The extensor assembly in two species of opossum,Philander opossum and Didelphis marsupialis

In considering primate and hominoid phylogeny, the fundamental position assigned to opossums is explained partially by the characteristic morphology of their hands and feet. One of the main functional features of the human hand is the ability to make a stabilized arch of the finger. Because the extensor assembly plays a key role in establishing an arched finger, the extensor systems of the digits of both the hands and feet were studied in two species of opossum, Philander opossum and Didelphis marsupialis. In the foot, two extensor tendons join in each toe to form one tendinous plate, which inserts onto the base of the second phalanx. Lumbricals join this plate along the tibial side, and interosseus insertions are found, although a true interosseus wing is lacking. At the proximal interphalangeal level, a terminal tendon takes its origin from this tendinous plate. This terminal tendon is oval in cross-section and contains elastic structures. Oblique bands arise from this terminal tendon and run proximally along the proximal interphalangeal joint inserting onto the base of the first phalanx. There are elastic structures in the flexor tendon on the dorsal side near its site of insertion. In the hand, the main extensor tendons are arranged differently and the interossei contribute substantially to the extensor assembly. Otherwise, the extensor assembly of the hands and feet are quite similar. The function of the so-called paratendinous intravaginal flexors is discussed as are evolutionary aspects of the extensor assembly.     

A rare insertion site for abductor pollicis longus and extensor pollicis brevis muscles

During an investigation performed on cadaver forearms in the anatomy department, an unusual insertion of the abductor pollicis longus (APL) muscle together with the extensor pollicis brevis (EPB) muscle was encountered unilaterally in a 40-year-old male cadaver forearm. APL originated from the posterior ulnar surface distal to the anconeus, the adjoining interosseous membrane and middle third of the posterior radial surface. It lay distal to the supinator muscle and close to the EPB, while the EPB arose from the posterior radial surface and from the adjacent interosseous membrane. These muscles were inserted to the palmar side of the base of the first metacarpal bone together. To our knowledge, this variation has not been cited in recent medical literature.     

Mechanical properties vary for different regions of the finger extensor apparatus

The extensor apparatus, an aponeurosis that covers the dorsal side of each finger, transmits force from a number of musculotendons to the phalanges. Multiple tendons integrate directly into the structure at different sites and the extensor apparatus attaches to the phalanges at multiple points. Thus, prediction of the force distribution within the extensor apparatus, or hood, and the transmission to the phalanges is challenging, especially as knowledge of the underlying mechanical properties of the tissue is limited. We undertook quantification of some of these properties through material testing of cadaver specimens. We punched samples at specified locations from 19 extensor hood specimens. Material testing was performed to failure for each sample with a custom material testing device. Testing revealed significant differences in ultimate load, ultimate strain, thickness, and tangent modulus along the length of the extensor hood. Specifically, thickness, ultimate load, and ultimate strain were greater in the more proximal sections of the extensor hood, while the tangent modulus was greater in the more distal sections. The variations in mechanical properties within the hood may impact prediction of force transmission and, thus, should be considered when modeling the action of the extensor apparatus. Across the extensor hood, tangent modulus values were substantially smaller than values reported for other soft tissues, such as the Achilles tendon and knee ligaments, while ultimate strains were much greater. Thus, the tissue in the extensor apparatus seems to have greater elasticity, which should be modeled accordingly.     

Forearm compartment syndrome: anatomical analysis of surgical approaches to the deep space

Forearm compartment syndrome is a surgical emergency that usually requires release of the superficial muscle compartments. In some clinical situations it is imperative to also explore the deep muscle compartments. There are no anatomical guides for surgical exploration of the deep compartments that would minimize collateral damage to surrounding vessels, nerves, and muscles. Surgical injury in the setting of ischemia, especially vascular injury, compounds the tissue damage that has already occurred. The authors evaluated four surgical approaches (three volar and one dorsal) to the deep forearm by performing detailed anatomical dissections on 10 embalmed and plastinated cadavers. They used a scoring system to rate the approaches for their ability to visualize the deep space without causing iatrogenic injury to superficial muscles, arteries, and nerves. In the volar forearm, an ulnar approach to the deep space is simple, causes the least iatrogenic surgical injury, and provides access to the deep volar forearm structures. The plane of dissection is between the flexor carpi ulnaris and the flexor digitorum superficialis. Dividing one or two distal segmental branches of the ulnar artery to the distal flexor digitorum superficialis exposes the pronator quadratus. Lifting the ulnar neurovascular bundle with the flexor digitorum superficialis in the middle third of the forearm exposes the flexor digitorum profundus and the flexor pollicis longus. This approach to the deep space requires no sharp dissection. In the dorsal forearm, a midline approach between the extensor digitorum communis and the extensor carpi radialis brevis is simple and safe.     

Radius of Paranthropus robustus from member 1, Swartkrans formation, South Africa

Recently recovered hominid postcrania from Member 1, Swartkrans Formation include the proximal and distal ends of a right radius attributed to a single individual of Paranthropus robustus. These fossils are essentially similar to Australopithecus afarensis, A. africanus, and P. boisei homologues. The head manifests an ape-like circumferentia articularis, and the distal end has prominent medial, dorsal, and lateral tubercles and a well developed brachioradialis crest, features also commonly exhibited by extant great apes. The volar set of the P. robustus radiocarpal joint, like that of Australopithecus homologues, more closely resembles the neutral condition exhibited by Homo than the greater flexion evinced by living apes. Compared with fossil and recent specimens of Homo, the configuration of the P. robustus radial head suggests enhanced stability against medial displacement during pronation and supination; the strong crest for the attachment of brachioradialis may attest to enhanced forearm flexor capability. In addition, this crest and the prominent dorsal tubercles may indicate enhanced hand extensor and, therefore, hand flexor capabilities. The differences in radial morphology between Paranthropus and Homo may relate to significant behavioral differences between these two synchronic taxa.     

Anatomical variations of the extensor tendons to the fingers over the dorsum of the hand: a study of 50 hands and a review of the literature

The extensor tendons to the fingers were studied in dissections of 50 fresh cadaveric hands, and the divisions of the tendons, as well as the communications (juncturae), were analyzed. The pattern of distribution most frequently observed was as follows. The extensor digitorum communis provided one tendon to the index finger, one to the middle finger, two to the ring finger, and none to the little finger. The extensor indicis exhibited one tendon, whereas the extensor digiti minimi exhibited two tendons. The extensor indicis tendon was always observed to lack a junctura tendinum. The extensor indicis was absent in both hands of one cadaver. A tendon slip from the extensor digiti minimi to the ring finger was observed in one hand. All surgeons must bear in mind the existence of these variations when performing common tendon transfers.     

Architecture of the human gastrocnemius muscle and some functional consequences

Measurements were performed on the m. gastrocnemius of eight human cadavers in order to describe, in some detail, the architecture of the muscle and its heads. The fibres of the lateral head contain more sarcomeres than those of the medial head. The effect of this difference on the length-force curve of the muscle, calculated with a planimetric muscle model, is diminished by the effect of the difference of fibre angle with respect to the line of pull of the muscle. Within the heads some variation of the number of sarcomeres of the proximal and distal fibres occurs in all muscles. In the lateral head the distal fibres contain fewer sarcomeres than the proximal fibres. In the medial head this is also found in some heads, while others show the reverse. In the lateral head the longer fibres have smaller angles of attachment to the tendon plate and vice versa, while in the medial heads this relationship is only found occasionally. Some variation in the number of sarcomeres is found in the fibres of one bundle. The effects of variations in the number of sarcomeres on the length-force curve are probably insignificant at greater muscle lengths, but may have some importance for the individual with relatively small muscle lengths.     

Extensor tendon injuries: acute management and secondary reconstruction

LEARNING OBJECTIVES: After reviewing the article, the participant should be able to: (1) Describe the anatomy of the extensor tendons at the level of the forearm, wrist, hand, and fingers. (2) Recognize variations in the anatomy. (3) Master the hand examination and define the relevant findings in acute injuries of the extensor tendon(s). (4) Delineate the techniques for extensor repair in both acute and secondary (delayed) management. SUMMARY: Extension of the fingers is an intricate process that reflects the combined action of two independent systems. The interossei and lumbricals constitute the intrinsic musculature of the hand. These muscles innervated by the median and ulnar nerves extend the proximal interphalangeal and distal interphalangeal joints and flex the metacarpophalangeal joints. The extrinsic extensors are a group of muscles innervated by the radial nerve, originating proximal to the forearm. The extrinsic digital extensor muscles include the extensor digitorum communis, extensor indicis proprius, and extensor digiti quinti. The digital extensors function primarily to extend the metacarpophalangeal joints, but also extend the proximal interphalangeal and distal interphalangeal joints. Normal extensor physiology reflects a delicate balance between these two unique extensor systems. In the injured hand, a functioning intrinsic system may potentially compensate for an extrinsic deficit. An understanding of the relevant anatomy and an appreciation for the complex interplay involved in extensor physiology is necessary to recognize and manage these injuries.     

Biomechanical Comparison of Osteoporotic Distal Radius Fractures Fixed by Distal Locking Screws with Different Length

Objectives

To evaluate the postoperative stability of osteoporotic distal radius fractures fixed with distal locking screws with different length.

Methods

A comminuted extra-articular dorsally unstable distal radius fracture, treated with volar locking plate system, was created. The 18 specimens were randomized into 3 groups based on distal locked screws with different length: Group A had unicortical screws with 50% length to the dorsal cortex. Group B had unicortical screws with 75% length to the dorsal cortex. Group C had bicortical screws. Axial compression and bending loads were imposed on the models before and after cycling testing as well as load to clinical and catastrophic failure.

Results

Minimum change in stiffness was observed before and after fatigue for all groups. The final stiffness to bending forces was statistically similar in all groups, but stiffness to axial compression was statistically significant different: Group A approached significance with respect to groups B and C (P = 0.017, 0.009), whereas stiffness in group B and C was statistically similar (P = 0.93). Load to clinical failure was significantly less for group A (456.54±78.59 N) compared with groups B (580.24±73.85 N) and C (591.07±38.40 N). Load to catastrophic failure was statistically similar between groups, but mean values for Group A were 18% less than means for Group C.

Conclusions

The volar locking plate system fixed with unicortical locking screws with at least 75% length not only produced early stability for osteoporotic distal radius fractures, but also avoided extensor tendon complications due to dorsal screw protrusion.     

Studies on the tendinous compartments of the extensor muscles on the back of the human hand and their tendon sheaths. I

In 47 dissected right and left hands of adults of both sexes, kept in a moist condition, significant practical-clinical investigations of the transitional zone between forearm and hand were undertaken. In particular it was sought to determine the characteristic sizes of the extensor retinaculum, the osteofibrous tunnels, the insertion tendons of the hand and finger extensor muscles, and their tendon sheaths. Together with the palmar carpal ligament, the 2 to 3 cm wide extensor retinaculum annularly surrounds the whole circumference of the carpus. It extends obliquely from radial-proximal to ulnar-distal and conducts the extensor tendons over the carpal articulations. According to recent studies, it is divided into a superficial and a deep fibrous layer. From the undermost surface, vertical and oblique septa run to the plane of the forearm and carpal bones. They separate the fibrous portion of the 6 tendinous compartments of the dorsum manus. In 8.5% of cases, an accessory and completely independent tunnel of the extensor pollicis brevis muscle exists in the material investigated, and in 2.2% of cases, there is an additional tunnel for the extensor carpi radialis muscle. Hence, one occasionally finds 8 separate osteofibrous gliding compartments for the extensor muscles in the dorsal hand region. The longest tunnel belongs, as a rule, to the extensor digiti minimi muscle, whilst the widest pertains to the extensor digitorum muscle. Within the tunnel and also proximal and distal to it, the extensor tendons are surrounded by synovial sheaths. Because of its wide encroachment on the dorsum of the hand, the insertion tendon of the extensor digiti minimi muscle possesses the longest tendon sheath, measuring 68.8 mm. The next longest sheath, that of the extensor pollicis longus muscle, which measures 56.2 mm, begins further proximal to the gap of the radiocarpal articulation. In 12.8% of cases, there are divided sheaths of the abductor pollicis longus and of the extensor pollicis brevis muscle. The tendon sheath of both extensor carpi radiales muscles is frequently divided into 2 compartments which, in 2/3 of cases, communicate. The compartment of the extensor carpi radialis brevis muscle, in 91.5% of cases, shares a window-like opening with the roof of the synovial vagina of the extensor pollicis longus muscle. The tendon sheath of the long extensor muscles of the fingers originates 5 mm proximal to the forearm border of the extensor retinaculum and has a communal recess. The IVth tendon sheath opens distally and splays out in a glove-like manner to some distal recesses.(ABSTRACT TRUNCATED AT 400 WORDS)     

Comparative morphology of the pollical distal phalanx

Functional analysis of human pollical distal phalangeal (PDP) morphology is undertaken to establish a basis for the assessment of fossil hominid PDP morphology. Features that contribute to the effectiveness of grips involving the distal thumb and finger pulp areas include: 1) distal thumb interphalangeal joint morphology, facilitating PDP conjunct pronation with flexion; 2) differentiation of a proximal, mobile pulp region from a distal, stable pulp region, providing for firm precision pinch grips and precision handling of objects; and 3) asymmetric attachment of the flexor pollicis longus (FPL) tendon fibers, favoring PDP conjunct pronation. A proportionately larger size of the ulnar vs. radial ungual spine suggests differential loading intensity of the ulnar side of the proximal ungual pulp and supporting nail bed. Stresses at the distal interphalangeal joint are indicated by the presence of a sesamoid bone within the volar (palmar) plate, which also increases the length of the flexor pollicis longus tendon moment arm. Dissections of specimens from six nonhuman primate genera indicate that these human features are shared variably with individuals in other species, although the full pattern of features appears to be distinctively human. Humans share variably with these other species all metric relationships examined here. The new data identify a need to systematically review long-standing assumptions regarding the range of precision and power manipulative capabilities that might reasonably be inferred from morphology of the distal phalangeal tuberosity and from the FPL tendon insertion site on the PDP.     

Vascular anatomy of the forearm muscles: a study of 50 dissections

This anatomic study is based on 50 adult cadaver upper extremities. The general disposition of the forearm arteries and muscles and the main anatomic variations encountered are specified. Constant existence of an "anterior oblique artery" satellite of the pronator teres was established. The median nerve artery was principally dedicated to the flexor digitorum superficialis and participated appreciably in the constitution of palmar arches in only one case. A supernumerary intermedial radial muscle was found only in two cases. The abductor pollicis longus and extensor pollicis brevis appeared as a single muscular and vascular unit in 84 percent of cases. All the arteries destined for muscles were reckoned whatever their caliber might be. Despite its limitations, this study confirms the very great number of the forearm muscular pedicles. Each forearm contained an average of 264 muscular vascular pedicles. The systematization of the origins and destinations of the 13,158 muscular pedicles is described in a numbered manner for each of the 20 normal forearm muscles and for each of the 12 studied arterial segments. The pronator teres was likely to be supplied by all the anterior arteries of the upper limb. The flexor carpi radialis had one or two dominant pedicles originated from the recurrens ulnaris anterior, recurrens ulnaris, or ulnaris-interossea communis arteries, and many transversal branches originated from the radial artery. The flexor carpi ulnaris was supplied in its proximal third by the recurrens ulnaris posterior artery and in its distal two-thirds by many branches of ulnar artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Does trabecular bone structure within the metacarpal heads of primates vary with hand posture?

Reconstructing function from hominin fossils is complicated by disagreements over how to interpret primitively inherited, ape-like morphology. This has led to considerable research on aspects of skeletal morphology that may be sensitive to activity levels during life. We quantify trabecular bone morphology in three volumes of interest (dorsal, central, and palmar) in the third metacarpal heads of extant primates that differ in hand function: Pan troglodytes, Pongo pygmaeus, Papio anubis, and Homo sapiens. Results show that bone volume within third metacarpal heads generally matches expectations based on differences in function, providing quantitative support to previous studies. Pongo shows significantly low bone volume in the dorsal region of the metacarpal head. Humans show a similar pattern, as manipulative tasks mostly involve flexed and neutral metacarpo-phalangeal joint postures. In contrast, Pan and Papio have relatively high bone volume in dorsal and palmar regions, which are loaded during knuckle-walking/digitigrady and climbing, respectively. Regional variation in degree of anisotropy did not match predictions. Although trabecular morphology may improve behavioral inferences from fossils, more sophisticated quantitative strategies are needed to explore trabecular spatial distributions and their relationships to hand function.     

Identification of a frequency response model of joint rotation

A second order, linear oscillator transfer function model is fit to the measured transfer function relating the abduction-adduction rotation of the first finger to the applied moment. Nearly constant isometric contractions of the first palmar and dorsal interossei are maintained by the subjects during the measurements. The stiffness and damping components of the identified models increase significantly with increasing isometric contraction when compared to those recorded under relaxed contraction. Muscle fatigue causes the natural frequency, damping ratio and stiffness of the joint rotation to decrease under full isometric contraction, and it causes the natural frequency and stiffness to increase when the muscles are relaxed.     

Cadaveric study of the arterial anatomy of the upper lip

Arterial distribution of the upper lip was investigated in this study. The location, course, length, and diameter of the superior labial artery and its alar and septal branches were determined on 14 preserved cadaver heads. Another cadaver head was used to show the arterial tree by the colored silicone injection technique. The superior labial artery was the main artery of the upper lip and always originated from the facial artery. The superior labial artery was 45.4 mm in length, with a range from 29 to 85 mm. The mean distance of the origin of the superior labial artery from the labial commissura was 12.1 mm. The superior labial artery was 1.3 mm in external diameter at its origin. The mean distance of origin of the superior labial artery from the lower border of the mandible was 46.4 mm. The alar division of the superior labial artery was mostly found as a single branch (82 percent). Its mean length was 14.8 mm and the mean diameter at the origin was 0.5 mm. The distance between the origins of the superior labial artery and the septal branch was 33.3 mm. The septal branch was single in most of the cases (90 percent). The mean length of the septal branch was 18.0 mm and the diameter at its origin was 0.9 mm. After all dissections, it was concluded that the arterial distribution of the upper lip was not constant. The superior labial artery can occur in different locations unilaterally and bilaterally, with the branches showing variability.     

Arterial anatomy of the lower lip: a cadaveric study

The aim of the study was to investigate the arterial anatomy of the lower lip. The location, course, length, and diameter of the inferior labial artery and the sublabial artery were revealed by bilateral meticulous anatomic dissections in 14 adult male preserved cadaver heads. Another cadaver head was used for silicone rubber injection to fill the regional arterial tree. The inferior labial artery was the main artery of the lower lip and in all cases branched off the facial artery. The mean length of the inferior labial artery was found to be 52.3 mm (range, 16 to 98 mm). The mean distance of the origin of the inferior labial artery from the labial commissura was 23.9 mm. The mean external diameter of the inferior labial artery at the origin was 1.2 mm. The sublabial artery was present in 10 (71 percent) of the cadavers. Mean measurements of this artery were 1 mm for diameter, 23.4 mm for length, and 27.6 mm for distance from the labial commissura. The sublabial artery may originate from the facial artery or the inferior labial artery. This study found that this region does not have a constant arterial distribution, the inferior labial artery and the sublabial artery (if it exists) can be in different locations unilaterally or bilaterally, and the diameter and the length may vary.     

Computer keyswitch force–displacement characteristics affect muscle activity patterns during index finger tapping

This study examined the effect of computer keyboard keyswitch design on muscle activity patterns during finger tapping. In a repeated-measures laboratory experiment, six participants tapped with their index fingers on five isolated keyswitch designs with varying force–displacement characteristics that provided pairwise comparisons for the design factors of (1) activation force (0.31 N vs. 0.59 N; 0.55 N vs. 0.93 N), (2) key travel (2.5 mm vs. 3.5 mm), and (3) shape of the force–displacement curve as realized through buckling-spring vs. rubber-dome switch designs. A load cell underneath the keyswitch measured vertical fingertip forces, and intramuscular fine wire EMG electrodes measured muscle activity patterns of two intrinsic (first lumbricalis, first dorsal interossei) and three extrinsic (flexor digitorum superficialis, flexor digitorum profundus, and extensor digitorum communis) index finger muscles. The amplitude of muscle activity for the first dorsal interossei increased 25.9% with larger activation forces, but not for the extrinsic muscles. The amplitude of muscle activity for the first lumbricalis and the duration of muscle activities for the first dorsal interossei and both extrinsic flexor muscles decreased up to 40.4% with longer key travel. The amplitude of muscle activity in the first dorsal interossei increased 36.6% and the duration of muscle activity for all muscles, except flexor digitorum profundus, decreased up to 49.1% with the buckling-spring design relative to the rubber-dome design. These findings suggest that simply changing the force–displacement characteristics of a keyswitch changes the dynamic loading of the muscles, especially in the intrinsic muscles, during keyboard work.     

The blood supply of the reverse temporalis muscle flap: anatomic study and clinical implications

Although the reverse temporalis muscle flap has been used clinically, the exact vascular connection between the superficial and deep temporal vessels has not been clearly defined. The purpose of this study was to investigate the vascular territory of the reverse temporalis muscle supplied by the superficial temporal vessels. Six cadaver heads were studied using a colored lead oxide injection through the superficial temporal artery. The specimens were examined macroscopically and radiographically. The reverse temporalis muscle flap was then applied to a clinical case presenting with traumatic anterior skull base defect communicating with the nasal cavity. The cadaver specimens demonstrated that the superficial temporal artery formed an average 1.3 +/- 0.2 cm in width of dense vascular zone, which was located within 1.8 cm below the superior temporal line. The dense vascular network further perfused the anterior and posterior deep temporal arteries and the muscular branch of the middle temporal artery to supply the temporalis muscle. The mean perfused area of the temporalis muscle was 83 percent, ranging from 79 to 89 percent, in five cadaver heads. One cadaver revealed only 55 percent of perfused area in the absence of the muscular branch of the middle temporal artery. The consistent area without perfusion was located in the distal third of the posterior portion of the reverse temporalis muscle. In clinical cases, the reverse temporalis muscle flap was used successfully to obliterate the anterior skull base defect without evidence of muscle flap necrosis. The exact blood supply to the distal third of the posterior portion of the reverse temporalis muscle flap needs to be investigated further in vivo. Particular attention was paid to the inclusion of the muscular branch of the middle temporal artery in this flap to augment the blood supply to the temporalis muscle.