• Archives of Plastic Surgery
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• 제33권1호
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• pp.120-123
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• 2006

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.

• 대한정형외과 초음파학회지
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• 제4권1호
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• pp.24-27
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• 2011

원위부 요골 골절의 합병증 중 하나인 장무지 신전건 파열은 지연성으로 발생한다고 알려져 있다. 요골 골절과 동시에 발생하는 급성 장무지 신전건 파열은 매우 드문 경우로, 저자들은 문헌 고찰과 함께 증례 보고 하고자 한다.

• Anatomy and Cell Biology
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• 제56권3호
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• pp.328-333
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• 2023

The first extensor compartment of the wrist is a distinctly variable anatomical area. Anatomical variations in this region contribute to the pathophysiology and treatment failure of de Quervain's disease, which is a kind of tenosynovitis that develops in the first extensor compartment of the wrist. We aim to describe the first extensor compartment morphology, to evaluate the septum frequency, location of the septum, and the number of tendons of abductor pollicis longus (APL) and extensor pollicis brevis muscles (EPB). First extensor compartment of 87 wrists of 45 cadavers were dissected. The presence or absence of septum and number of tendon slips of APL and EPB revealed. The proximal and distal widths of the compartments were measured. Septums were detected in 60.9% (n=53) of the wrists. Incomplete (distal) and complete (proximal) septa were present in 35.6% (n=31) and 25.3% (n=22) of the cases. Only 26.4% of the wrists had a single slip of APL tendon. The Remaining had multiple slips. The median inner width of the proximal and distal compartments in all wrists were calculated as in the order of 9.11±1.14 mm and 8.55±1.12 mm. We believe that understanding the anatomy of the first extensor compartment in the Turkish population would be helpful to surgeons, radiologists, and physiotherapists to diagnose and manage de Quervain's disease.

• Archives of Hand and Microsurgery
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• 제24권1호
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• pp.63-67
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• 2019

장무지신전건의 자연파열은 주로 요골 원위부의 리스터 결절(Lister's tubercle) 부위에 발생한 골절, 스테로이드 주사, 그리고 류마티스 관절염과 같은 염증성 병변에 의해서 제 3 신전 구획에서 주로 발생할 수 있다. 저자들은 반복적으로 손목관절의 운동을 이용하여 드럼 연주를 하는 리듬게임 후 발생한 장무지신전건의 자연파열 1예를 경험하였고, 본 증례와 같이 반복적이고 과도한 손목관절의 운동에 의해서도 장무지신전건이 파열될 수 있음을 문헌고찰과 함께 보고하고자 한다.

• Anatomy and Cell Biology
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• 제57권2호
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• pp.246-255
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• 2024

Knowledge of the superficial radial nerve (SRN) relationship and anatomic variations of the first extensor compartment (1st EC) will contribute to a better outcome of de Quervain tenosynovitis treatment. We dissected 87 embalmed cadaveric wrists to determine the relationship of the SRN, the 1st EC length, distance from the proximal and distal 1st EC borders to radial styloid process (RSP), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slip numbers, and the presence of septum. Our results revealed SRN crossing over the 1st EC in 59.5%. The lateral branch of the superficial radial nerve to the 1st EC midline in most cases (61.9%) except for one specimen, where lateral antebrachial cutaneous nerve was the closest. Distances from proximal and distal 1st EC borders to the RSP were 19.7±4.1 mm and 7.6±1.8 mm, respectively. Extensor retinaculum (ER) width over 1st EC (1st EC length) was 14.8±3.2 mm. Complete and incomplete septa were found in 17.2%, and 42.5%, respectively. The most frequent APL tendon slip number in the compartment was two in overall 47 specimens (54.0%). Almost all compartments (85 specimens; 97.7%) contained one EPB tendon slip. We detected bilateral EPB absence in one cadaver. Moreover, we recorded a tendon slip from extensor pollicis longus traveling into 1st EC bilaterally in one cadaver and observed the EPB muscle belly extension into 1st EC in 9 wrists. Awareness of 1st EC anatomic variations would be essential for successful surgical and nonsurgical outcomes.

• Korean Journal of Acupuncture
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• 제19권1호
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• pp.15-23
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• 2002

This study was carried to identify the component of Large Intestine Meridian Muscle in human, dividing into outer, middle, and inner part. Brachium and antebrachium were opened widely to demonstrate muscles, nerve, blood vessels and the others, displaying the inner structure of Large Intestine Meridian Muscle. We obtained the results as follows; 1. Meridian Muscle is composed of the muscle, nerve and blood vessels. 2. In human anatomy, it is present the difference between a term of nerve or blood vessels which control the muscle of Meridian Muscle and those which pass near by Meridian Muscle. 3. The inner composition of meridian muscle in human arm is as follows. 1) Muscle; extensor digitorum tendon(LI-1), lumbrical tendon(LI-2), 1st dosal interosseous muscle(LI-3), 1st dosal interosseous muscle and adductor pollicis muscle(LI-4), extensor pollicis longus tendon and extensor pollicis brevis tendon(LI-5), adductor pollicis longus muscle and extensor carpi radialis brevis tendon(LI-6), extensor digitorum muscle and extensor carpi radialis brevis mucsle and abductor pollicis longus muscle(LI-7), extensor carpi radialis brevis muscle and pronator teres muscle(LI-8), extensor carpi radialis brevis muscle and supinator muscle(LI-9), extensor carpi radialis longus muscle and extensor carpi radialis brevis muscle and supinator muscle(LI-10), brachioradialis muscle(LI-11), triceps brachii muscle and brachioradialis muscle(LI-12), brachioradialis muscle and brachialis muscle(LI-13), deltoid muscle(LI-14, LI-15), trapezius muscle and supraspinous muscle(LI-16), platysma muscle and sternocleidomastoid muscle and scalenous muscle(LI-17, LI-18), orbicularis oris superior muscle(LI-19, LI-20) 2) Nerve; superficial branch of radial nerve and branch of median nerve(LI-1, LI-2, LI-3), superficial branch of radial nerve and branch of median nerve and branch of ulna nerve(LI-4), superficial branch of radial nerve(LI-5), branch of radial nerve(LI-6), posterior antebrachial cutaneous nerve and branch of radial nerve(LI-7), posterior antebrachial cutaneous nerve(LI-8), posterior antebrachial cutaneous nerve and radial nerve(LI-9, LI-12), lateral antebrachial cutaneous nerve and deep branch of radial nerve(LI-10), radial nerve(LI-11), lateral antebrachial cutaneous nerve and branch of radial nerve(LI-13), superior lateral cutaneous nerve and axillary nerve(LI-14), 1st thoracic nerve and suprascapular nerve and axillary nerve(LI-15), dosal rami of C4 and 1st thoracic nerve and suprascapular nerve(LI-16), transverse cervical nerve and supraclavicular nerve and phrenic nerve(LI-17), transverse cervical nerve and 2nd, 3rd cervical nerve and accessory nerve(LI-18), infraorbital nerve(LI-19), facial nerve and infraorbital nerve(LI-20). 3) Blood vessels; proper palmar digital artery(LI-1, LI-2), dorsal metacarpal artery and common palmar digital artery(LI-3), dorsal metacarpal artery and common palmar digital artery and branch of deep palmar aterial arch(LI-4), radial artery(LI-5), branch of posterior interosseous artery(LI-6, LI-7), radial recurrent artery(LI-11), cephalic vein and radial collateral artery(LI-13), cephalic vein and posterior circumflex humeral artery(LI-14), thoracoacromial artery and suprascapular artery and posterior circumflex humeral artery and anterior circumflex humeral artery(LI-15), transverse cervical artery and suprascapular artery(LI-16), transverse cervical artery(LI-17), SCM branch of external carotid artery(LI-18), facial artery(LI-19, LI-20)

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.62-67
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• 2015

Purpose: Pollicization typically involves surgical migration of the index finger to the position of the thumb. This procedure facilitates the conversion of a useless hand into a well-functioning one in patients who are not amenable to the toe-to-hand transfer. However, middle finger pollicization has been rarely reported. Materials and Methods: We reconstructed a thumb by immediate pollicization of the remnants of the middle finger in two patients who sustained a tumor and a trauma, respectively. The former, after cancer ablation was performed, has not been reported literally, and the latter involved free devitalized pollicization of the middle finger using a microsurgical anastomosis. The distal third extensor communis tendon was sutured to the proximal extensor pollicis longus tendon and the distal flexor digitorum superficialis and profundus were sutured to the proximal flexor pollicis longus. The abductor pollicis brevis tendon was sutured to the distal end of the first palmar interosseous muscle. Coaptation of the third digital nerve and the superficial radial nerve branch was performed. Results: Patients showed uneventful postoperative courses without complication such as infection or finger necrosis. Based on the principles of pollicization, a wide range of pinch and grasp movements was successfully restored. They were pleased with the functional and cosmetic results. Conclusion: Although the index finger has been the digit of choice for pollicization, we could also use the middle finger on specific occasions. This procedure provides an excellent option for the reconstruction of a mutilated thumb and could be performed advantageously in a single step.

• Korean Journal of Acupuncture
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• 제22권1호
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• pp.67-74
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• 2005

Objectives : This study was carried to identify the component of the Pericardium Meridian Muscle in human. Methods : The regional muscle group was divided into outer, middle, and inner layer. The inner part of body surface were opened widely to demonstrate muscles, nerve, blood vessels and to expose the inner structure of the Pericardium Meridian Muscle in the order of layers. Results We obtained the results as follows; He Perfcardium Meridian Muscle composed of the muscles, nerves and blood vessels. In human anatomy, it is present the difference between terms (that is, nerves or blood vessels which control the muscle of the Pericardium Meridian Muscle and those which pass near by the Pericardium Meridian Muscle). The inner composition of the Pericardium Meridian Muscle in human is as follows ; 1) Muscle P-1 : pectoralis major and minor muscles, intercostalis muscle(m.) P-2 : space between biceps brachialis m. heads. P-3 : tendon of biceps brachialis and brachialis m. P-4 : space between flexor carpi radialis m. and palmaris longus m. tendon(tend.), flexor digitorum superficialis m., flexor digitorum profundus m. P-5 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum superficialis m., flexor digitorum profundus m. tend. P-6 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum profundus m. tend., pronator quadratus m. H-7 : palmar carpal ligament, flexor retinaculum, radiad of flexor digitorum superficialis m. tend., ulnad of flexor pollicis longus tend. radiad of flexor digitorum profundus m. tend. H-8 : palmar carpal ligament, space between flexor digitorum superficialis m. tends., adductor follicis n., palmar interosseous m. H-9 : radiad of extensor tend. insertion. 2) Blood vessel P-1 : lateral cutaneous branch of 4th. intercostal artery, pectoral br. of Ihoracoacrornial art., 4th. intercostal artery(art) P-3 : intermediate basilic vein(v.), brachial art. P4 : intermediate antebrachial v., anterior interosseous art. P-5 : intermediate antebrarhial v., anterior interosseous art. P-6 : intermediate antebrachial v., anterior interosseous art. P-7 : intermediate antebrachial v., palmar carpal br. of radial art., anterior interosseous art. P-8 : superficial palmar arterial arch, palmar metacarpal art. P-9 : dorsal br. of palmar digital art. 3) Nerve P-1 : lateral cutaneous branch of 4th. intercostal nerve, medial pectoral nerve, 4th. intercostal nerve(n.) P-2 : lateral antebrachial cutaneous n. P-3 : medial antebrachial cutaneous n., median n. musrulocutaneous n. P-4 : medial antebrachial cutaneous n., anterior interosseous n. median n. P-5 : median n., anterior interosseous n. P-6 : median n., anterior interosseous n. P-7 : palmar br. of median n., median n., anterior interosseous n. P-8 : palmar br. of median n., palmar digital br. of median n., br. of median n., deep br. of ulnar n. P-9 : dorsal br. of palmar digital branch of median n. Conclusions : This study shows some differences from already established study on meridian Muscle.