scholarly journals Innervation Patterns of the Lumbrical Muscles of the Foot in Human Fetuses

2019 ◽  
Vol 110 (3) ◽  
Author(s):  
Betül Asena Kara ◽  
Deniz Uzmansel ◽  
Orhan Beger
Keyword(s):  
Morphological Properties ◽  
Flexor Hallucis Longus ◽  
Human Fetuses ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Innervation Patterns ◽  
Lumbrical Muscle ◽  
Lumbrical Muscles ◽  
Flexor Digitorum ◽  
Communicating Branches

Background We sought to describe the innervation patterns of the foot lumbrical muscles and their morphological properties in human fetuses and to define the communicating branches between the medial (MPN) and lateral (LPN) plantar nerves, which play a part in the innervation of those muscles. Methods Thirty formalin-fixed fetuses (13 male and 17 female) with a mean ± SD gestational age of 25.5 ± 3.8 weeks (range, 18–36 weeks) from the inventory of the Mersin University Faculty of Medicine Anatomy Department were bilaterally dissected. Innervation patterns of the lumbrical muscles and the communicating branches between the MPN and the LPN were detected and photographed. Results No variations were seen in lumbrical muscle numbers. In the 60 feet, the first lumbrical muscle started directly from the flexor digitorum longus tendon in 48 and from the flexor hallucis longus slips in addition to the flexor digitorum longus tendon in 12. Fifty-five feet had the classic innervation pattern of the lumbrical muscles, and five had variations. No communicating branches were seen in 48 feet, whereas 12 had connections. Conclusions This study classified innervation patterns of the foot lumbrical muscles and defined two new innervation types. During surgeries on the foot and ankle in neonatal and early childhood terms, awareness of the communicating branches between the MPN and the LPN and innervation of the intrinsic muscles of the foot, such as the lumbrical muscles, might aid in preventing possible complications.

scholarly journals Safe Zone for the Plantar Portal

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Shingo Maeda ◽  
Takaaki Hirano ◽  
Akiyama Yui ◽  
Hiroyuki Mitsui ◽  
Hisateru Niki
Keyword(s):  
Endoscopic Surgery ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Peroneus Longus Tendon ◽  
Medial Plantar Nerve ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Lateral Plantar Nerve ◽  
Medial Side ◽  
Flexor Digitorum

Category: Arthroscopy Introduction/Purpose: Open surgery of the sole of the foot requires an extensive amount of soft tissue to be dissected. In recent years, various types of endoscopic surgery for the sole of the foot have been reported, making it possible to dynamically evaluate and treat plantar lesions with a small skin incision and minimal dissection. However, there have also been reports of complications involving plantar nerve injury. A good knowledge of the plantar nerve anatomy is crucial for safe endoscopic surgery of the sole. We aimed to anatomically dissect the soles of cadaveric feet to investigate the safe zones for plantar portals. Methods: We studied 36 feet of 24 cadavers. The soft tissue of the sole was dissected, and the relationships between the plantar nerve and flexor digitorum longus tendon, flexor hallucis longus tendon and peroneus longus tendon were studied. The plantar nerve course was digitally imaged and uploaded into Image J software to determine the nerve position. The back of the calcaneus, the medial side of the base of M (Metatarsal) 1, the medial side of the head of M1, the lateral side of the head of M5, and the proximal tip of M5 were plotted and defined as A, B, C, D, and E respectively on Image J. The nerve courses were plotted on AB, BE, and CD, and the percentage at which they were positioned on the line segment was calculated. Next, the bifurcation positions of each nerve were plotted and measured to the defined line segments. Results: No major differences were noted in the course of the medial plantar nerve and lateral plantar nerve. The medial plantar nerve and lateral plantar nerve ran between B and E, at 32.4% ± 4% and 61.2%± 5.1% respectively from B. No plantar arteries were found to run between the medial plantar nerve and lateral plantar nerve on BE. Taking mean and standard deviation values into account, no neurovascular structure existed from 36.4% to 56.1% along a line between the medial aspect of the base of M1 to the proximal tip of M5. The flexor digitorum longus tendon and peroneus longus tendon passed through the deep layer of this region. Conclusion: We believe this region to be a safe zone for creating plantar endoscopic portal. The plantar central portal can be created at the center of the sole. An approach from the plantar central portal to the flexor digitorum longus tendon, flexor hallucis longus tendon, and peroneus longus tendon with the plantar lateral portal, posteromedial portal, and toe portal allows for a greater range of vision and treatment options and may further advance endoscopic surgery of the sole.

Lumbrical Muscles Neural Branching Patterns: A Cadaveric Study With Potential Clinical Implications

Hand ◽  
2020 ◽  
pp. 155894472096388
Author(s):  
Michele R. Colonna ◽  
Maria Piagkou ◽  
Andrea Monticelli ◽  
Cesare Tiengo ◽  
Franco Bassetto ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cadaveric Study ◽  
Flexor Digitorum Profundus ◽  
Branching Patterns ◽  
Fresh Frozen ◽  
Innervation Patterns ◽  
Muscle Innervation ◽  
Lumbrical Muscle ◽  
Lumbrical Muscles ◽  
Flexor Digitorum

Background Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum profundus and course distally along the radial side of the corresponding metacarpophalangeal joints, in front of the deep transverse metacarpal ligament. The first and second lumbrical muscles are typically innervated by the median nerve, and third and fourth by the ulnar nerve. A plethora of lumbrical muscle variants has been described, ranging from muscles’ absence to reduction in their number or presence of accessory slips. The current cadaveric study highlights typical and variable neural supply of lumbrical muscles. Materials Eight (3 right and 5 left) fresh frozen cadaveric hands of 3 males and 5 females of unknown age were dissected. From the palmar wrist crease, the median and ulnar nerve followed distally to their terminal branches. The ulnar nerve deep branch was dissected and lumbrical muscle innervation patterns were noted. Results The frequency of typical innervations of lumbrical muscles is confirmed. The second lumbrical nerve had a double composition from both the median and ulnar nerves, in 12.5% of the hands. The thickest branch (1.38 mm) originated from the ulnar nerve and supplied the third lumbrical muscle, and the thinnest one (0.67 mm) from the ulnar nerve and supplied the fourth lumbrical muscle. In 54.5%, lumbrical nerve bifurcation was identified. Conclusion The complex innervation pattern and the peculiar anatomy of branching to different thirds of the muscle bellies are pointed out. These findings are important in dealing with complex and deep injuries in the palmar region, including transmetacarpal amputations.

Transplantation with Allograft for Rupture of the Flexor Hallucis Longus Tendon with Subsequent Longitudinal Tear of the Flexor Digitorum Longus Tendon at the Master Knot of Henry

2014 ◽  
Vol 104 (5) ◽  
pp. 508-513 ◽  
Author(s):  
John F. Grady ◽  
Yelena Boumendjel ◽  
Ngan T. Nguyen ◽  
Autumn Caldwell
Keyword(s):  
Full Range ◽  
Tendon Sheath ◽  
Flexor Hallucis Longus ◽  
Posterior Tibial Tendon ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
First Case ◽  
Active Flexion ◽  
Flexor Digitorum ◽  
Longitudinal Tear

A rare case of closed complete rupture of the flexor hallucis longus tendon with subsequent longitudinal tear of the flexor digitorum longus tendon is reported in a marathon runner. This is also a first case report of flexor hallucis longus transplant with cadaveric posterior tibial tendon allograft. Two minimal incisions distal and proximal to the malleolus allowed for tunneling with urethral dilators to open the tendon sheath for transplantation, avoiding the need for a large incision. Postoperatively, the patient regained active flexion at the interphalangeal joint of the left hallux. Four months after surgery, full range of motion was observed and dynamometric exam revealed 68% of the strength of the contralateral side. The patient was able to resume competitive running after the surgery and performed well in her age bracket.

scholarly journals Isolated proximal rupture of flexor digitorum longus tendon in a traumatic open subtalar dislocation

2014 ◽  
Vol 96 (6) ◽  
pp. e10-e12 ◽  
Author(s):  
Y Ghani ◽  
K Marenah ◽  
PA Kumar
Keyword(s):  
Functional Recovery ◽  
Low Energy ◽  
Ankle Fractures ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Musculotendinous Junction ◽  
Subtalar Dislocation ◽  
Longus Tendon ◽  
Tendon Ruptures ◽  
Flexor Digitorum

Tendon ruptures associated with ankle fractures and dislocations or subtalar dislocations are very rare entities with only a few reports of these in the literature. We report a case of an open subtalar dislocation and associated isolated proximal rupture of the flexor digitorum longus tendon at the musculotendinous junction, following a relatively low energy trauma. The finding of the avulsed flexor digitorum longus tendon was intraoperative, and management involved thorough washout of the joint and a primary side-to-side tenodesis with the flexor hallucis longus tendon. The patient has made a good functional recovery from his injuries. This case is reported because of the rarity of this combination of injuries and the associated management dilemma with which it presented us.

Spontaneous Atraumatic Rupture of the Flexor Hallucis Longus Tendon Under the Sustentaculum Tali: Case Report, Review of the Literature, and Treatment Options

Foot & Ankle ◽  
1993 ◽  
Vol 14 (7) ◽  
pp. 414-417 ◽  
Author(s):  
Francesca M. Thompson ◽  
Steven W. Snow ◽  
Stuart J. Hershon
Keyword(s):  
Systemic Disease ◽  
Treatment Options ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Unaffected Side ◽  
Longus Tendon ◽  
Aged Woman ◽  
Active Range Of Motion ◽  
Middle Aged Woman ◽  
Flexor Digitorum

A case of spontaneous rupture of the flexor hallucis longus tendon within the hind part of the foot is reported in a middle-aged woman who had no trauma or systemic disease. Repair was effected by tenodesis to the flexor digitorum longus tendon above and below the fibro-osseous tunnel. Hyperextension of the interphalangeal joint which most troubled the patient was corrected postoperatively. Active range of motion was equal in extension. Flexion at the IP joint was present, but significantly less than the unaffected side.

scholarly journals Anatomy of the Distal End of Flexor Digitorum Longus Tendon and Percutaneous Release Technique: A Cadaveric Study

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988427
Author(s):  
Baofu Wei ◽  
Ruoyu Yao ◽  
Annunziato Amendola
Keyword(s):  
Distal Phalanx ◽  
Neurovascular Bundle ◽  
Middle Phalanx ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Pull Out ◽  
Percutaneous Release ◽  
Significant Difference ◽  
Distal Interphalangeal ◽  
Flexor Digitorum

Background: The transfer of flexor-to-extensor is widely used to correct lesser toe deformity and joint instability. The flexor digitorum longus tendon (FDLT) is percutaneously transected at the distal end and then routed dorsally to the proximal phalanx. The transected tendon must have enough mobility and length for the transfer. The purpose of this study was to dissect the distal end of FDLT and identify the optimal technique to percutaneously release FDLT. Methods: Eight fresh adult forefoot specimens were dissected to describe the relationship between the tendon and the neurovascular bundle and measure the width and length of the distal end of FDLT. Another 7 specimens were used to create the percutaneous release model and test the strength required to pull out FDLT proximally. The tendons were randomly released at the base of the distal phalanx (BDP), the space of the distal interphalangeal joint (SDIP), and the neck of the middle phalanx (NMP). Results: At the distal interphalangeal (DIP) joint, the neurovascular bundle begins to migrate toward the center of the toe and branches off toward the center of the toe belly. The distal end of FDLT can be divided into 3 parts: the distal phalanx part (DPP), the capsule part (CP), and the middle phalanx part (MPP). There was a significant difference in width and length among the 3 parts. The strength required to pull out FDLT proximally was about 168, 96, and 20 N, respectively, for BDP, SDIP, and NMP. Conclusion: The distal end of FDLT can be anatomically described at 3 locations: DPP, CP, and MPP. The tight vinculum brevis and the distal capsule are strong enough to resist proximal retraction. Percutaneous release at NMP can be performed safely and effectively. Clinical Relevance: Percutaneous release at NMP can be performed safely and effectively during flexor-to-extensor transfer.

Sign in / Sign up

Export Citation Format

Share Document