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http://dx.doi.org/10.5115/acb.2011.44.2.160

Accessory muscle in the forearm: a clinical and embryological approach  

Ciftcioglu, Engin (Department of Anatomy, Medical Faculty, Ondokuz Mayıs University)
Kopuz, Cem (Department of Anatomy, Medical Faculty, Ondokuz Mayıs University)
Corumlu, Ufuk (112 Emergency Service, Medical Practioner-CarSamba-Samsun)
Demir, Mehmet T. (Government Research Hospital, Emergency Service)
Publication Information
Anatomy and Cell Biology / v.44, no.2, 2011 , pp. 160-163 More about this Journal
Abstract
Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.
Keywords
Accessory muscle; Flexor carpi ulnaris muscle; Forearm; Ulnar nerve compression syndrome; Embryology;
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1 King TS, O'Rahilly R. M. palmaris accessorius and duplication of M. palmaris longus. Acta Anat 1950;10:327-31.   DOI
2 Kopuz C, Fidan B, Islam A. An unusually distal and complete additional flexor profundus muscle to the index finger. J Anat 1997;191(Pt 3):465-7.   DOI
3 Wahba MY, Singh GD, Lozanoff S. An anomalous accessory flexor digiti minimi profundus muscle: a case study. Clin Anat 1998;11:55-9.   DOI   ScienceOn
4 Kanaya K, Wada T, Isogai S, Murakami G, Ishii S. Variation in insertion of the abductor digiti minimi: an anatomic study. J Hand Surg Am 2002;27:325-8.   DOI   ScienceOn
5 Wingerter S, Gupta S, Le S, Shamasunder S, Bernstein R, Rabitaille W, Kukuyeva Y, Downie S. Unusual origin of the flexor digiti minimi brevis muscle. Clin Anat 2003;16:531-3.   DOI   ScienceOn
6 Bakinde N, Yotovski P, Voigt T, Rager G. Accessory muscle in the hypothenar region: a functional approach. Ann Anat 2005;187:149-52.   DOI   ScienceOn
7 Nayak SR, Ramanathan L, Prabhu LV, Raju S. Additional flexor muscles of the forearm: case report and clinical significance. Singapore Med J 2007;48:e231-3.
8 Jeffery AK. Compression of the deep palmar branch of the ulnar nerve by an anomalous muscle: case report and review. J Bone Joint Surg Br 1971;53:718-23.
9 Roberts PH. An anomalous accessory palmaris longus muscle. Hand 1972;4:40-1.   DOI   ScienceOn
10 Kernohan J, Dakin PK, Quain JS, Helal B. An anomalous flexor digitorum superficialis indicis muscle in association with a fibroma presenting as a stiff painful finger. J Hand Surg Br 1984;9:335-6.   DOI   ScienceOn
11 Ametewee K, Harris A, Samuel M. Acute carpal tunnel syndrome produced by anomalous flexor digitorum superficialis indicis muscle. J Hand Surg Br 1985;10:83-4.   DOI   ScienceOn
12 Elias LS, Schulter-Ellis FP. Anomalous flexor superficialis indicis: two case reports and literature review. J Hand Surg Am 1985;10:296-9.   DOI
13 Tonkin MA, Lister GD. The palmaris brevis profundus: an anomalous muscle associated with ulnar nerve compression at the wrist. J Hand Surg Am 1985;10(6 Pt 1):862-4.   DOI
14 Lahey MD, Aulicino PL. Anomalous muscles associated with compression neuropathies. Orthop Rev 1986;15:199-208.
15 Kostka KH, Steen M. The abductor digiti minimi longus muscle as a cause of distal ulnar compression syndrome. Handchir Mikrochir Plast Chir 1990;22:53-4.
16 Bergman RA, Thompson SA, Afifi AK, Saadeh FA. Compendium of human anatomic variation. Baltimore and Munich: Urban and Schwarzenberg Co.; 1998. p.12-8.
17 Ang GG, Rozen WM, Vally F, Eizenberg N, Grinsell D. Anomalies of the flexor carpi ulnaris: clinical case report and cadaveric study. Clin Anat 2010;23:427-30.   DOI   ScienceOn
18 Vichare NA. Anomalous muscle belly of the flexor digitorum superficialis: report of a case. J Bone Joint Surg Br 1970;52:757-9.
19 Hayes CW Jr. Anomalous flexor sublimis muscle with incipient carpal tunnel syndrome: case report. Plast Reconstr Surg 1974;53:479-83.   DOI   ScienceOn
20 Murakami Y, Todani K. The extensor indicis brevis muscle with an unusual ganglion. Clin Orthop Relat Res 1982;(162):207-9.
21 Thomas CG Jr. Clinical manifestations of an accessory palmaris muscle. J Bone Joint Surg Am 1958;40:929-30.   DOI
22 Lipscomb PR. Duplication of hypothenar muscles simulating soft-tissue tumour of the hand: report of a case. J Bone Joint Surg Am 1960;42:1058-61.   DOI
23 Ashby BS. Hypertrophy of the palmaris longus muscle: report of a case. J Bone Joint Surg Br 1964;46:230-2.
24 Hollinshead WH. Anatomy for surgeons. Vol. 3. 2nd ed. Philadelphia: Harper and Row Co.; 1968. p.408-9.
25 Standring S. Gray's anatomy: the anatomia basis of clinical practice. 14th ed. London: Churchill & Livingstone Co; 2008. p.846-7.
26 Williams PL, Bannister LM, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MW. Gray's anatomy. 38th ed. Edinburg: Churchill & Livingstone Co.; 1995. p. 789, 847-8.
27 Grechenig W, Clement H, Egner S, Tesch NP, Weiglein A, Peicha G. Musculo-tendinous junction of the flexor carpi ulnaris muscle: an anatomical study. Surg Radiol Anat 2000;22:255-60.
28 Macalister A. Additional observations on muscular anomalies in the human anatomy. Vol. 25. Dublin: Transactions of the Royal Irish Academy; 1875. p.1-134.
29 Still JM Jr, Kleinert HE. Anomalous muscles and nerve entrapment in the wrist and hand. Plast Reconstr Surg 1973;52:394-400.   DOI
30 Salgeback S. Ulnar tunnel syndrome caused by anomalous muscles: case report. Scand J Plast Reconstr Surg 1977;11:255-8.   DOI
31 Pribyl CR, Moneim MS. Anomalous hand muscle found in the Guyon's canal at exploration for ulnar artery thrombosis: a case report. Clin Orthop Relat Res 1994;(306):120-3.
32 Anson BJ. Morris' human anatomy. New York: McGraw-Hill Co.; 1966. p.501-14.
33 Cihak R. Ontogenesis of the skeleton and intrinsic muscles of the human hand and foot. Ergeb Anat Entwicklungsgesch 1972;46:1-5.
34 Grim M. Ultrastructure of the ulnar portion of the contrahent muscle layer in the embryonic human hand. Folia Morphol (Praha) 1972;20:113-5.
35 James MR, Rowley DI, Norris SH. Ulnar nerve compression by an accessory abductor digiti minimi muscle presenting following injury. Injury 1987;18:66-7.   DOI   ScienceOn
36 Sheppard JE, Prebble TB, Rahn K. Ulnar neuropathy caused by an accessory abductor digiti minimi muscle. Wis Med J 1991;90:628-31.   DOI   ScienceOn
37 Hutton P, Kernohan J, Birch R. An anomalous flexor digitorum superficialis indicis muscle presenting as carpal tunnel syndrome. Hand 1981;13:85-6.   DOI   ScienceOn