Median nerve neuralgia caused by a fibrovascular band in the distal forearm

Holtzman, Robert N. N.; Patel, Mukund R.; Mark, Michael H.

doi:10.1016/s0363-5023(86)80245-3

Cited by 9 publications

(4 citation statements)

References 1 publication

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“…The information on such variation is of importance for the differential diagnosis of other compression causes such as enlarged veins [10] or a fibrovascular band [11].…”

Section: Discussionmentioning

confidence: 99%

A Study of Upper Limb Muscle Anomalies and Their Effects on the Neurovascular Structures

Chitra¹,

Kalaiyarasi²

2016

IJAR

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Background: Variations in the morphology of the upper limb muscles are not uncommon. These variant muscles may compress the adjacent neurovascular structures by their anomalous positions. The knowledge of supernumerary heads of biceps brachii, variant bicipital aponeurosis and an abnormal tendinous insertion of coracobrachialis may cause clinical conditions like median nerve entrapment, compression of brachial artery, pronator syndrome etc. Materials and Methods: The present study was undertaken to observe the anomalous origin and insertion of upper limb muscles and their relation to neurovascular structures in vicinity. This study was carried out in 60 upper limbs of 30 formalin fixed human cadavers in the Department of Anatomy, KAPV Government Medical College, Trichy. Results: Among the sixty upper limbs, variations were found in three separate limbs. The variations included an accessory head of biceps brachii, a muscular slip from the bicipital aponeurosis which gave extensions to the forearm muscles and an anomalous origin and tendinous extension of coracobrachialis muscle to the medial epicondyle of humerus. Conclusion: Knowledge of supernumerary heads of biceps brachii, accessory slips from bicipital aponeurosis and anomalous origin and insertion of coracobrachialis is essential in preoperative diagnosis and surgery of upper limbs, as they may cause compression of neurovascular structures like brachial artery, median nerve and ulnar nerve.

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“…The information on such variation is of importance for the differential diagnosis of other compression causes such as enlarged veins [10] or a fibrovascular band [11].…”

Section: Discussionmentioning

confidence: 99%

A Study of Upper Limb Muscle Anomalies and Their Effects on the Neurovascular Structures

Chitra¹,

Kalaiyarasi²

2016

IJAR

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“…There are several mechanisms by which the median nerve may be compromised in the distal forearm. These include anomalous forearm muscle bellies and tendons, most commonly the palmaris longus muscle2, 5, 10, 21, 28; vascular anomalies, including a fibrovascular band17 and a thrombosed aneurysm in the distal forearm8; forearm fractures1, 11 or soft tissue trauma; and forearm intraneural tumors3 or cysts 27. Many of these conditions present with local forearm pain, swelling, or a palpable mass.…”

Section: Discussionmentioning

confidence: 99%

Transient forearm conduction block in the median nerve

2002

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We present two cases referred for electrophysiological confirmation of carpal tunnel syndrome (CTS). Initial nerve conduction studies were normal. Approximately 20 min into the examination, both patients developed sensory symptoms and weakness in the distal median nerve territory while the elbow was extended and forearm supinated. Further studies demonstrated complete conduction block across the forearm in the median motor and sensory nerve fibers. When measurable, conduction velocities remained normal or were modestly slow. Complete clinical and electrophysiological recovery occurred within 2 min following forearm pronation, suggesting that dysfunction was probably due to focal transient ischemia. Patients describing increased sensory symptoms during routine electrophysiological assessments for CTS should be investigated to rule out the possibility of a more proximal abnormality.

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“…However construction of the muscle may cause compression on the median nerve since it passes between the fibers of the accessory head. So, information on such a variation is of importance for the differential diagnoses of the other compression causes such as enlarged veins (Braun & Spinner, 1991) or a fibrovascular band (Holtzman et al, 1986). Biceps brachii is without doubt a considerable component in plastic surgery (Muneuchi et al, 2004;Willcox et al, 2002; Har-Shai et al, 1998) but it is known that accessory heads of biceps brachii would be expandable and possibly has more value in flap surgery rather than the two main heads.…”

Section: Such Variations Are Of Importance For the Anatomistsmentioning

confidence: 99%

Unusual Relation of the Median Nerve with the Accessory Head of the Biceps Brachii Muscle: An Original Case Report

et al. 2006

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SUMMARY:During the laboratory dissection of the brachial region and the arm, an abnormal relation of median nerve with the accessory head of biceps brachii muscle has been observed unilaterally on the right upper limb of a male cadaver. Whereas the short and long heads have their normal origin, additional-excess third head originated from the anteromedial surface of the superior part of the humerus. Some fibers of this accessory head on the medial side arise from the deep fascia surrounding the brachialis muscle. The fibers then cross the median nerve superficially before joining the third head which has inserted into a common tendon together with the long and short heads.To have information of such variations is of importance either for anatomists or clinicians especially for plastic surgeons in flap surgery. Case Report 562 tendon (Fig. 1). Some fibers of this accessory head on the medial side arose from the deep fascia surrounding the brachialis and crossed the median nerve superficially before joining the third head (Fig 2). After piercing the accessory head the median nerve descends over the brachialis muscle and enters to the forearm passing between the two heads of pronator teres in its usual course. This accessory head also inserted in to the common tendon with the long and short heads. It was observed that the accessory head was innervated by the muscular branches of musculocutaneous nerve as the main two heads. The vascular supply of this third head was also the brachial artery. Fig. 1. On the right side, biceps brachii is cut; long and short heads are reflected keeping the accessory head intact. The musculocutaneous nerve is pulled laterally. The accessory head of biceps brachii originates form the anteromedial surface of humerus, from the lateral side of the insertion of cracobrachialis muscle and inserts into the posterior aspect of the common biceps tendon. cbm: Coracobrachialis muscle, lbm: Long head of biceps brachii, sbm: Short head of biceps brachii, ah: Accessory head of biceps brachii, *: Medial fibers of the accessory head originating from the deep fascia of brachialis muscle, ≠: Common tendon of biceps brachii, bbm: Biceps brachii muscle, bm: Brachialis muscle, mn: Median nerve. 563 DISCUSSIONIt is well known that the biceps brachii muscle variations are not rare (Asvat et al.;Rodriguez-Niedenführ et al.;Bergman et al., 1984;Greig et al., 1952;Tamura, 1971). Some authors emphasize that the most frequent variations of biceps brachii was in the number of the bellies (Bergman et al., 2000). Supernumerary heads of the biceps brachii have been described as part of three-, four-, five or even seven headed biceps brachii (Swieter & Carmichael, 1980). However the three headed biceps brachii is the most commonly reported variation of the biceps brachii. It has been mentioned in the literature that the occasional presence of a third head varies according to the population from which the cadavers were sampled (Rodriguez-Niedenführ et al.). It has been stated that an accessory head had been observed i...

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Median nerve neuralgia caused by a fibrovascular band in the distal forearm

Cited by 9 publications

References 1 publication

A Study of Upper Limb Muscle Anomalies and Their Effects on the Neurovascular Structures

A Study of Upper Limb Muscle Anomalies and Their Effects on the Neurovascular Structures

Transient forearm conduction block in the median nerve

Unusual Relation of the Median Nerve with the Accessory Head of the Biceps Brachii Muscle: An Original Case Report

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