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Two muscular variations in the elbow associated with the anterior interosseous nerve
Łukasz Olewnik1, Bartłomiej Szewczyk2, Nicol Zielinska2
1Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland. lukasz.olewnik@umed.lodz.pl.
Insights
This case report details rare anatomical variations in a human forearm, including a dual-headed pronator teres and an accessory flexor pollicis longus head. These variations pose risks for neurovascular compression, particularly of the anterior interosseous nerve.
Area of Science:
- Anatomy
- Morphology
- Clinical Anatomy
Background:
- Anatomical variations in the forearm musculature and neurovasculature are clinically significant.
- Understanding these variations is crucial for surgical procedures and diagnosing entrapment syndromes.
Observation:
- A rare variant of the pronator teres muscle with two distinct proximal attachments was observed.
- An accessory head of the flexor pollicis longus muscle was identified, originating from the medial epicondyle.
- A high division of the median nerve was also noted in conjunction with these variations.
Findings:
- The dual-banded pronator teres may lead to ulnar artery compression.
- The accessory flexor pollicis longus head, alongside the high median nerve division, creates a potential compression site for the anterior interosseous nerve.
Implications:
- These anatomical anomalies highlight potential risks for anterior interosseous nerve syndrome and ulnar artery entrapment.
- Awareness of such variations is essential for surgeons and clinicians to prevent iatrogenic injuries.
- This case contributes to the understanding of forearm anatomical variability and its clinical relevance.
Abstract:
The coexistence of different muscular-neurovascular variations is of significant clinical importance. A male cadaver, 76 years old at death, was subjected to routine anatomical dissection; the procedure was performed for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz. The right forearm and hand were dissected using standard techniques according to a strictly specified protocol. The presence accessory head of the flexor pollicis longus may potentially compress the anterior interosseous nerve. The present case report describes a rare variant of the ulnar head of the pronator teres, characterized by two independent bands (i.e., two proximal attachments). The main band originates from the coronoid process and the second originates from the tendon of the biceps brachii. This type of attachment could potentially affect the compression of the ulnar artery running between the two bands. Additionally, the accessory head of the flexor pollicis longus was observed, which started on the medial epicondyle; its coexistence with a high division median nerve creates a potential pressure site on the anterior interesosseous nerve.
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