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      Accessory Flexor Carpi Ulnaris and Bilaterally Variant Vascular Anatomy of Upper Limb: An Unusual Presentation

      case-report

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          Abstract

          We report a rare combination of variations in the upper limb of a human cadaver. Accessory flexor carpi ulnaris with absent palmaris longus was observed in the left forearm during routine dissection of a male cadaver. Variant vascular pattern was observed bilaterally. Brachial artery bifurcated at a higher level. Ulnar artery gave rise to persistent median artery (PMA) which pierced the median nerve and accompanied it deep into flexor retinaculum to terminate as two common palmar digital arteries. Superficial palmar arch was not formed as the PMA did not anastomose with either the radial or ulnar artery. Radial artery was small and deep palmar arch was mainly contributed by the deep branch of ulnar artery. Awareness of these coexistent variations in the forearm and hand is anatomically as well as clinically important in reconstructive hand surgeries.

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          Most cited references10

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          Median artery revisited.

          This study confirms that the median artery may persist in adult life in 2 different patterns, palmar and antebrachial, based on their vascular territory. The palmar type, which represents the embryonic pattern, is large, long and reaches the palm. The antebrachial type,which represents a partial regression of the embryonic artery is slender, short, and terminates before reaching the wrist. These 2 arterial patterns appear with a different incidence. The palmar pattern was studied in the whole sample (120 cadavers) and had an incidence of 20%, being more frequent in females than in males (1.3:1), occurring unilaterally more often than bilaterally (4:1) and slightly more frequently on the right than on the left (1.1:1). The antebrachial pattern was studied in only 79 cadavers and had an incidence of 76%, being more frequent in females than in males (1.6:1); it was commoner unilaterally than bilaterally (1.5:1) and was again slightly more prevalent on the right than on the left (1.2:1). The origin of the median artery was variable in both patterns. The palmar type most frequently arose from the caudal angle between the ulnar artery and its common interosseous trunk (59%). The antebrachial pattern most frequently originated from the anterior interosseous artery (55%). Other origins, for both patterns, were from the ulnar artery or from the common interosseous trunk. The median artery in the antebrachial pattern terminated in the upper third (74%) or in the distal third of the forearm (26%). However, the palmar pattern ended as the 1st, 2nd or 1st and 2nd common digital arteries (65%) or joined the superficial palmar arch (35%). The median artery passed either anterior (67%) or posterior (25%) to the anterior interosseous nerve. It pierced the median nerve in the upper third of the forearm in 41% of cases with the palmar pattern and in none of the antebrachial cases. In 1 case the artery pierced both the anterior interosseous and median nerves.
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            Clinical assessment of absence of the palmaris longus and its association with other anatomical anomalies-- a Chinese population study.

            Ethnic variations in the prevalence of absence of the palmaris longus (PL) are well known. Many techniques for clinically determining the presence of the PL have been described. Studies have also attempted to correlate its absence with other anatomical anomalies. However, most studies have been done in Caucasian populations. The presence of the PL was clinically determined in 329 normal Chinese men and women using the standard technique. In subjects with an absent PL, 4 other tests were performed to confirm absence and an Allen's test was done to assess the palmar arches. All subjects were examined for the presence of the flexor digitorum superficialis (FDS) to the little finger. The overall prevalence of absence of the PL was 4.6%. All techniques were equally effective in determining the absence of the PL. There was no significant difference in its absence with regard to the body side or sex. Absolute deficiency of FDS to the little finger was seen in 6.4%. No correlation could be detected between the absence of the PL and FDS of the little finger. The prevalence of absence of the PL and absence of FDS to the little finger in a Chinese population is much lower compared to previous reports in the literature. There is no association between absence of the PL and absence of the FDS to the little finger. Although all techniques of examining for the absence of the PL are equally effective, the method suggested by Mishra seems the best as it was easily understood by subjects and can be used even when thumb abduction is not possible.
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              Gray's anatomy: the anatomical basis of clinical practice

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                Author and article information

                Journal
                Int J Appl Basic Med Res
                Int J Appl Basic Med Res
                IJABMR
                International Journal of Applied and Basic Medical Research
                Medknow Publications & Media Pvt Ltd (India )
                2229-516X
                2248-9606
                Apr-Jun 2017
                : 7
                : 2
                : 143-145
                Affiliations
                [1] Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
                Author notes
                Address for correspondence: Dr. Sulochana Sakthivel, Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006, India. E-mail: sulo.ss@ 123456gmail.com
                Article
                IJABMR-7-143
                10.4103/ijabmr.IJABMR_326_16
                5441265
                28584749
                58afadd4-4f84-4922-8981-481e396286ae
                Copyright: © 2017 International Journal of Applied and Basic Medical Research

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 10 August 2016
                : 07 March 2017
                Categories
                Case Report

                accessory flexor carpi ulnaris,deep palmar arch,persistent median artery,superficial palmar arch

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