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)     

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.     

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.     

Radial half of extensor carpi radialis longus tendon as graft to elongate muscle tendon unit for correction of finger clawing

In 12 patients, the extensor carpi radialis longus muscle tendon unit was elongated using the radial half of the parent tendon so that it could reach the site of new insertion, the A1-A2 pulley of flexor sheath or lateral bands, after routing the transfer through the carpal tunnel. The tendon was of appropriate thickness and could be split into two halves to be used as a graft. Further splitting of the tendon into four tails was possible. The transferred slips retained adequate strength to activate the fingers after the operation. It is suggested that splitting of the extensor carpi radialis longus tendon to use one half as a tendon graft be considered in patients in whom extensor carpi radialis longus transfer is planned to correct finger clawing. This technique is simple, needs minor modification in the sequence of operative steps, reduces operating time, and saves the patient from postoperative discomfort, muscle herniation, and scarring at the donor site (usually the thigh).     

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)     

Extensor carpi radialis longus muscle and the evolution of the first intermetacarpal ligament

The morphology and function of tendinous connections between the bases of the first and second metacarpal bone was studied in dissected specimens. The sample comprises 28 hands from eight species of cercopithecidae and pongidae and 23 human hands. Four types were identified: (1) No intermetacarpal connections were present. (2) The extensor carpi radialis longus tendon was divided at the carpus and the side branch inserted on the ulnar side of the base of the first metacarpal bone. (3) Part of the fibers of the extensor carpi radialis longus bypassed the insertion on the second metacarpal bone and continued to the base of the first metacarpal bone. A few proper intermetacarpal fibers were included. (4) An extracapsular, intermetacarpal ligament was present. Its fibers were mainly separated from the extensor carpi radialis longus. Type 1 is a general mammalian form. Type 2 is common in higher, non-human primates. Type 3 was found in 2 of the 23 human hands and otherwise among the anthropoid apes only. Type 4 is apomorph in man. Individual variations exist though. Type 3 and especially type 4 could check ab- and adductions and guide a circumduction in the first carpometacarpal joint.     

Innervated radial thenar flap combined with radial forearm flap transfer for thumb reconstruction

A radial thenar flap combined with radial forearm flap was used for the reconstruction of the ipsilateral thumb in four patients. Vascular supply of the combined flap was based on the radial artery and extending the vascular pedicle to the superficial palmar branch of the radial artery. The flap was sensated by the palmar branch of the superficial radial nerve. The size of the flap averaged 15 x 5 cm and the innervated region of the thenar eminence was an area approximately 5 x 3 cm located over the proximal parts of the abductor pollicis brevis and opponens pollicis muscles. The flap was transferred as a free flap in three patients and as an advancement flap in one patient. The flaps survived completely without complications. Satisfactory restoration of sensation was achieved in the flap area, as shown by 6 mm of average moving two-point discrimination. This combined flap may be a feasible reconstructive option for large palmar defects of the fingers such as degloving injuries.     

Free flap from the flexor aspect of the wrist for resurfacing defects of the hand and fingers

The distal portion of the flexor aspect of the forearm has been used as the donor site of full-thickness skin grafts, venous skin grafts, and Chinese forearm flaps. This article describes the use of a free flap harvested from the flexor aspect of the wrist and based on the superficial palmar branch of the radial artery to repair skin defects of the hand and fingers. The advantages of this flap are as follows: (1) the operative field is the same; (2) the radial artery is preserved; (3) it is thin, pliable, and hairless and thus can supply a gliding surface for tendons beneath it; (4) when it involves a palmaris longus tendon and/or the palmar cutaneous branch of the median nerve, it can be used as a vascularized tendon or nerve graft; and (5) in view of the flow-through type of the pedicle of the flap, the digital artery can be reconstructed simultaneously. However, it should be noted that a hypesthesia in the proximal central carpal area remains when the palmar cutaneous branch of the median nerve is harvested as a vascularized nerve graft. The scar of the donor site should be left in the distal wrist crease. If it is not lying in the distal wrist crease, it may suggest that the patient has tried to commit suicide.     

Reversed forearm island flap supplied by the septocutaneous perforator of the radial artery: anatomical basis and clinical applications

The cutaneous perforators of the radial artery adjacent to the superficial branch of the radial nerve and the lateral antebrachial cutaneous nerve were investigated, and the vascular anatomical features of the reversed forearm island flap supplied by those accompanying perforators were documented. Ten fresh cadavers were systemically injected with lead oxide, gelatin, and water. Twenty forearms were then dissected, and an overall map of the cutaneous vasculature and source vessels was constructed. The accompanying arteries were observed to lie along the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve and to nourish the skin through cutaneous branches. Vascular communication among these cutaneous vessels was evaluated, to determine the cutaneous vascular territory of the radial forearm flap. This anatomical information facilitates flap design in the forearm region. Clinical experience regarding the usefulness of the reversed forearm island flap for hand reconstruction for a series of five patients is presented.     

A simulation analysis of the combined effects of muscle strength and surgical tensioning on lateral pinch force following brachioradialis to flexor pollicis longus transfer

Biomechanical simulations of tendon transfers performed following tetraplegia suggest that surgical tensioning influences clinical outcomes. However, previous studies have focused on the biomechanical properties of only the transferred muscle. We developed simulations of the tetraplegic upper limb following transfer of the brachioradialis (BR) to the flexor pollicis longus (FPL) to examine the influence of residual upper limb strength on predictions of post-operative transferred muscle function. Our simulations included the transfer, ECRB, ECRL, the three heads of the triceps, brachialis, and both heads of the biceps. Simulations were integrated with experimental data, including EMG and joint posture data collected from five individuals with tetraplegia and BR-FPL tendon transfers during maximal lateral pinch force exertions. Given a measured co-activation pattern for the non-paralyzed muscles in the tetraplegic upper limb, we computed the highest activation for the transferred BR for which neither the elbow nor the wrist flexor moment was larger than the respective joint extensor moment. In this context, the effects of surgical tensioning were evaluated by comparing the resulting pinch force produced at different muscle strength levels, including patient-specific scaling. Our simulations suggest that extensor muscle weakness in the tetraplegic limb limits the potential to augment total pinch force through surgical tensioning. Incorporating patient-specific muscle volume, EMG activity, joint posture, and strength measurements generated simulation results that were comparable to experimental results. Our study suggests that scaling models to the population of interest facilitates accurate simulation of post-operative outcomes, and carries utility for guiding and developing rehabilitation training protocols.     

Muscle geometry affects accuracy of forearm volume determination by magnetic resonance imaging (MRI)

Upper extremity musculoskeletal modeling is becoming increasingly sophisticated, creating a growing need for subject-specific muscle size parameters. One method for determining subject-specific muscle volume is magnetic resonance imaging (MRI). The purpose of this study was to determine the validity of MRI-derived muscle volumes in the human forearm across a variety of muscle sizes and shapes. Seventeen cadaveric forearms were scanned using a fast-spoiled gradient echo pulse sequence with high isotropic spatial resolution (1mm(3) voxels) on a 3T MR system. Pronator teres (PT), extensor carpi radialis brevis (ECRB), extensor pollicis longus (EPL), flexor carpi ulnaris (FCU), and brachioradialis (BR) muscles were manually segmented allowing volume to be calculated. Forearms were then dissected, muscles isolated, and muscle masses obtained, which allowed computation of muscle volume. Intraclass correlation coefficients (ICC(2,1)) and absolute volume differences were used to compare measurement methods. There was excellent agreement between the anatomical and MRI-derived muscle volumes (ICC = 0.97, relative error = 12.8%) when all 43 muscles were considered together. When individual muscles were considered, there was excellent agreement between measurement methods for PT (ICC = 0.97, relative error = 8.4%), ECRB (ICC = 0.93, relative error = 7.7%), and FCU (ICC = 0.91, relative error = 9.8%), and fair agreement for EPL (ICC = 0.68, relative error = 21.6%) and BR (ICC = 0.93, relative error = 17.2%). Thus, while MRI-based measurements of muscle volume produce relatively small errors in some muscles, muscles with high surface area-to-volume ratios may predispose them to segmentation error, and, therefore, the accuracy of these measurements may be unacceptable.     

The long head of the triceps brachii as a free functioning muscle transfer

This anatomic study investigates the possibility of using the long head of the triceps brachii muscle as a free functioning muscle transfer for the upper limb. It has been reported that the long head is not difficult to harvest and that its loss does not create significant donor-site morbidity. The muscle was studied in 23 fresh frozen upper limbs. The long head in all 23 specimens had a constant and proximal vascular pedicle from the profunda brachii artery and vein. The mean pedicle was long (4 cm) and had large-caliber vessels (diameter, 3-mm artery and 4-mm vein). Angiograms were carried out in five specimens and dye perfusion studies in six specimens. A single branch from the radial nerve of at least 7 cm in length innervated the muscle. Muscle architecture was studied in 12 specimens and revealed that the long head of the triceps is better suited for forearm reconstruction than either the gracilis or the latissimus dorsi muscles. The mean physiologic cross-sectional area (8.36 cm(2)) and fiber length (10.8 cm on the superficial surface and 8.2 cm on the deep surface) of the long head match more closely those of the flexor digitorum profundus and the extensor digitorum communis, the muscles most commonly replaced.     

A new technique for the selective recording of extensor carpi radialis longus and brevis EMG.

Tennis Elbow or Lateral Epicondylalgia is manifested by pain over the region of the lateral epicondyle of the humerus, related to use of the wrist extensor muscles. Extensor carpi radialis longus (ECRL) and brevis (ECRB) have been implicated in the dysfunction associated with Lateral Epicondylalgia. For muscles in the human forearm, particularly those in close proximity, selective recordings are nearly impossible without the use of fine wire, indwelling electrodes. These can be inserted in precise locations and have small recording areas. Standard electromyography texts indicate, however, that the activity of ECRL and ECRB cannot be distinguished, even with intramuscular electrodes. We present a new technique for determining the most appropriate sites at which to insert intramuscular electrodes for selective recordings of ECRB and ECRL. The location of ECRB and ECRL was measured on 10 cadaver specimens, 5 right arms and 5 left arms. The distance from the muscle origin to (1) insertion, (2) largest portion of the muscle belly, (3) most proximal fibres and (4) most distal fibres were measured and expressed relative to forearm length. The mean distance and 95% confidence interval was calculated for each of the four measures. These data indicated a significant separation of the belly of each muscle along the length of the forearm. These relative distances were used to mark electrode insertion points on three volunteers. Fine wire electrodes were used to record the electromyogram in three participants. Each participant was required to perform isometric contractions to produce (1) wrist extension torque, (2) radial deviation torque, (3) elbow flexion torque and (4) finger extension. The electromyographic recordings show clear differentiation of ECRB and ECRL with the relative activation patterns reflecting the underlying anatomical organisation of the two muscles. This technique provides an important objective method that can be used in conjunction with manual muscle testing to provide a means of ensuring accurate intramuscular electromyographic recording from these two muscles.     

Wrist tendon moment arms: Quantification by imaging and experimental techniques

Subject-specific musculoskeletal models require accurate values of muscle moment arms. The aim of this study was to compare moment arms of wrist tendons obtained from non-invasive magnetic resonance imaging (MRI) to those obtained from an in vitro experimental approach. MRI was performed on ten upper limb cadaveric specimens to obtain the centrelines for the flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), and abductor pollicis longus (APL) tendons. From these, the anatomical moment arms about each of the flexion-extension (FE) and radioulnar deviation (RUD) axes of the wrist were calculated. Specimens were mounted on a physiologic wrist simulator to obtain functional measurements of the moment arms using the tendon excursion method. No differences were observed between anatomical and functional values of the FE and RUD moment arms of FCR, ECRL and ECRB, and the RUD moment arm of ECU (p > .075). Scaling the anatomical moment arms relative to ECRB in FE and ECU in RUD reduced differences in the FE moment arm of FCU and the RUD moment arm of APL to less than 15% (p > .139). However, differences persisted in moment arms of FCU in RUD, and ECU and APL in FE (p < .008). This study shows that while measurements of moment arms of wrist tendons using imaging do not always conform to values obtained using in vitro experimental approaches, a stricter protocol could result in the acquisition of subject-specific moment arms to personalise musculoskeletal models.     

Evolution and homologies of primate and modern human hand and forearm muscles, with notes on thumb movements and tool use

In this paper, we explore how the results of a primate-wide higher-level phylogenetic analysis of muscle characters can improve our understanding of the evolution and homologies of the forearm and hand muscles of modern humans. Contrary to what is often suggested in the literature, none of the forearm and hand muscle structures usually present in modern humans are autapomorphic. All are found in one or more extant non-human primate taxa. What is unique is the particular combination of muscles. However, more muscles go to the thumb in modern humans than in almost all other primates, reinforcing the hypothesis that focal thumb movements probably played an important role in human evolution. What makes the modern human thumb myology special within the primate clade is not so much its intrinsic musculature but two extrinsic muscles, extensor pollicis brevis and flexor pollicis longus, that are otherwise only found in hylobatids. It is likely that these two forearm muscles play different functional roles in hylobatids and modern humans. In the former, the thumb is separated from elongated digits by a deep cleft and there is no pulp-to-pulp opposition, whereas modern humans exhibit powerful thumb flexion and greater manipulative abilities, such as those involved in the manufacture and use of tools. The functional and evolutionary significance of a third peculiar structure, the intrinsic hand structure that is often called the ‘interosseous volaris primus of Henle’ (and which we suggest is referred to as the musculus adductor pollicis accessorius) is still obscure. The presence of distinct contrahentes digitorum and intermetacarpales in adult chimpanzees is likely the result of prolonged or delayed development of the hand musculature of these apes. In relation to these structures, extant chimpanzees are more neotenic than modern humans.     

Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel

Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3 kPa, α=8.5 for the superficial tendons, μ=39.4 kPa, α=9.2 for the deep tendons, μ=24.9 kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9 kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome.     

Thumb postures and physical loads during mobile phone use – A comparison of young adults with and without musculoskeletal symptoms

The aim of this study was to evaluate thumb postures, thumb movements and muscle activity when using mobile phones for SMS messaging and to determine whether there were differences in these exposures (a) across various mobile phone tasks, (b) between gender and (c) between subjects with and without musculoskeletal symptoms in shoulders and upper extremities. Fifty-six young adults (15 healthy and 41 with musculoskeletal symptoms) performed a series of distinct tasks on a mobile phone. Muscular load in four forearm/hand muscles in the right arm and the right and left trapezius muscles were measured using electromyography (EMG). Thumb movements were registered using an electrogoniometer. The results showed that postures (sitting or standing) and the type of mobile phone task (holding the phone versus texting) affected muscle activity and thumb positions. Females compared to males had higher muscle activity in the extensor digitorum and the abductor pollicis longus when entering SMS messages and tended to have greater thumb abduction, higher thumb movement velocities and fewer pauses in the thumb movements. Subjects with symptoms had lower muscle activity levels in the abductor pollicis longus and tended to have higher thumb movement velocities and fewer pauses in the thumb movements compared to those without symptoms.     

Structure of tendon organs of the rat after neonatal de-efferentation

Summary The number, size and structure of tendon organs were examined in leg muscles of the rat 3–19 weeks after de-efferentation performed in newborn animals by removal of the lumbosacral spinal cord. After this operation, tendon organs differentiated and grew in disused muscles and were innervated by primary sensory neurons, the dorsal roots of which had been disrupted.Three weeks after de-efferentation extensor digitorum longus muscles contained 14.1±1.0 (mean±standard error) and soleus muscles had 14.2±1.6 tendon organs, which corresponds to the mean number of tendon organs in the respective control muscles. The mean size of tendon organs was, however, changed. Tendon organs became on the average by 53% longer and by 35% thinner in de-efferented extensor digitorum longus muscles that were prolonged due to immobilization, as compared with shorter and wider tendon organs in de-efferented soleus muscle that remained in the shortened position.The ultrastructural differentiation of tendon organs was completed after the operation as under normal conditions. Thus it can be concluded that elimination of muscle function during the period of postnatal development indirectly affects the mean size of these receptors, but does not otherwise interfere with their morphogenesis.     

Split flexor carpi radialis muscle

A detailed anatomic and intramuscular neural staining study in 22 human and 5 monkey upper limbs revealed that the flexor carpi radialis can be raised on its proximal neurovascular pedicle and that the muscle can be split along its tendon into two independently functioning neuromuscular compartments, each with its own nerve and blood supply. A study of the muscle architecture in the human specimens found the radial compartment to have significantly longer fiber length and a larger physiologic cross-sectional area than the ulnar compartment. Independence of function of each compartment was demonstrated in electrical stimulation studies in six monkeys (Macaca fascicularis), but no significant difference was noted in the peak isometric load between the two compartments (p = 0.68) in the monkey. The extra functioning muscle units become important in local transfers for restoring function in multiple nerve palsies as in Hansen's disease, severe traumatic loss of muscle in crush injuries and compartment syndromes, and after wide resection in infective and neoplastic conditions in the forearm and hand.     

Upright posture of man and morphologic evolution of the musculi extensores digitorum pedis with reference to evolutionary myology. III

The following anatomical objects were studied with regard to myology during evolution: M. extensor hallucis longus (MEHL), M. extensor digitorum longus (MEDL) with M. peroneus tertius (MP III), M. peroneus brevis (MPB) with M. peroneus digiti V (MPD V), M. extensor hallucis brevis (MEHB), M. extensor digitorum brevis (MEDB), and the Retinaculum musculorum extensorum imum (RMEI). The study was carried out by the preparation of 3 different groups of material. The 1st group consists of lower extremities of humans. The number of the extremities differs for the particular objects between 151 and 358 (see page 381). The 2nd group of material consists of 122 Membra pelvina from Marsupialia, Insectivora, and Primates. Table 1 shows as well the mammalian species as the number of the studied extremities. The extremities of the 1st and 2nd group were preserved in an manner suitable for a macroscopic preparation. The 3rd group of material consists of 71 lower extremities from embryos and fetus. The lower legs and feet were stained either according to the method described by Morel and Bassal with eosin added or according to Weigert. From this material, complete series of cross sections were prepared. Table 2 shows the age of the embryos (VCL [mm]) as well as the number of the studied extremities. It is important that up to the age of 46 mm VCL the difference in the age of the embryos usually amounts from 0.5 to 1.0 mm. This small difference in the age of the embryos and fetus allows a very good follow up of the changes in construction during the organogenesis. The comparison of the 3 different groups shows the following changes for the above mentioned muscles: The M. extensor hallucis longus (MEHL) is a muscle which is not split. The same result applies for its tendon which inserts at the distal phalanx of the hallux. This primitive form of the muscle amounts actually to 51.12% in human beings. In 48.88% of the cases, additional tendons and muscles are formed by the MEHL. Most of these supplements are positioned on the medial side of the main tendon, only a few lie to the lateral side. For the supplement tendons, the medial one as well as the lateral one occasionally possess a muscle belly. The muscle of the medial tendon is split off from the proximal margin of the MEHL. The muscle of the lateral tendon is split off from the distal margin of the MEHL.(ABSTRACT TRUNCATED AT 400 WORDS)