Shipra Paul

Anomalous Branching Pattern of Lateral Cord of Brachial Plexus

Durante una diseccion de rutina fue encontrada una formacion inusual del nervio mediano en el miembro superior derecho, de un inividuo de sexo masculino, de 55 anos de edad. El nervio mediano tenia una contribucion adicional del faciculo lateral. Los dos ramos del fasciculo lateral, designados como ramos superior e inferior, fueron observados a diferentes niveles. El ramo superior tuvo un estrecho contacto con la tercera parte de la arteria axilar y cruzaba la vena axilar anteriormente para unirse con un ramo del fasciculo medial y formar el nervio mediano. El nervio mediano asi formado estaba relacionado medialmente con la arteria axilar (en vez de su posicion normal de situacion anterolateral). El nervio mediano se dirigia hacia bajo y se unia con un ramo inferior adicional del fasciculo lateral. El nervio ulnar, que se originaba del fasciculo medial, descendia posterior y se unia en la vaina fascial con el nervio cutaneo medial del antebrazo. La presencia de un ramo adicional del fasciculo lateral contribuyendo a la formacion del nervio mediano y su inusual relacion con la arteria axilar, tiene un interes clinico para los neurologos, quienes diagnostican lesiones nerviosas, y cirujanos que estan expuestos a encontrar variaciones de estructuras nerviosas durante disecciones radicales de cuello. El ramo adicional del fasciculo lateral puede comprimir la arteria axilar y causar insuficiencia vascular

Variant abductor pollicis longus muscle: a case report.

Abductor pollicis longus (APL) muscle is known to exhibit different variations with respect to its attachments. Various studies have reported the splitting of the APL muscle. Comparative anatomical findings of split insertion of APL is commonly found in chimpanzees, gorillas and gibbons. In the present study, we describe an anomalous APL muscle, which originated from the posterior surface of the shaft of the radius and ulna and traversed a course deep to the extensor retinaculum. Interestingly, immediately after emerging form the deeper aspect of extensor retinaculum, the thin tendon of the APL muscle continued again as a muscular belly in relation to the dorsolateral part of the 1st metacarpal bone, to end as a tendon with its attachment to the base of the proximal phalanx. Such an unusual variation of APL with its attachment into proximal phalanx is a rare finding and may be of importance in altering the mechanics of the thumb during abduction. The clinical significance of such an anatomical variation of APL may be important during reconstructive surgeries involving thumb and also of academic interest.Abductor pollicis longus (APL) muscle is known to exhibit different variations with respect to its attachments. Various studies have reported the splitting of the APL muscle. Comparative anatomical findings of split insertion of APL is commonly found in chimpanzees, gorillas and gibbons. In the present study, we describe an anomalous APL muscle, which originated from the posterior surface of the shaft of the radius and ulna and traversed a course deep to the extensor retinaculum. Interestingly, immediately after emerging form the deeper aspect of extensor retinaculum, the thin tendon of the APL muscle continued again as a muscular belly in relation to the dorsolateral part of the 1st metacarpal bone, to end as a tendon with its attachment to the base of the proximal phalanx. Such an unusual variation of APL with its attachment into proximal phalanx is a rare finding and may be of importance in altering the mechanics of the thumb during abduction. The clinical significance of such an anatomical variation of APL may be important during reconstructive surgeries involving thumb and also of academic interest.

Anomalous pseudoganglion and its branches: A case report

The posterior interosseous nerve lies between the superficial and the deep extensor muscles and is reduced to a thread-like structure that descends on the interosseous membrane to the dorsum of the carpus (Standring, 2005). Its expanded termination is known as ‘‘pseudoganglion’’ (Standring, 2005). According to the standard textbook of anatomy, the finer branches from the pseudoganglion supply the carpal bones, their articulations and ligaments, the metacarpo-phalangeal and the proximal interphalangeal joints but do not supply the dorsal interossei or the extensor muscles of the forearm (Standring, 2005). During routine dissection of cadavers, we detected anomalous branching pattern of the pseudoganglion bilaterally in a 55-year-old male cadaver. The pseudoganglion was located on the dorsal aspect of the carpal bones. It gave branches to (1) the dorsal interosseous muscle (‘‘A’’ in Fig. 1), (2) a recurrent branch to the extensor muscles of the forearm (‘‘B’’ in Fig. 1), and (3) a branch to carpal bones (‘‘C’’ in Fig. 1). The radial nerve through its branch (i.e., ‘‘PIn’’ in Fig. 1) innervated the other extensor muscles of the forearm. Standard textbooks mention the usual location of the pseudoganglia of the posterior interosseous nerve without highlighting any of its variations (Standring, 2005). A previous research study had reported the presence of pseudoganglia in the accessory obturator nerves (Tubbs et al., 2003). A pseudoganglion has been reported to be located in the branches of the axillary, posterior interosseous, and phrenic nerves (Schaeffer, 1953; Standring, 2005). Studies have detected the presence of pseudoganglion in the lateral femoral cutaneous nerve as it traversed inferior to the inguinal ligament (Edelson and Nathan, 1977), and Gitlin (1957) reported a pseudoganglion in the nerve to the teres minor. Clinicians and anatomists have always debated the definition of ‘‘pseudoganglion’’ or ‘‘ganglion.’’ The anatomists consider a ganglion strictly to be a collection of cell bodies outside the central nervous system (Tubbs et al., 2003), whereas the clinician terms this swelling in the nerve as a ‘‘pseudoganglion’’ or ‘‘ganglion’’ (Tubbs et al., 2003). Clinicians have suggested that pseudoganglions may arise due to mechanical friction, whereas anatomists have not found any such histological finding (i.e., thickening of epineurium) in support of such views (Tubbs et al., 2003). Considering the paucity of literature on the variations and the branches of pseudoganglion that supply the dorsal interossei and the digital extensor muscles, this study assumes clinical significance for hand surgeons, orthopedicians, and neurologists diagnosing nerve lesions.

Dorsal Digital Branch of the Thumb: An Anatomical Study

Fue estudiado en los miembros superiores de 50 cadaveres, el origen del nervio digital dorsal para el pulgar (NDDP) desde el ramo superficial del nervio radial (RSNR) y sus relaciones con el tendon del musculo braquiorradial (TMB) y su vaina fascial (VF). El NDDP del RSNR se origino en el tercio medio del antebrazo en 3 casos (3%), en el tercio distal del antebrazo en 10 casos (10%) y en la muneca y dorso de la mano en 87 casos (87%). En todos los casos en que el NDDP se originaba en el tercio medio del antebrazo y en la mitad de los casos en que se originaba en el tercio distal del antebrazo, tenia relaciones estrechas con el TMB o su VF. La importancia clinica de este estudio se basa en que el NDDP suple el dorso del pulgar y primer espacio interdigital, el cual tiene pequenisima superposicion cutanea. Alguna herida o compresion de este nervio puede llevar a neuritis dolorosa. El conocimiento anatomico de estas variaciones son importantes para neurologos y cirujanos durante los procedimientos de liberacion de Quervain, artroscopia y enfermedad de Wartenberg

Variations of Thoracic Splanchnic Nerves and its Clinical Implications

El presente estudio relata un patron de ramos anomalos de la cadena simpatica toracica. A nivel del ganglio de T3, un ramo anomalo denominado cadena simpatica accesoria (CSA), descendio anteroedialmente a la cadena simpatica principal (CSP). La CSP y la CSA comunicadas cada una con la otra a nivel de los ganglios de T9, T10 y T11, indicaban la ausencia de patrones clasicos de nervios esplacnicos mayor, menor y minimo del lado derecho. Sin embargo, en el lado izquierdo, la cadena simpatica estaba dispuesta en un de patron normal. Nuestra opinion es que la CSA estaria representando un origen alto del nervio esplacnico mayor a nivel del ganglio de T3 y que los ramos de CSP de los ganglios T9, T10 y T11 podrian ser los nervios esplacnicos menor y minimo, los cuales se unian lejos a la CSA (presumiblemente el nervio esplacnico mayor) para formar un tronco comun. Este tronco comun perforaba la cruz derecha del diafragma para alcanzar el plexo suprarrenal derecho, dando despues pequenos ramos para el plexo celiaco. El conocimiento de tales variaciones de la cadena simpatica toracica pueden ser de ayuda para los cirujanos, pudiendo ser evitada alguna denervacion incompleta o prevenir algun dano involuntario durante la simpactectomia toracica