Verdan C
Rev Chir Orthop Reparatrice Appar Mot. 1981;67(3):221-30.
Anomalies of muscles and tendons in hand and wrist are not uncommon. Their signification in practicing handsurgery must be known. They can rarely be foreseen. When found at random during operation, they may be often neglected. But they are sometimes the cause of different syndromes such as disability of some artist's hands, painful wrist by sports of efforts, nerve compression simulating a carpal tunnel syndrome, camptodactylia, etc. They may also necessitate a modification of planning tendon transfers or grafting. On the dorsal aspect one must point out the extensor digitorum brevis; the absence or hypotrophy of extensor communis digiti quinti, anomalies of the connexus inter-tendinei which can hinder the independency of finger extension; numerous variations of the abductor pollicis longus and extensor pollicis brevis, the latter moving often in a proper tendon sheath. On the palmar aspect, beside the classic absence of palmaris longus, one must also know the anomalies of insertion and the possibility of hypertrophy of this muscle, which can compress the median nerve simulating a carpal tunnel syndrome. The digital flexors can present fusions between each other, especially 4th and 5th, or between flexor pollicis longus and flexor profundus indicis. The intrinsics also have variations concerning their numbers and their proximal and distal insertions. Different clinical cases are described and clearly illustrated in colour.
手部和腕部肌肉与肌腱的异常并不罕见。必须了解它们在手部外科手术中的意义。它们很难被预先察觉。在手术中偶然发现时,它们常常会被忽视。但它们有时是导致不同综合征的原因,比如一些艺术家手部功能障碍、因用力运动导致的腕部疼痛、模拟腕管综合征的神经受压、手指屈曲畸形等。它们也可能需要对肌腱转移或移植的计划进行调整。在背侧,必须指出指短伸肌;小指固有伸肌缺如或发育不全、腱间结合异常可能会妨碍手指伸展的独立性;拇长展肌和拇短伸肌有众多变异,后者常走行于一个独立的腱鞘内。在掌侧,除了常见的掌长肌缺如,还必须了解该肌肉的附着异常及肥大的可能性,这可能会压迫正中神经,模拟腕管综合征。指屈肌之间可能会出现融合,尤其是第四指和第五指之间,或者拇长屈肌和示指深屈肌之间。手部内在肌在数量以及近端和远端附着方面也有变异。书中描述了不同的临床病例并配有清晰的彩色插图。