Innervation Pattern of Pronator Teres Muscle and Its Relation to Median Nerve: A Cadaveric Study

basanagouda, Channa; Halagatti, Manjunath

doi:10.16965/ijar.2017.258

Cited by 3 publications

(5 citation statements)

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“…We believe that variations between our findings and those of others 1,10,15 -concerning the number, length, and origin of nerve branches-were a direct result of the anatomical dissection itself. Most of the other studies used embalmed cadavers, which are difficult to dissect.…”

Section: Discussionsupporting

confidence: 45%

“…Most of the other studies used embalmed cadavers, which are difficult to dissect. 1,6,10,15,35 We used fresh cadavers and in vivo dissection, followed by electrical stimulation, which we believe is more precise. Gunther et al 14 observed that gross dissection findings of PT branches were different than those of their own extended microdissections.…”

Section: Discussionmentioning

confidence: 99%

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Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Bertelli

Nehete

Duarte

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe authors describe the anatomy of the motor branches of the pronator teres (PT) as it relates to transferring the nerve of the extensor carpi radialis brevis (ECRB) to restore wrist extension in patients with radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer technique in several patients followed for at least 24 months postoperatively.METHODSThe authors dissected both upper limbs of 16 fresh cadavers. In 6 patients undergoing nerve surgery on the elbow, they dissected the branches of the median nerve and confirmed their identity by electrical stimulation. Of these 6 patients, 5 had had a radial nerve injury lasting 7–12 months, underwent transfer of the distal PT motor branch to the ECRB, and were followed for at least 24 months.RESULTSThe PT was innervated by two branches: a proximal branch, arising at a distance between 0 and 40 mm distal to the medial epicondyle, responsible for PT superficial head innervation, and a distal motor branch, emerging from the anterior side of the median nerve at a distance between 25 and 60 mm distal to the medial epicondyle. The distal motor branch of the PT traveled approximately 30 mm along the anterior side of the median nerve; just before the median nerve passed between the PT heads, it bifurcated to innervate the deep head and distal part of the superficial head of the PT. In 30% of the cadaver limbs, the proximal and distal PT branches converged into a single trunk distal to the medial epicondyle, while they converged into a single branch proximal to it in 70% of the limbs. The proximal and distal motor branches of the PT and the nerve to the ECRB had an average of 646, 599, and 457 myelinated fibers, respectively.All patients recovered full range of wrist flexion-extension, grade M4 strength on the British Medical Research Council scale. Grasp strength recovery achieved almost 50% of the strength of the contralateral side. All patients could maintain their wrist in extension while performing grasp measurements.CONCLUSIONSThe distal PT motor branch is suitable for reinnervation of the ECRB in radial nerve paralysis, for as long as 7–12 months postinjury.

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Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Bertelli

Nehete

Duarte

et al. 2021

Journal of Neurosurgery

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“…8 In another study done in indian population by Basangauda, et al the median nerve passed between the two heads of pronator teres muscle in (87.09%), deep to the pronator teres muscle in (4.83%), through the ulnar head of pronator teres muscle in (4.83%) and deep to the humeral head of pronator teres muscle. 9 In a similar type of study done by Gaikwad, et al noted thatmedian nerve passed between ulnar and humeral head in (92%) extremities. 10 In contrast to this a study done by Olenwik, et al in European population in cadavers MN passed between the heads of the PT muscle (74%) or under the muscle (26%).…”

Section: Discussionmentioning

confidence: 79%

“…In another study done in indian population by Basangauda, et al the median nerve passed between the two heads of pronator teres muscle in (87.09%), deep to the pronator teres muscle in (4.83%), through the ulnar head of pronator teres muscle in (4.83%) and deep to the humeral head of pronator teres muscle. 9 …”

Section: Discussionmentioning

confidence: 99%

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Median Nerve Passing below the Ulnar Head of Pronator Teres in Cadavers of a Medical College in Western Nepal: A Descriptive Cross-sectional Study

Sharma¹,

Pandit²,

Subedi³

2022

J Nepal Med Assoc

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Introduction: Median nerve passes between two heads of pronator teres muscle while passing through the elbow. Detailed knowledge of these variations in the course of Median Nerve in relation to pronator teres and its neighboring structure is required for diagnosis of pronator syndrome. The aim of the study is to find out the proportion of Median Nerve passing below the ulnar head of pronator teres in cadavers of a medical college in Western Nepal. Methods: A descriptive cross-sectional study was carried out at the Department of Anatomy in a medical college of Nepal from 20th July 2021 to 2nd September 2021 after ethical clearance from the same institution (Reference number: UCMS/IRC/079/21). Variations in the course of the median nerve while passing through pronator teres were observed, recorded and photographed. Convenience sampling method was used. Data were analyzed using Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage. Results: Out of 54 prosected specimens of upper limbs, 4 (7.40%) (0.418-14.38 at 95% Confidence Interval) Median Nerve passed below the ulnar head of pronator teres muscle and in 50 (92.60%) specimens Median Nerve passed between two heads of pronator teres. Conclusions: Our study shows that the median nerve passed below the ulnar head of pronator teres muscle is higher as compared to other studies done in similar settings. Thus, knowledge of variations in the course of Median Nerve in elbow has immense importance in the academic and clinical arena.

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Innervation Patterns of the Pronator Teres Muscle and Their Possible Role in Neurotization: A Systematic Review of Cadaveric Studies

Potu

Ravishankar

2021

Acta Med. (Hradec Kralove, Czech Repub.)

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Background: Contrary to the classic anatomical description, many recent studies have reported wide variations in branching patterns and location of motor branches that are supplying the pronator teres muscle. To understand these variations and their implications in surgical procedures of the nerve transfers, a systematic review was performed on the innervation of pronator teres muscle from cadaveric studies.Methods: A systematic literature search was performed in databases such as Medline, PubMed, Google Scholar, SciELO, ScienceDirect, Cochrane reviews and orthopedics textbooks using the search terms “pronator teres nerve branches”; AND “number” OR “location” OR “length” OR “diameter” yielded 545 article links. Articles were evaluated according to PRISMA guidelines. Results: A total of twenty cadaveric studies including 648 branches have registered 52.9% of two branch innervation pattern followed by 31.3%-single branch pattern; 13.5%-three branch pattern; 1.7%-four branch pattern, and 0.4%-five branch patterns, respectively. Of the 403 branches studied for their location in relation with the humeral intercondylar line, most branches were located distal to the line (50.3%), followed by 32.7% (proximal to it) and 16.8% at the line, respectively. The distance of branches located proximal and distal to humeral intercondylar line was in the range of 1.25–10 cm, and 1.1–7.5 cm, respectively. The mean length and diameter of nerves reported were 4.37 ± 2.43 cm, and 1.5 mm, respectively. Conclusions: Our data defined the morphometrics of nerve branches and they often met the required diameter for neurotization procedures. Our findings also demonstrated that the morphometrics, branching pattern and their location vary between populations and this information is very vital for surgeons during the nerve transfers.

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Innervation Pattern of Pronator Teres Muscle and Its Relation to Median Nerve: A Cadaveric Study

Abstract: Background: Pronator teres is one among the superficial muscles of the front of forearm, being supplied by the median nerve, this muscles bears a significant relation with the trunk of the nerve. There are variations in the number of branches to pronator teres and their level of origin.

Cited by 3 publications

References 8 publications

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Distal pronator teres motor branch transfer for wrist extension restoration in radial nerve paralysis

Median Nerve Passing below the Ulnar Head of Pronator Teres in Cadavers of a Medical College in Western Nepal: A Descriptive Cross-sectional Study

Innervation Patterns of the Pronator Teres Muscle and Their Possible Role in Neurotization: A Systematic Review of Cadaveric Studies

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