Epitrochleoanconeus muscle

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Epitrochleoanconeus muscle
Dissected elbow showing epitrochleoanconeus from Toldt 1919 p320.tif
The inner side of the right elbow showing the epitrochleoanconeus muscle. From Toldt (1919).
Illustration of epitrochleoanconeus muscle from Gruber 1866.tif
Illustration of a dissected elbow joint showing ulnar nerve (a), epitrochleoanconeus (1 in red), triceps extensor cubiti (2) and flexor carpi ulnaris muscles (3). From Gruber (1866).
Details
Origin Inferior surface of the medial epicondyle of the humerus
Insertion olecranon process
Nerve Ulnar nerve
Identifiers
Latin Musculus epitrochleoanconaeus
Anatomical terms of muscle

The epitrochleoanconeus muscle (anconeous epitrochlearis muscle, anconeus-epitrochlearis or anconeus sextus) is a small accessory muscle of the arm which runs from the back of the inner condyle of the humerus over the ulnar nerve to the olecranon. The average prevalence of this muscle is 14.2% in healthy individuals. [1]

Contents

Structure

The epitrochleoanconeus is a short striated muscle which originates on the posterior surface of the medial epicondyle of the humerus. The muscle runs over the ulnar nerve, forms an arch over the cubital tunnel and inserts on the olecranon. It is innervated by the ulnar nerve.

Variation

There are cases where there is no structure at all bridging the space occupied by the epitrochleoanconeus. [2] The muscle tends to be hypertrophied when associated with cubital tunnel syndrome. [1]

Clinical significance

The presence of the epitrochleoanconeus muscle can lead to ulnar neuropathy, or cubital tunnel syndrome, due to compression of the ulnar nerve. [3] [4] [5] The absence of epitrochleoanconeus muscle or Osborne's ligament can increase the chances of ulnar nerve dislocation. [2]

History

While there were previous identifications of the epitrochleoanconeus in animal studies, under a variety of names, Gruber (1866) seems to offer the first extensive comparative study involving the epitrochleoanconeus in man. [6] This was shortly followed by several accounts by Wood describing his identification of the muscle during a series of dissections in humans along with comparative studies in other animals. [7] [8]

Other animals

In animals with a discrete developed epitrochleoanconeus the muscle acts as an adductor of the olecranon and a supinator of the forearm. [9] A variety of names have been given to this muscle in different species including flexor antebrachii ulnaris, epitrochleo-cubitalis and entepicondylo-ulnaris. The epitrochleoanconius is common amongst tetrapods being found in reptiles, amphibians, mammals and birds. [10]

The epitrochleoanconeus is found widely amongst mammals having been characterised in the mid 19th century in a variety of species including two-toed sloth, duck billed platypus and echidna. Galton (1874) gave an overview of the several species characterised at that point and noted that at least 15 species had been figured with the muscle in Cuvier's "Anatomie comparée" of 1855 but that the muscle was given a wide variety of aliases and was not shown in many species where it should have been seen. [9] The muscle is common in lower primates but has been lost as a discrete muscle in apes, although it has reoccurred in chimpanzees. [9] [11]

See also

Related Research Articles

Radial nerve

The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin.

Median nerve Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

Ulnar nerve Nerve which runs near the ulna bone

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

Wrist drop Medical condition

Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

Cubital tunnel

The cubital tunnel is a space of the dorsal medial elbow which allows passage of the ulnar nerve around the elbow. It is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris. The roof of the cubital tunnel is elastic and formed by a myofascial trilaminar retinaculum.

Flexor carpi ulnaris muscle

The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint.

Olecranon

The olecranon, from the Greekolene meaning elbow and kranon meaning head, is a large, thick, curved bony eminence of the ulna, a long bone in the forearm that projects behind the elbow. It forms the most pointed portion of the elbow and is opposite to the cubital fossa or elbow pit. The olecranon serves as a lever for the extensor muscles that straighten the elbow joint.

Flexor retinaculum of the hand A thickened fascia over the carpal tunnel

The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.

Ulnar canal

The ulnar canal or ulnar tunnel (also known as Guyon's canal or tunnel) is a semi-rigid longitudinal canal in the wrist that allows passage of the ulnar artery and ulnar nerve into the hand. The roof of the canal is made up of the superficial palmar carpal ligament, while the deeper flexor retinaculum and hypothenar muscles comprise the floor. The space is medially bounded by the pisiform and pisohamate ligament more proximally, and laterally bounded by the hook of the hamate more distally. It is approximately 4 cm long, beginning proximally at the transverse carpal ligament and ending at the aponeurotic arch of the hypothenar muscles.

Anterior interosseous nerve

The anterior interosseous nerve is a branch of the median nerve that supplies the deep muscles on the anterior of the forearm, except the ulnar (medial) half of the flexor digitorum profundus. Its nerve roots come from C8 and T1.

Recurrent branch of the median nerve

The recurrent branch of the median nerve is the branch of the median nerve which supplies the thenar muscles. It is also occasionally referred to as the thenar branch of the median nerve, or the thenar muscular branch of the median nerve.

The posterior compartment of the forearm contains twelve muscles which are chiefly responsible for extension of the wrist and digits, and supination of the forearm. It is separated from the anterior compartment by the interosseous membrane between the radius and ulna.

Ulnar tunnel syndrome Medical condition

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is caused by entrapment of the ulnar nerve in the Guyon canal as it passes through the wrist. Symptoms usually begin with a feeling of pins and needles in the ring and little fingers before progressing to a loss of sensation and/or impaired motor function of the intrinsic muscles of the hand which are innervated by the ulnar nerve. Ulnar tunnel syndrome is commonly seen in regular cyclists due to prolonged pressure of the Guyon's canal against bicycle handlebars. Another very common cause of sensory loss in the ring and pink finger is due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome.

Ulnar nerve entrapment Medical condition

Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from the spine at cervical vertebra C7 to the wrist; the most common point of entrapment is in the elbow. Prevention is mostly through correct posture and avoiding repetitive or constant strain. Treatment is usually conservative, including medication, activity modification and exercise, but may sometimes include surgery. Prognosis is generally good, with mild to moderate symptoms often resolving spontaneously.

Ulnar neuropathy Medical condition

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. Motor function can be assessed by testing for a positive Froment's sign, or making an OK sign, little finger abduction can be tested as well.

Elbow Joint between the upper and lower parts of the arm

The elbow is the region between the upper and lower parts of the arm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the elbow pit, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the upper arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body.

Struthers ligament

Struthers' ligament is a feature of human anatomy consisting of a band of connective tissue at the medial aspect of the distal humerus. It courses from the supracondylar process of the humerus to the medial humeral epicondyle. It is not a constant ligament, and can be acquired or congenital. The structure was highlighted by John Struthers, who discussed the feature's evolutionary significance with Charles Darwin. Struthers originally reported that the ligament usually arose at a position 3.2 to 6.4 cm from the medial condyle, being 1.2 to 1.9 cm in length, and nearer to the anterior than the medial border of the humerus.

Wartenberg's sign is a neurological sign consisting of involuntary abduction of the fifth (little) finger, caused by unopposed action of the extensor digiti minimi.

Median nerve palsy Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Osbornes ligament Connective tissue in the body

Osborne's ligament, also Osborne's band, Osborne's fascia, Osborne's arcade, arcuate ligament of Osborne, or the cubital tunnel retinaculum, refers to either the connective tissue which spans the humeral and ulnar heads of the flexor carpi ulnaris (FCU) or another distinct tissue located between the olecranon process of the ulna and the medial epicondyle of the humerus. It is named after Geoffrey Vaughan Osborne, a British orthopedic surgeon, who described the eponymous tissue in 1957.

References

PD-icon.svgThis article incorporates text in the public domain from page 448 of the 20th edition of Gray's Anatomy (1918)

  1. 1 2 Suwannakhan, Athikhun; Chaiyamoon, Arada; Yammine, Kaissar; Yurasakpong, Laphatrada; Janta, Sirorat; Limpanuparb, Taweetham; Meemon, Krai (2021-12-01). "The prevalence of anconeus epitrochlearis muscle and Osborne's ligament in cubital tunnel syndrome patients and healthy individuals: An anatomical study with meta-analysis". The Surgeon. 19 (6): e402–e411. doi:10.1016/j.surge.2020.12.006. ISSN   1479-666X.
  2. 1 2 O'Driscoll SW, Horii E, Carmichael SW, Morrey BF (1991). "The cubital tunnel and ulnar neuropathy". J Bone Joint Surg Br. 73 (4): 613–7. doi: 10.1302/0301-620X.73B4.2071645 . PMID   2071645.
  3. Gervasio O, Zaccone C (2008). "Surgical approach to ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle and a prominent medial head of the triceps". Neurosurgery. 62 (3 Suppl 1): 186–92, discussion 192–3. doi:10.1227/01.neu.0000317392.29551.aa. PMID   18424985. S2CID   22925073.
  4. Nellans K, Galdi B, Kim HM, Levine WN (2014). "Ulnar neuropathy as a result of anconeus epitrochlearis". Orthopedics. 37 (8): e743–5. doi:10.3928/01477447-20140728-92. PMID   25102512.
  5. Uscetin I, Bingol D, Ozkaya O, Orman C, Akan M (2014). "Ulnar nerve compression at the elbow caused by the epitrochleoanconeus muscle: a case report and surgical approach". Turk Neurosurg. 24 (2): 266–71. doi: 10.5137/1019-5149.JTN.6913-12.0 . PMID   24831373.
  6. Gruber, W. (1866) "Über den Musculus epitrochleo-anconeus des Menschen und der Säugethiere." Mem. de L'Acadèmie Impèriale des Sciences de St. Petersbourg S. 7., 10(5):1-26.
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