A new classification of the brachial extensors in Tarsius.

The muscular system of the tarsier was first described by Burmeister (1846), who noted that brachial extensors (triceps complex) have six heads. The first three heads, respectively, correspond to the long, lateral and medial heads of the triceps brachii muscle in man. The fourth head is the anconaeus and the fifth is the dorsoepitrochlearis. Schultz (1984) divided the sixth head into two different parts (preaxial and postaxial) from the viewpoint of nerve supply. The present study found that the whole sixth head is innervated by the ulnar nerve, and we propose that it is recognized as the proximal and distal heads of the (preaxial) epitrochleoanconaeus muscle. The proximal head may have developed specially in the tarsier in addition to the distal head observed in other prosimians. It is thought to support the extension of the elbow joint and contribute to the tarsier's effective locomotion.     

Long head of the triceps branch transfer to axillary nerve in C5, C6 brachial plexus injuries: anterior approach

Shoulder abduction is a very complex movement and quite important for upper limb function, as more distal functions depend on a stable shoulder, especially in C5, C6 brachial plexus injuries. Various studies in the literature have emphasized the importance of improved functional outcome and shoulder reanimation with concomitant neurotization of suprascapular nerve and axillary nerve in C5, C6 brachial plexus injuries. A number of approaches to axillary nerve transfer in brachial plexus injuries have been reported. The author describes an innovative anterior deltopectoral approach for axillary nerve transfers in five patients with C5, C6 brachial plexus injuries. The spinal accessory nerve was neurotized with the suprascapular nerve through a transverse supraclavicular incision. The axillary nerve and the long head of the triceps branch were identified through the anterior deltopectoral approach and neurotized at the posterior cord level. This approach gives easy access to other donors such as the medial pectoral, thoracodorsal, and median and ulnar nerves. Oberlin's transfer was also performed for elbow flexion by extending the deltopectoral incision. The regained shoulder active abduction (M5) averaged 120 degrees and active external rotation averaged 65 degrees at the final follow-up of 26 months (average). This anterior deltopectoral approach is an excellent alternative for axillary nerve transfer in brachial plexus injuries and produces results comparable with those of other approaches. All brachial plexus surgeons must understand the anatomy and the relationship of the axillary nerve to the surrounding structures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.     

The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans

The posterior branch of the medial antebrachial cutaneous nerve courses in proximity to the cubital tunnel and is particularly prone to injury during ulnar nerve release at the elbow. Inadvertent injury to medial antebrachial cutaneous nerve branches during surgery can result in the formation of painful neuromas that can be misdiagnosed as recurrent disease. It is important to understand the relevant anatomy of the medial antebrachial cutaneous nerve branches during cubital tunnel surgery to avoid significant postoperative morbidity. This prospective observational anatomic study examined the position of the posterior branch of the medial antebrachial cutaneous nerve in relationship to a standard approach to the cubital tunnel in a randomly selected group of 97 patients undergoing primary surgery over a 3-year period. Medial antebrachial cutaneous nerve branches were noted to cross at or proximal to the medial humeral epicondyle 61 percent of the time at an average proximal distance of 1.8 cm. Medial antebrachial cutaneous nerve branches were noted to cross distal to the medial humeral epicondyle 100 percent of the time at an average distal distance of 3.1 cm. Understanding the general position of crossing medial antebrachial cutaneous nerve branches during ulnar nerve release at the elbow may help to prevent iatrogenic injury to this cutaneous nerve.     

The lateral root of the ulnar nerve

In 158 brachial plexuses the origin of the fibers of the ulnar nerve-whether only from the medial or also from the lateral fascicle-was investigated. A lateral root was found in 56%. This lateral root may either be accompanied by fibers of the median nerve (type 1) or may run separately (type 2). Where this root crosses the medial root of the median nerve, either a small minority of fibers of the latter nerve may run behind the ulnar fibers (type a), or all median fibers are in front of them (type b). Considering the relation 56:44% between ulnar nerves with and without a lateral root both possibilities have to be considered as normal variations, none as a variety. In analogy to the term 'median loop' the term 'ulnaris loop' is suggested for specimens with a lateral root.     

Struthers' ligament and associated median nerve variations in a cadaveric specimen.

A Ligament of Struthers has been identified and studied in a cadaveric arm. Its relationships to a rudimentary supracondylar process, the pronator teres muscle, the median nerve, and the medial epicondyle of the humerus are described. Compared to an extensively studied series of normals, the ligament in this case was associated with abnormally proximal branching of the median nerve, a finding which is surgically significant and not addressed in the literature to date.     

Intraoperative radial nerve injury during coronary artery surgery – report of two cases

Background

Peripheral nerve injury and brachial plexopathy are known, though rare complications of coronary artery surgery. The ulnar nerve is most frequently affected, whereas radial nerve lesions are much less common accounting for only 3% of such intraoperative injuries.

Case presentations

Two 52- and 50-year-old men underwent coronary artery surgery. On the first postoperative day they both complained of wrist drop on the left. Neurological examination revealed a paresis of the wrist and finger extensor muscles (0/5), and the brachioradialis (4/5) with hypoaesthesia on the radial aspect of the dorsum of the left hand. Both biceps and triceps reflexes were normoactive, whereas the brachioradialis reflex was diminished on the left. Muscles innervated from the median and ulnar nerve, as well as all muscles above the elbow were unaffected. Electrophysiological studies were performed 3 weeks later, when muscle power of the affected muscles had already begun to improve. Nerve conduction studies and needle electromyography revealed a partial conduction block of the radial nerve along the spiral groove, motor axonal loss distal to the site of the lesion and moderate impairment in recruitment with fibrillation potentials in radial innervated muscles below the elbow and normal findings in triceps and deltoid. Electrophysiology data pointed towards a radial nerve injury in the spiral groove. We assume external compression as the causative factor. The only apparatus attached to the patients' left upper arm was the sternal retractor, used for dissection of the internal mammary artery. Both patients were overweight and lying on the operating table for a considerable time might have caused the compression of their left upper arm on the self retractor's supporting column which was fixed to the table rail 5 cm above the left elbow joint, in the site where the radial nerve is directly apposed to the humerus.

Conclusion

Although very uncommon, external compression due to the use of a self retractor during coronary artery surgery can affect – especially in obese subjects – the radial nerve within the spiral groove leading to paresis and should therefore be included in the list of possible mechanisms of radial nerve injury.     

Changes in the activity of succinate dehydrogenase in muscle fibers of functionally different muscles in the rat after a reduction in exertion--hypodynamia

In 105 male rats of Wistar strain distal parts of one of the thoracic extremities are amputated with keeping intact the places where the brachial muscle is fixed. This does not restrict the volume of the brachium movements but essentially decreases their dynamic component (power loading). For 45 days dynamics of succinate-dehydrogenase (SDG) activity is being revealed in muscle fibers (MF) of functionally different muscles: m. brachialis, m. serratus ventralis and m. triceps brachii (the medial head). Average tendency of the process, changes in the distribution margins, asymmetry and kurtosis are taken into account. Under hypodynamia reconstruction of the MF has a wavy character with a gradually longer period of fluctuations. In all the muscles appear MF with a greater than in the control SDG activity. In the medial head of the m. triceps brachii the fibers with the lowest SDG activity disappear. The amount of MF with the lowest activity decreases, while those with the higher--increases, the process being more pronounced in the m. triceps brachii. The amount of MF with middle activity of the enzyme remains nearly unchanged. MF with different initial enzymatic activity do not change simultaneously. The degree of the changes in the fibers and the power leading are connected with each other, the fibers with the low initial SDG activity including into the reaction at a sharper decrease of the latter. The changes in quantitative ratio of MF with different SDG activity are not the same in every muscle studied.     

Elbow extensor muscles of the horse: postural and dynamic implications.

Based on histochemical and immunohistochemical evidence, horse elbow extensor muscles are composed of two morphologically distinct muscle groups. The long and lateral heads of the triceps brachii are large, predominantly type II (presumed fast) muscles. The long and lateral heads of the triceps together account for 96% of the weight of the elbow extensors (long head of triceps is 81%). The long and lateral heads contain three histochemical fiber types: types I, IIa and IIb. Type I muscle fibers account for approximately 18 and 27% of the fibers in the long and lateral heads of the triceps, respectively. In the lateral head, type IIa and IIb fibers account equally for the remaining 70%, while in the long head of the triceps type IIb fibers predominate (50%) over type IIa fibers (32%). In contrast, the much smaller medial head of the triceps (2% of triceps mass) and the anconeus (2% of mass) contain almost exclusively type I muscle fibers. It is hypothesized that the medial head and anconeus, with their slow fibers, contribute to the postural maintenance of the forelimb by preventing flexion at the elbow joint during passive stance. The larger long and lateral heads, with their generally fast fiber populations, are most likely important during dynamic activity.     

Succinate dehydrogenase activity of brachial muscle antagonists after decrease in the force load at various times of the day in rats

In 140 male rats of Wistar strain the distal part of one thoracic extremity has been amputated in such a way that places of the brachial muscle fixation remained intact. This resulted in decrease of the force component of muscle contractions (more intensive in the musculus triceps brachii) without essential swing and speed of movements. The operation was performed during one day at three series: at 7 a. m. 3 p. m. and 11 p. m. During following 45 days the muscles developing various contraction force were studied: the medial head of the musculus triceps brachii and brachial muscle. Succinate dehydrogenase (SDG) activity in muscle fibers (MF) was estimated photometrically. In MF initially characterized with various SDG activity, attention was payed to its dynamics and also relation of the fibers number, possessing various level of the enzymatic activity was taken into consideration. SDG activity in MF and relation of various MF change wavy-like, fluctuating from the control meaning and returning to them again. MF with different SDG activity do not similarly react to a sharp decrease of the force loading. Fibers with high enzymatic activity react to changes of the force loading immediately, intensity of the reaction at this stage slightly depends on degree of biomechanical changes; at later stages the response is differentiated: if the loading is decreased considerably (musculus triceps brachii), the process continues developing and increasing uninterruptedly, if it decreases moderately (brachial muscle)--it stabilizes and even has tendency to adaptation and returning towards the control state.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of contractile properties in human arm and leg muscles

Isometric twitch properties have been compared in two pairs of opposing human limb muscles; these were the brachial biceps and triceps, and the anterior tibial and plantarflexor muscles. All four muscles were examined in each of 24 healthy subjects (16 men and 8 women). The brachial triceps had the shortest contraction and half-relaxation times and the greatest twitch potentiation, while the plantarflexors had the most prolonged twitches and least potentiation; the anterior tibial and brachial biceps muscles had similar characteristics. Susceptibility to fatigue was less in the plantarflexors than in the other three muscles. When muscles were assessed without reference to their anatomical sites, a significant relationship was noted between contraction time and potentiation, but not between either of these features and fatiguability. There was no evidence that muscles were uniformly 'faster' or 'slower' in some subjects than in others.     

The brachial plexus in the squirrel monkey (Saimiri sciureus)

Based on the statistical data obtained from 37 squirrel monkeys, the standard type of the brachial plexus was determined. Each of the superior (C6, normally also C5), middle (C7), and inferior (C8 and T1, rarely with rudimentary T2) trunks gives off the anterior and posterior divisions. The lateral cord composed of the superior and the middle anterior divisions usually breaks up immediately into the musculocutaneous nerve and the lateral root of the median nerve. The medial cord (generally the peripheral extension of the inferior anterior division itself) terminates in the ulnar nerve and in the medial root of the median nerve. The dorsal cord formed by the union of the 3 posterior divisons extends peripherally as the radial nerve; the axillary nerve arises before the union of the 3 posterior divisons is completed. The frequently encountered aberrant connecting branches, the musculocutaneous nerve tending to separate from the plexus, and the long lateral root of the median nerve characterize the feature of the plexus.The data were compared with previous findings about the plexus of other primates.This investigation was conducted during the tenure of a postdoctoral fellowship in the Department of Anatomy, UCLA School of Medicine, Los Angeles, California, U.S.A.     

Hox11 genes establish synovial joint organization and phylogenetic characteristics in developing mouse zeugopod skeletal elements

Hox11 genes are essential for zeugopod skeletal element development but their roles in synovial joint formation remain largely unknown. Here, we show that the elbow and knee joints of mouse embryos lacking all Hox11 paralogous genes are specifically remodeled and reorganized. The proximal ends of developing mutant ulna and radius elements became morphologically similar and formed an anatomically distinct elbow joint. The mutant ulna lacked the olecranon that normally attaches to the triceps brachii muscle tendon and connects the humerus to the ulna. In its place, an ulnar patella-like element developed that expressed lubricin on its ventral side facing the joint and was connected to the triceps muscle tendon. In mutant knees, both tibia and fibula fully articulated with an enlarged femoral epiphyseal end that accommodated both elements, and the neo-tripartite knee joint was enclosed in a single synovial cavity and displayed an additional anterior ligament. The mutant joints also exhibited a different organization of the superficial zone of articular cartilage that normally exerts an anti-friction function. In conclusion, Hox11 genes co-regulate and coordinate the development of zeugopod skeletal elements and adjacent elbow and knee joints, and dictate joint identity, morphogenesis and anatomical and functional organization. Notably, the ulnar patella and tripartite knee joints in the mouse mutants actually characterize several lower vertebrates, including certain reptiles and amphibians. The re-emergence of such anatomical structures suggests that their genetic blueprint is still present in the mouse genome but is normally modified to the needs of the mammalian joint-formation program by distinct Hox11 function.     

健侧C7 神经移位经椎体前通路的解剖学研究及经颈椎后入路 解剖学探讨

目的:为临床上开展健侧C7神经移位经椎体前通路治疗臂丛损伤提供解剖学基础。方法:选取10具20侧正常成人尸体颈段标本,将双侧臂丛充分显露,远端向C7神经根前后股进行干支分离,在前后股加入外侧束及后束前将其切断,近端向椎间孔处游离,测量C7神经根从椎间孔至分股处的长度及C7神经至前后股长度,测量并记录C7神经根及前后股经椎体前通路、颈前皮下通路到对侧臂丛上、下干的距离。结果:C7神经根的长度(58.62±8.70)mm,C7神经前、后股的长度(70.03±10.79)mm,(65.15±9.11)mm,C7神经根经颈前皮下、椎体前通路至对侧上下干的缺损长度分别是(98.18±10.18)mm,(107.14±9.88)mm;(32.10±11.49)mm,(37.28±10.01)mm两组相比有统计学差异。结论:从解剖学角度而言,健侧C7神经移位经椎体前通路能明显缩短移植神经长度,在临床上具有可操作性。     

Immunocytochemical localization of somatostatin in human brain

The distribution of somatostatin (SRIF) was examined in normal human forebrain, using thick vibratome cut sections. The unlabeled antibody enzyme method of immunocytochemistry revealed a widespread distribution of SRIF immunoreactive neurons and fibers throughout the septum, diencephalon and corpus striatum. Within the septum SRIF neurons and fibers were observed in the medial and lateral septal nuclei, the nucleus of the diagonal band, the nucleus accumbens and the bed nucleus of the stria terminalis. SRIF neurons and fibers were found in several hypothalamic and anterior thalamic nuclei as well as all regions of the corpus striatum. An interesting collection of SRIF immunoreactive neurons and processes were observed forming a wide band extending anteriorly from the lateral preoptic area through the lateral hypothalamus and substantia innominata posteriorly. This report on the localization of immunoreactive SRIF in the human forebrain extends previous anatomical findings and lends morphological support to recent biochemical studies.     

Anatomical observations on the arcade of Frohse and other structures related to the deep radial nerve. Anatomical interpretation of deep radial nerve entrapment neuropathy

In a series of 120 elbow regions (66 male, 54 female) from embalmed human cadavers, the authors observed the course of the deep radial nerve and then related it to structures such as a) the deep surface of the initial part of the extensor carpi radialis brevis, which was found to be tendinous in 90% of the cases, b) the superior hiatus of the supinator muscle, which formed a fibrous arcade of Frohse in 61% of the cases, and the distance of its peak from the lateral condyle, which ranged from 4 to 6 cm, and c) the angle between the superficial oblique muscle fibres of the supinator and the long axis of the radius, which varies from 18 degrees to 38 degrees and crossed the nerve almost transversely. The above anatomical factors--and particularly the thickened fibrous arcade of Frohse--are all important for the deep radial entrapment neuropathy in predisposed individuals.     

Responses of the goldfish head lateral line to moving objects

We investigated how fibers in the anterior lateral line nerve of goldfish, Carassius auratus, respond to water motions generated by an object that was moved alongside the fish. Motion direction was from anterior to posterior or opposite, object diameter was between 0.1 and 4 cm and the distance between object and fish varied between 1 and 6 cm. Fibers exhibited monophasic responses characterized by a transient increase in discharge rate, biphasic responses consisting of an increase followed by a decrease in discharge rate or vice versa, or triphasic responses characterized by a rate increase followed by a decrease and again an increase or by the inverse pattern. In two-thirds of the fibers response patterns depended on object motion direction. Of these, about 60% responded to a reversal of motion direction with an inversion of the response pattern. Our results differ from previous data obtained from posterior lateral line nerve fibers in the relative proportions of the observed response patterns, and by a much smaller proportion of fibers that exhibited a direction-dependent response. These differences can be explained by the fact that the spatial orientations of the neuromasts on the head are more heterogenuous than on the trunk.     

Anatomical specificity of regenerated muscle sensory afferents in the spinal cord of the bullfrog

The specificity of central projections made by regenerated muscle sensory fibers in the brachial spinal cord was studied with anatomical tracing methods. Sensory fibers were interrupted by freezing dorsal roots in postmetamorphic bullfrogs. After several months, regenerated sensory fibers were labeled with horseradish peroxidase applied to the triceps brachii muscle nerve, and their arborizations within the spinal cord were reconstructed from serial cross sections. Most of the regenerated projections from triceps muscle sensory afferents ended in or near their normal terminal field. A few branched and appeared to terminate more dorsally than normal, however, sometimes within the region where cutaneous afferents normally terminate. In contrast to the normal pathway followed by muscle afferents within the spinal cord, many regenerated afferents grew along the circumference of the spinal cord, just under the pial surface, and then turned abruptly toward the midline and into their appropriate terminal region. This suggests that regenerating afferents may actively seek out their appropriate targets and are not simply passively guided to them.     

Anatomy of the cruciate ligaments and their function in extension and flexion of the human knee joint

The areas of the femoral origin of the cruciate ligaments have approximately the shape of sectors of ellipses, the one for the anterior ligament on the lateral condyle posteroproximally and the one for the posterior ligament on the medial condyle distally. By means of a new technique of dissection, combined with the use of X-rays, the change in distance between the origin and insertion and so the change of tension of single bundles of the ligaments could be analyzed. Only a rather thin bundle in each cruciate ligament is in constant tension: "guiding bundles." The maximal diminution of distance between the origin and insertion for some bundles is 65%. In the anterior cruciate ligament the majority of fibres are taut in extreme extension: "limiting bundles." The same is true in the posterior cruciate ligament in extreme flexion. There are also some fibres, especially in the posterior cruciate ligament, that are taut only in an intermediate position. The geometric analysis of the function of different groups of fibers was performed by a modification of Menschik's concept of a four-bar link.     

Ultrastructure of the Circulatory System of the Phoronid Phoronopsis harmeri Pixell, 1912. 2. Main vessels

The ultrastructure of the wall of the main blood vessels of the phoronid Phoronopsis harmeri is described. The walls of the lophophoral and left lateral vessels consist of myoepithelial cells of the coelomic lining (peritoneal cells), a thin basal lamina, and an incomplete endothelial lining. In the head region of the body, the wall of the medial vessel consists of myoepithelial cells of the coelomic lining (peritoneal cells), a basal lamina, and true muscular endothelial cells. The anterior part of the medial vessel functions as the heart. In the anterior part of the body, the medial vessel wall consists of five layers: the external nonmuscular coelothelium, a layer of the extracellular matrix, the internal muscular coelothelium, an internal layer of the extracellular matrix, and an incomplete endothelial lining. The complicated structure of the medial vessel wall may be explained by the superimposition of the lateral mesentery on the ordinary vessel wall.     

Traction, prenatal development, and the labioseptopremaxillary region

Twenty-nine human fetuses ranging in age from 8 to 22 weeks were coronally sectioned for gross light microscope analysis of the labioseptopremaxillary region. In "normal" fetuses from 8 to 15 weeks, the septopremaxillary ligament was present. The horizontal and oblique fibers of the orbicularis oris muscle were poorly developed initially and increased in density with age. The anterior nasal spine and the alveolar process of the maxillae were present and in the same coronal plane. From 15 to 22 weeks, the horizontal and oblique fibers were well developed and inserted into the perichondrium of both alar and nasal cartilages. The septopremaxillary ligament was thus obliterated or more difficult to define, and the anterior nasal spine was located anterior to the alveolar process. In the cleft fetuses from 8 to 15 weeks, the nasal septum was absent or horizontally rotated. No septopremaxillary ligament or orbicularis oris fibers were noted, and the anterior nasal spine was not distinguishable. From weeks 15 to 20, the fibers of the orbicularis oris muscle were poorly differentiated, inserting asymmetrically into the perichondrium of the lateral alar cartilage on the noncleft side, the septopremaxillary ligament was absent, and the anterior nasal spine and the premaxillae were in the same coronal plane. These results suggest that the midfacial deficiencies seen in some cleft patients might have an origin in prenatal dysmorphology.