the incidence of lateral root of the ulnar nerve through cadaveric dissection and to analyze its impact on myotomes corresponding to the flexor carpi ulnaris (FCU) assessed by electrodiagnostic study. Dissection of the brachial plexus (BP) was performed in 38 arms from 19 cadavers, and the connecting branches between the lateral cord and medial cord (or between lateral cord and ulnar nerve) were investigated. We also reviewed electrodiagnostic reports from January 2006 to May 2008 and selected 106 cases of single-level radiculopathy at C6, C7, and C8. The proportion of abnormal needle electromyographic findings in the FCU was analyzed in these patients. In the cadaver study, branches from the lateral cord to the ulnar nerve or to the medial cord were observed in 5 (13.1%) of 38 arms. The incidences of abnormal electromyographic findings in the FCU were 46.2% (36/78) in C7 radiculopathy, 76.5% (13/17) in C8 radiculopathy and 0% (0/11) in C6 radiculopathy. In conclusion, the lateral root of the ulnar nerve is not an uncommon anatomical variation of the BP and the FCU commonly has the C7 myotome. Needle EMG of the FCU may provide more information for the electrodiagnosis of cervical radiculopathy and brachial plexopathy.
Brachial Plexus/anatomy & histology/physiology ; Brachial Plexus Neuropathies/diagnosis ; Cadaver ; Electrodiagnosis/methods ; Electrophysiology/*methods ; Female ; Forearm/*anatomy & histology ; Humans ; Male ; Muscle, Skeletal/*innervation/physiology ; Radiculopathy/diagnosis ; Ulnar Nerve/*anatomy & histology/physiology

OBJECTIVETo report the therapeutic effect of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve for the treatment of soft tissue defect at the dorsum of hand.

METHODS11 cases with soft tissue defects at the dorsum of hands were treated. The size of soft tissue defects ranged from 3.0 cm x 2.5 cm to 6.5 cm x 4.0 cm. The size of the flaps ranged from 3.5 cm x 3. 0 cm to 7. 0 cm x 4. 0 cm.

RESULTSAll the 11 flaps survived. The follow-up period was 2 months to 2 years. The texture and elasticity of the flaps were good. The appearance and function of the hands were satisfactory. The superficial sense was recovered. The wounds at the donor site of forearms were closed primarily in 7 cases, or covered by split-thickness skin grafts in other 4 cases. The appearance of the donor site was satisfactory too.

CONCLUSIONSThe retrograde island neurovascular flap pedicled with lateral antebrachial cutaneous nerve is an optimal method for soft tissue defects at the dorsum of hand.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Forearm ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; innervation ; Treatment Outcome ; Young Adult

PURPOSE: We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique. MATERIALS AND METHODS: 78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 microg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately. RESULTS: The PN group (391.2+/-171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8+/-59.0 sec) and PV2 (211.4+/-58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4+/-149.6 sec) than PV1 (557.6+/-194.9 sec) and PV2 (561.5+/-129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%). CONCLUSION: The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.
Adult ; Anesthetics, Local/*administration & dosage/adverse effects ; Brachial Plexus/*drug effects/*ultrasonography ; Brachial Plexus Block/adverse effects/*methods ; Female ; Forearm/surgery ; Hand/surgery ; Humans ; Injections ; Male ; Middle Aged ; Peripheral Nerves/ultrasonography ; Prospective Studies ; Single-Blind Method ; Treatment Outcome ; *Ultrasonography, Interventional ; Upper Extremity/innervation/*surgery ; Vascular System Injuries/etiology ; Wrist/surgery