Abstract
Purpose
Knowledge of accessory flexor carpi ulnaris (AFCU) is not only important for proper orientation in the surgical field but it can be used for tendon transfer as well. AFCU commonly occurs with concomitant variants, and its presence should rise caution in order to prevent iatrogenic injury.
Methods
During a routine dissection for research data collection at the Institute of Anatomy, a AFCU with concomitant variants was observed in a European cadaver fixed with Thiel’s method. A thorough review of the literature concerning all the encountered variants was performed.
Results
AFCU was found in the right upper limb with its insertion on the flexor retinaculum. Palmaris longus muscle was absent in this limb, and an accessory branch of the anterior interosseous artery coursed over the pronator quadratus muscle to anastomose with the ulnar artery 5 cm proximally to the pisiform. On the left hand, a variable lumbrical of the second finger originating from the flexor retinaculum was found, which was not described in the literature before.
Conclusions
AFCU commonly occurs together with concomitant variants, and special attention is needed when performing surgery on such forearm.
Similar content being viewed by others
References
Alvin M, Alan N, Leone J, Fredieu JR (2011) A unilateral accessory flexor carpi ulnaris muscle observed during cadaveric dissection. Clin Anat 24(8):971–973. https://doi.org/10.1002/ca.21234
Ang GG, Rozen WM, Vally F, Eizenberg N, Grinsell D (2010) Anomalies of the flexor carpi ulnaris: clinical case report and cadaveric study. Clin Anat 23(4):427–430. https://doi.org/10.1002/ca.20952
Arnold G, Zech M (1977) An accessory muscle and additional variants of the forearm. Handchirurgie 9(3):135–136
Bhardwaj P, Bhandari L, Sabapathy SR (2013) Supernumerary flexor carpi ulnaris—case report and review. Hand Surg 18(3):393–397. https://doi.org/10.1142/S0218810413720222
Campos D, Nazer MB, Bartholdy LM, Souza PL (2010) Accessory flexor carpi ulnaris muscle: a case report of a rare variation in human. J Morphol Sci 27(1):30–31
Chong SJ, Al-Ani S, Pinto C, Peat B (2009) Bilateral flexor carpi radialis brevis and unilateral flexor carpi ulnaris brevis muscle: case report. J Hand Surg Am 34(10):1868–1871. https://doi.org/10.1016/j.jhsa.2009.08.002
Georgiev GP, Jelev L, Ovtscharoff WA (2009) Unusual combination of muscular and arterial variations in the upper extremity: a case report of a variant palmaris longus and an additional tendinous portion of the flexor carpi ulnaris together with a persistent median artery. Anatomy 3:58–61. https://doi.org/10.2399/ana.09.031
Lemon M, Belcher HJ (2002) An anomalous flexor carpi ulnaris. J Hand Surg Br 27(2):194–197. https://doi.org/10.1054/jhsb.2001.0705
Lippert H, Pabst R (1985) Arterial variations in man. In: Bergman JF (ed) Bergman’s comprehensive encyclopedia of human anatomic variation, 1st edn. Urban & Schwanzenberg, München, pp 71–77
Mehta HJ, Gardner WU (1961) A study of lumbrical muscles in the human hand. Am J Anat 11(109):227–238. https://doi.org/10.1002/aja.1001090302
Milena GL, Santiago FR, Santon CC, Barea LC (2001) Forearm soft tissue mass caused by an accessory muscle. Eur Radiol 11(8):1487–1489. https://doi.org/10.1007/s003300100827
Mori M (1964) Statistics on the musculature of Japanese. Okajimas Folia Anat Jpn 40:195–300
Poisel S (1974) Ursprung und Verlauf des R. muscularis des Nervus digitalis palmaris communis I (N. medianus). Chir Praxis 18:471–474
Quain R (1844) Anatomy of the arteries of the human body and its applications to pathology and operative surgery. Taylor and Walton, London, pp 312–313
Schultz RJ, Endler MP, Huddleston HD (1973) Anomalous median nerve and an anomalous muscle belly of the first lumbrical associated with carpal tunnel-syndrome. J Bone Jt Surg Am 55(8):1744–1746
Acknowledgements
We are very thankful to the body donor for his kind donation.
Funding
Funding was provided by Charles University, Prague, Czech Republic (Grant No. PROGRES Q37).
Author information
Authors and Affiliations
Contributions
VK was involved in project development, dissection, and manuscript writing/editing. MS contributed to photo documentation, its processing and manuscript writing/editing. GF was involved in dissection supervision and manuscript writing/editing. DK contributed to manuscript writing/editing.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kunc, V., Stulpa, M., Feigl, G. et al. Accessory flexor carpi ulnaris muscle with associated anterior interosseous artery variation: case report with the definition of a new type and review of concomitant variants. Surg Radiol Anat 41, 1315–1318 (2019). https://doi.org/10.1007/s00276-019-02261-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-019-02261-4