ABERRANT ABDUCTOR DIGITI MINIMI MUSCLE FOUND DURING OPEN SURGICAL DECOMPRESSION OF THE CARPAL TUNNEL: CASE REPORT. Músculo abductor digiti minimi aberrante hallado durante una cirugía abierta descompresiva del tunel carpiano: reporte de caso

  • Svetoslav A Slavchev University Hospital of Orthopaedics “Prof. B. Boychev”, Medical University, Sofia
  • Georgi P Georgiev University Hospital of Orthopaedics “Prof. B. Boychev”, Medical University, Sofia

Resumen

En este artículo reportamos un caso interesante de músculo hipotenar aberrante encontrado durante una descompresión del túnel carpiano. La variante muscular surgía de la fascia antebraquial voloradial, y pasaba sobre la arteria y el nervio ulnar en el canal de Guyón, y se insertaba en la cara ulnar hipotenar. La tensión en el vientre muscular produjo ligera abducción de la quinta articulación metacarpofa-lángica, lo que confirmó que el músculo era abductor digiti minimi aberrante. Observamos asimismo las diferentes variaciones de este músculo y ponemos énfasis en su potencial implicancia clínica.

 

Herein, we present an interesting case of an aberrant hypothenar muscle found during carpal tunnel decompression. The variant muscle arised from the voloradial antebrachial fascia and coursed over the ulnar artery and nerve in the Guyon canal, and inserted into the ulnar aspect of the hypothenar. Tension on the muscle belly provided slight abduction of the fifth metacarpophalangeal joint, which confirmed it to be an aberrant abductor digiti minimi muscle. We also discuss different variations of this muscle and emphasize its potential clinical implications.

Citas

Al-Qattan MM. 2004.Ulnar nerve compression at the wrist by the accessory abductor digiti minimi muscle: wrist trauma as a precipitating factor. Hand Surg 9: 79-82.

De Smet L. 2002.Median and ulnar nerve compression at the wrist caused by anomalous muscles. Acta Orthop Belg 68: 431-438.

Dimitriou C, Natsis K. 2007. Accessory abductor digiti minimi muscle causing ulnar nerve entrapment at the Guyon's canal: a case report. Clin Anat 20: 974-975.

Dodds GA 3rd, Hale D, Jackson WT. 1990. Incidence of anatomic variants in Guyon's canal. J Hand Surg Am 15: 352-355.

Georgiev GP, Jelev L, Surchev L. 2007. Undescribed variant muscle – “deep abductor-flexor” of the little finger, in relation to ulnar nerve compression at the wrist. Ann Anat 189: 276-282.

Georgiev GP, Jelev L. 2007. Variant triple origin of the flexor digiti minimi brevis (manus) muscle in relation to ulnar nerve and artery compression at the wrist. Clin Anat 20: 976-977.

Georgiev GP, Jelev L. 2009. Unusual coexistence of a variant abductor digiti minimi and reversed palmaris longus and their possible relation to median and ulnar nerves entrapment at the wrist. Rom J Morphol Embryol 50: 725-727.

Georgiev GP, Jelev L. 2011. An aberrant flexor digiti minimi brevis manus muscle. J Hand Surg Am 36: 1965-1967.

Harvie P, Patel N, Ostlere SJ. 2004. Prevalence and epidemiological variation of anomalous muscles at Guyon's canal. J Hand Surg Br 29: 26-29.

Hoppenfeld S, DeBoer P. 1994. Surgical Exposures in Orthopaedics: The Anatomic Approach. 2nd Ed. Philadelphia: J. B. Lippincott Company. 163-176.

Jeffery AK. 1971. Compression of the deep palmar branch of the ulnar nerve by an anomalous muscle. Case report and review. J Bone Joint Surg 53B: 718-723.

Le Double A. 1897. Muscles de la main. In: Traité des Variations du Système Musculaire de l’Homme. Tome II. Paris: Schleicher Frères. 170-177.

Macalister A. 1875. Additional observations on muscular anomalies in human anatomy (third series), with a catalogue of the principal muscular variations hitherto published. Trans Roy Irish Acad 25: 1-130.

Pribyl CR, Moneim MS. 1994. Anomalous hand muscle found in the Guyon's canal at exploration for ulnar artery thrombosis. A case report. Clin Orthop Relat Res 306: 120-123.

Ruocco MJ, Walsh JJ, Jackson JP. 1998. MR imaging of ulnar nerve entrapment secondary to an anomalous wrist muscle. Skeletal Radiol 27: 218-221.

Saadeh FA, Bergman RA. 1988. An unusual accessory flexor (opponens) digiti minimi muscle. Anat Anz 165: 327-329.

Santoro TD, Matloub HS, Gosain AK. 2000. Ulnar nerve compression by an anomalous muscle following carpal tunnel release: a case report. J Hand Surg Am 25: 740-744.

Shea JD, McClain EJ. 1969. Ulnar-nerve compression syndromes at and below the wrist. J Bone Joint Surg Am 51: 1095-1103.

Simodynes EE, Cochran RM. 1981. Anomalous muscles in the hand and wrist-report of three cases. J Hand Surg Am 6: 553-554.

Spinner RJ, Lins RE, Spinner M. 1996. Compression of the medial half of the deep branch of the ulnar nerve by an anomalous origin of the flexor digiti minimi. A case report. J Bone Joint Surg Am 78: 427-430.

Turner MS, Caird DM. 1977. Anomalous muscles and ulnar nerve compression at the wrist. Hand 9: 140-142.

Zeiss J, Jakab E, Khimji T, Imbriglia J. 1992. The ulnar tunnel at the wrist (Guyon's canal): normal MR anatomy and variants. AJR Am J Roentgenol 158: 1081-1085.

Publicado
2016-03-28
Sección
Presentación de Casos