The palmaris longus is harvested as a tendon graft in various surgical procedures. We herein report the variations in the insertion of the palmaris longus tendon. During a routine dissection, a rare variation in the insertion of the palmaris longus tendon was observed. In the left forearm, the palmaris longus tendon bifurcated, while in the right forearm, the palmaris longus tendon trifurcated, giving rise to an accessory muscle, which passed superficial to the ulnar artery and ulnar nerve. The accessory muscle was supplied by a deep branch of the ulnar nerve, and the ulnar artery was observed to be tortuous. During reconstructive surgeries, surgeons should bear in mind the accessory muscle. Also, since the palmaris longus muscle provides a very useful graft in tendon surgery, every surgeon should be aware of the variations in the insertion of the palmaris longus tendon.
Cadaver ; Forearm ; anatomy & histology ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; anatomy & histology ; Tendons ; anatomy & histology ; Ulnar Artery ; anatomy & histology ; Ulnar Nerve ; anatomy & histology

OBJECTIVESTo investigate anatomical mechanism of the ulnar wrist pain caused by the compression of the dorsal branch of the ulnar nerve, and discuss the diagnosis and treatment of the compression.

METHODS40 sides of the upper extremities of adult cadavers were studied anatomically. The dorsal branch of the ulnar nerve and its relationship to the surroundings was dissected and observed grossly and microscopically. 13 cases of the compression of the dorsal branch of the ulnar nerve were treated and followed up.

RESULTSThe dorsal branch of the ulnar nerve was penetrated from the deep of the flexor carpi ulnaris muscle 5.6 approximately 6.8 cm proximally from the styloid process of the ulna, then ran along the ulna and divided into 2 approximately 3 big branches at the medial side of the head of the ulna. The transverse branch was apt to injury during wrist movement as it crossed or rounded the head of the ulna where it was close to the peristeam. Seven of 13 cases of the compression of the dorsal branch of the ulnar nerve were treated by local block, and 6 by surgical neurolysis. Nine cases of this group got showed good effect without recurrence after 4 months to 1 year follow-up.

CONCLUSIONThe anatomical basis of the compression of the dorsal branch of the ulnar nerve is repetitive traction to this nerve during wrist movement, and the compression of the transverse branch is the main cause of ulnar wrist pain. The compression of the dorsal branch of the ulnar nerve should be considered to the patients with ulnar wrist pain and abnormal sensation along the dorsal ulnar side of hand.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Ulnar Nerve ; anatomy & histology ; Ulnar Nerve Compression Syndromes ; diagnosis ; physiopathology ; therapy ; Wrist ; anatomy & histology

The superficial brachial artery (SBA), a branch of the axillary artery, is one of the most common arterial variations in this area. While it is more vulnerable to accidental arterial injection or injury, it could be useful for the nourishment of a medial arm skin free flap. To analyze the relationship between the SBA of axillary origin and segmental variation of the axillary artery, we dissected 304 arms of Korean cadavers. We found an SBA of axillary origin in 12.2% of cadaveric arms. Unilateral occurrence was detected in 16 cadavers and bilateral in 10. SBAs gave rise to radial and ulnar arteries in the cubital fossa (8.9%), continued in the forearm as the radial artery (2.3%), or ended in the upper arm (1.0%). The SBA ended as ulnar artery was not found in any of the cadavers. The bifurcation of the SBA into the radial and ulnar arteries, presence of an SBA that ends in the upper arm, and the lack of continuation as the ulnar artery are characteristics of SBAs in Korean cadavers.
Arm/*blood supply ; Axillary Artery/anatomy & histology ; Brachial Artery/*anatomy & histology/*physiology ; Cadaver ; Female ; Humans ; Korea ; Male ; Median Nerve/blood supply ; Models, Anatomic ; Radial Artery/anatomy & histology ; Ulnar Artery/anatomy & histology

OBJECTIVETo investigate the relationship between immunogenicity and decellularization processes of chemically acellular nerve allografts.

METHODSAdult Sprague Dawley rats were used as nerve donors and adult male Wistar rats used as nerve recipient hosts. 25 mm nerve segments were excised from SD rats' sciatic nerves. The nerve segments were decellularized via an improved chemical decelluarization treatment as follows: (1) nerve segments were rinsed with cold sterile Ringer's solution; (2) stabilized by pinning the ends to a thin plastic support, and submerged in 4% Triton-100 solution 12 h; (3) soaked into 3% sodium deoxycholate for 12 h; (4) washed in distilled water for 6 h. The procedures were repeated once again. The acellular nerve allografts from SD rats were sterilized by gamma irradiation and implanted into Wistar rats subcutanously. The control group was implantation of fresh nerve allografts from SD rats. The immunogenicity of acellular nerve allograft was tested by immunohistochemical examination of the intensity of CD3(+), CD4(+) and CD8(+) cells that infiltrated the allografts. Ulnar nerve segments were obtained from forearms of dogs and decellularized according to above procedures. According as the decellularization times, The ulnar nerve segments were divided into three subgroups: in group I, group II and group III, the nerve segments were decellularized repeatedly two, three and four cycles respectively. Each ulnar nerve segment was subdivided into five portions from proximal to distal end. The degrees of decellularization, demyelination and basal lamina integrity of extracellular matrix scaffold were observed with microscope and assessed by a score system. The immunohistochemical staining of GAG was observed.

RESULTSThe intensity of CD3(+), CD4(+) and CD8(+) T cells that infiltrated the allografts was greatly lower in acellular nerves than in fresh nerves. The mild cell-mediated host-graft immunorejection in acellular nerves was observed. On the decellularization procedures, the cells were completely extracted from nerves in all groups, but the myelin sheath were partially existed, and the GAG was present in the basal membrane of myelin sheath. In the score of demyelination, there were no statistical differences between groups (P > 0.05). The statistical difference of basal lamina integrity scores between group I and group II, group I and group III were significant (P < 0.05). As increasing the times of process, the degrees of disintegrity of basal lamina was significantly enhanced.

CONCLUSIONSAlthough decellularization processes significantly reduce the cell-mediated immunorejection of acellular nerve allografts, it can induce mild immunoreaction all the same, the antigen that responsible for immunogenicity may be the residual component of GAG in myelin sheath.

Animals ; Cell Separation ; methods ; Dogs ; Immunohistochemistry ; Male ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Sciatic Nerve ; cytology ; immunology ; transplantation ; Transplantation, Homologous ; immunology ; Ulnar Nerve ; anatomy & histology ; cytology

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