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Surgical and Radiologic Anatomy : SRA Aug 2017Gantzer's muscle (GM) is an additional muscle in the forearm, which develops as an accessory head of the flexor pollicis longus or the flexor digitorum profundus. The...
PURPOSE
Gantzer's muscle (GM) is an additional muscle in the forearm, which develops as an accessory head of the flexor pollicis longus or the flexor digitorum profundus. The study aimed to determine the topography of the GM and to define the topographical relationship between the GM and the neurovascular structures surrounding it.
METHODS
After confirming the presence of GM, its topography and the neurovascular structures were analyzed to determine the correlation between them in 73 upper limbs.
RESULTS
The incidence of GM was 47.95% (35/73) and the average insertion point of GM was identified at 49.33 ± 7.47‰ (119.82 ± 20.80 mm) on the reference line between the medial epicondyle and the pisiform bone. And the branching points of the median nerve and the ulnar artery were located 19.91 ± 11.23‰ (52.21 ± 24.67 mm), 17.45 ± 8.39‰ (42.53 ± 20.54 mm) on the reference line, respectively. The presence of GM had no significant correlation with the position of the nerve branches. On the other hand, the branching point of the ulnar artery was distally located in the cases with the presence of the GM (17.35 ± 8.65 vs 19.42 ± 10.87, p = 0.031). There was a significant positive correlation between the point of arterial bifurcation and the length of the GM (r = 0.407, p = 0.015).
CONCLUSIONS
This study suggested that the GM has a topographical relation with the arterial structures, perhaps for embryological reasons.
Topics: Anatomic Variation; Cadaver; Dissection; Forearm; Humans; Muscle, Skeletal
PubMed: 28289869
DOI: 10.1007/s00276-016-1803-x -
Skeletal Radiology Aug 2022To describe our techniques for ultrasound-guided injection of the pisotriquetral joint (PTJ), and to report our experience in a case series.
PURPOSE
To describe our techniques for ultrasound-guided injection of the pisotriquetral joint (PTJ), and to report our experience in a case series.
METHODS
Between 7/1/14 and 11/30/20, we performed 42 injections in 33 patients with ulnar-sided wrist pain, referred by clinicians who suspected the PTJ as the pain generator. There were 16 males and 17 females, average age 46.7 years. The patients were positioned in one of five ways: sitting with the hand maximally supinated; sitting with the hand maximally pronated; supine with the elbow flexed across the chest and the ulnar aspect of the wrist facing upward; supine with the elbow flexed, the arm externally rotated, and the ulnar aspect of the wrist facing upward; prone with the symptomatic hand at their side and the ulnar aspect of the wrist facing upward.
RESULTS
The procedures were performed by any of twelve fellowship-trained musculoskeletal radiologists. Fifteen patients reported immediate relief of symptoms, including 6 patients whose pisotriquetral joints were normal sonographically. Four patients underwent subsequent surgical excision of their pisiforms and the fifth underwent arthroscopic debridement of the pisotriquetral joint.
CONCLUSION
Ultrasound is a facile imaging modality for guiding pisotriquetral injections, which may be accomplished with a variety of patient positions and injection techniques.
Topics: Arthralgia; Carpal Joints; Female; Humans; Male; Middle Aged; Pisiform Bone; Ultrasonography, Interventional; Wrist Joint
PubMed: 35079865
DOI: 10.1007/s00256-022-03992-z -
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing... Aug 2016To investigate the clinical value of ultrasound examination of carpal canal structure in patients with mild hand-arm vibration disease. A total of 29 patients (58...
To investigate the clinical value of ultrasound examination of carpal canal structure in patients with mild hand-arm vibration disease. A total of 29 patients (58 wrists) with mild hand-arm vibration disease who were treated in Shenzhen Prevention and Treatment Center for Occupational Diseases from May to December, 2015 were enrolled as observation group, and 20 healthy volunteers (40 wrists) were enrolled as the control group. Color Doppler ultrasound was used to observe the morphology and echo of the median nerve in the carpal canal and 9 muscle tendons and transverse carpal ligament. The thickness of transverse carpal ligament and diameter of the median nerve at the level of the hamulus of hamate bone were measured, as well as the cross-sectional area of the median nerve at the level of pisiform bone. In the 29 patients with hand-arm vibration disease patients in the observation group, 8 experienced entrapment of the median nerve in the carpal canal, among whom 5 had entrapment in both wrists; there were 13 wrists (23%) with nerve entrapment and 45 wrists (77%) without nerve entrapment. Compared with the control group, the patients with hand-arm vibration disease and nerve entrapment in the observation group showed significant thickening of the transverse carpal ligament at the level of the hamulus of hamate bone and a significant increase in the cross-sectional area of the median nerve at the level of pisiform bone (<0.05) , while there were no significant differences in the thickness of transverse carpal ligament at the level of the hamulus of hamate bone and the cross-sectional area of the median nerve at the level of pisiform bone (9.397 and -4.385, both >0.05) . Ultrasound examination can clearly show the radiological changes of carpal canal contents in patients with mild hand-arm vibration disease and has a certain diagnostic value in nerve damage in patients with hand-arm vibration disease.
Topics: Arm; Carpal Tunnel Syndrome; Case-Control Studies; Hand-Arm Vibration Syndrome; Humans; Median Nerve; Ultrasonography, Doppler, Color; Vibration; Wrist
PubMed: 27682671
DOI: 10.3760/cma.j.issn.1001-9391.2016.08.013 -
Acta Orthopaedica Belgica Dec 2018The aim is to report the long-term clinical results after pisiform excision in patients with refractory flexor carpi ulnaris (FCU) tendinopathy. We performed pisiform...
The aim is to report the long-term clinical results after pisiform excision in patients with refractory flexor carpi ulnaris (FCU) tendinopathy. We performed pisiform excision in 14 patients with recalcitrant FCU tendinopathy, who had failed conservative treatment. Nine patients were followed-up for more than 2 years. Pre-operative pain visual analog scale (VAS) was extracted from the electronic medical records. Post-operative symptoms and function were assessed with pain VAS, quick disabilities of arm, shoulder and hand (DASH) score, patient rated wrist evaluation (PRWE) score, and satisfaction VAS for surgery at the final follow-up. After the mean follow-up period of 6 years, all patients showed improvement in pain VAS (from 5.9 to 1.2). The post-operative scores of quick DASH and PRWE were 3.5 and 13.1, respectively. Satisfaction VAS score was 8.8 and all patients returned to their work. Excision of the pisiform bone improved symptoms in patients with refractory FCU tendinopathy.
Topics: Humans; Orthopedic Procedures; Patient Satisfaction; Pisiform Bone; Tendinopathy; Treatment Outcome
PubMed: 30879461
DOI: No ID Found -
Acta Radiologica (Stockholm, Sweden :... Mar 2019Corticosteroid injections are a popular technique for carpal tunnel syndrome (CTS) treatment and are believed to provide rapid symptom relief.
Diffusion tensor imaging findings of the median nerve before and after carpal tunnel corticosteroid injection in patients with carpal tunnel syndrome: a preliminary study.
BACKGROUND
Corticosteroid injections are a popular technique for carpal tunnel syndrome (CTS) treatment and are believed to provide rapid symptom relief.
PURPOSE
To use magnetic resonance diffusion tensor imaging (MR-DTI) to determine the association between diffusion values of the median nerve (MN) at several anatomic locations and symptom relief in patients with CTS following corticosteroid injection.
MATERIAL AND METHODS
MR-DTI was performed on 15 wrists of 12 patients with CTS before and two weeks after ultrasound-guided corticosteroid injections. We recorded the patients' clinical data including sex, age, side of injection, satisfaction, and symptom relief. Satisfaction and symptom relief were rated using a Likert scale and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scale. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the MN at the levels of the distal radioulnar joint (DRUJ), pisiform bone, and hamate bone were determined.
RESULTS
All patients had ≥50% satisfaction on the injection side. In comparison with baseline values, post-injection ADC was significantly lower ( P = 0.001) but FA was not significantly higher ( P = 0.11) at the pisiform bone level on the injected wrists. At the DRUJ and hamate bone levels, no obvious inter-scan change in FA and ADC ( P > 0.05) was observed. The decrease in ADC at the pisiform bone level strongly correlated with the decrease in BCTQ scores (r = 0.628; P = 0.012).
CONCLUSION
Symptom relief in patients with CTS receiving corticosteroid injection is related to the change in ADC of the median nerve at the level of the pisiform bone, as determined using MR-DTI.
Topics: Adrenal Cortex Hormones; Adult; Aged; Anisotropy; Carpal Tunnel Syndrome; Diffusion Tensor Imaging; Female; Humans; Injections; Male; Median Nerve; Middle Aged; Pain Measurement; Patient Satisfaction; Surveys and Questionnaires; Treatment Outcome; Ultrasonography, Interventional
PubMed: 29979105
DOI: 10.1177/0284185118784977 -
Advanced Biomedical Research 2015Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study...
BACKGROUND
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study (EDS). Ultrasonography (US) also has been shown to be a useful diagnostic tool in CTS and is based on an increase in the median nerve cross-sectional area (CSA) at the level of the pisiform bone. In this study we assessed findings in US in correlation with severity of CTS.
MATERIALS AND METHOD
This was a cross-sectional case-control study, which was carried out on November 2012 to July 2013. Subjects were chosen from patients who referred to the Alzahra Hospital (Isfahan, Iran). Patients were classified as having mild, moderate, and severe CTS according to EDS and high-resolution US was performed for CSA measurement at the tunnel inlet.
RESULTS
A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria. The mean ± SD of the CSA was 0.12 ± 0.03 cm(2) (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm(2) (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm(2) (range, 0.11-0.32) in severe CTS. We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).
CONCLUSION
In conclusion it is expected that sonography may serve as an additional or complementary method which is useful and reliable in assessing the severity of CTS.
PubMed: 26322286
DOI: 10.4103/2277-9175.161537 -
Muscle & Nerve Apr 2015We assessed the yield of high-resolution ultrasonography (HRUS) in patients with clinically definite carpal tunnel syndrome (CTS) and normal nerve conduction studies...
INTRODUCTION
We assessed the yield of high-resolution ultrasonography (HRUS) in patients with clinically definite carpal tunnel syndrome (CTS) and normal nerve conduction studies (NCS).
METHODS
This blinded, prospective, cross-sectional study involved 35 patients (60 hands) with clinically definite CTS and normal NCS, and 20 controls (40 hands). Cross-sectional area (CSAs) of the median nerve at the level of the pisiform bone and flexor retinaculum thickness (FRT) were measured.
RESULTS
CSA was abnormal in 48.6% of patients (confidence interval 32.0-65.2%, P = 0.95). FRT was increased in only 34.3% (18.3-49.7%), but was independently abnormal in 2 patients. CSA abnormalities correlated with positive provocative tests and sensory loss. The HRUS changes were mild.
CONCLUSIONS
HRUS confirms clinically diagnosed CTS in about half of the patients with normal NCS.
Topics: Adult; Carpal Tunnel Syndrome; Cross-Sectional Studies; Female; Hand; Humans; Male; Median Nerve; Middle Aged; Neural Conduction; Prospective Studies; Ultrasonography; Young Adult
PubMed: 25131376
DOI: 10.1002/mus.24425 -
Journal of Pediatric Orthopedics. Part B Nov 2015Simultaneous fracture and dislocation of the pisiform is a rare condition, and only two cases have been reported in children. We retrospectively collected and reviewed...
Simultaneous fracture and dislocation of the pisiform is a rare condition, and only two cases have been reported in children. We retrospectively collected and reviewed clinical and radiographic data of a child with a type II Salter-Harris fracture of the distal radius, associated with fracture dislocation of the pisiform. In addition, we performed a systematic review of the literature available to date.
Topics: Child; Humans; Joint Dislocations; Male; Pisiform Bone; Radiography; Radius Fractures; Retrospective Studies; Wrist Injuries
PubMed: 26163866
DOI: 10.1097/BPB.0000000000000210 -
Journal of Anatomy Nov 2014The human pisiform is a small, nodular, although functionally significant, bone of the wrist. In most other mammals, including apes and Australopithecus afarensis,... (Comparative Study)
Comparative Study
The human pisiform is a small, nodular, although functionally significant, bone of the wrist. In most other mammals, including apes and Australopithecus afarensis, pisiforms are elongate. An underappreciated fact is that the typical mammalian pisiform forms from two ossification centers. We hypothesize that: (i) the presence of a secondary ossification center in mammalian pisiforms indicates the existence of a growth plate; and (ii) human pisiform reduction results from growth plate loss. To address these hypotheses, we surveyed African ape pisiform ossification and confirmed the presence of a late-forming secondary ossification center in chimpanzees and gorillas. Identification of the initial ossification center occurs substantially earlier in apes relative to humans, raising questions concerning the homology of the human pisiform and the two mammalian ossification centers. Second, we conducted histological and immunohistochemical analyses of pisiform ossification in mice. We confirm the presence of two ossification centers separated by organized columnar and hypertrophic chondrocyte zones. Flattened chondrocytes were highly mitotic, indicating the presence of a growth plate. Hox genes have been proposed to play a fundamental role in growth plate patterning. The existence of a pisiform growth plate presents an interesting test case for the association between Hox expression and growth plate formation, and could explain the severe effects on the pisiform observed in Hoxa11 and Hoxd11 knockout mice. Consistent with this hypothesis, we show that Hoxd11 is expressed adjacent to the pisiform in late-stage embryonic mouse limbs supporting a role for Hox genes in growth plate specification. This raises questions concerning the mechanisms regulating Hox expression in the developing carpus.
Topics: Animals; Female; Gorilla gorilla; Growth Plate; Homeodomain Proteins; Humans; Male; Mice; Osteogenesis; Pan troglodytes; Pisiform Bone; Pregnancy; Transcription Factors
PubMed: 25279687
DOI: 10.1111/joa.12235 -
Singapore Medical Journal Mar 2015We herein present a case of right triquetral fracture with associated pisiform and flexor carpi ulnaris subluxation in a 29-year-old man. Initial radiography showed a...
We herein present a case of right triquetral fracture with associated pisiform and flexor carpi ulnaris subluxation in a 29-year-old man. Initial radiography showed a right triquetral fracture. Computed tomography and magnetic resonance imaging demonstrated a triquetral fracture with a subluxated pisiform. Open reduction and lag screw fixation of the right triquetrum was performed, with good subsequent recovery of function. Although triquetral fracture with subluxation of the pisotriquetral joint is uncommon, attending clinicians should bear in mind the possibility of such an injury when managing traumatic ulnar-sided wrist pain.
Topics: Accidental Falls; Adult; Fracture Fixation; Fractures, Bone; Humans; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Tendons; Tomography, X-Ray Computed; Treatment Outcome; Wrist Joint
PubMed: 25820858
DOI: 10.11622/smedj.2015049