Get A guide to laparoscpic surgery PDF

By Azad Najmaldin Pierre J. Guillou

ISBN-10: 0632061693

ISBN-13: 9780632061693

ISBN-10: 086542649X

ISBN-13: 9780865426498

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Sample text

The fascicles ultimately destined for the recurrent motor branch have been found in 60 % of dissections to arise from the extreme radial aspect of the median nerve, in 22 % from the central-anterior aspect, and in the remaining 18 % between the extreme radial-anterior and the central aspect of the median nerve. In 56 % of reported dissections, the recurrent motor branch of the median nerve passes through a separate fascial tunnel immediately prior to entering the thenar muscles. There is no unique correlation between the presence of the distal tunnel and the motor branch orientation in the median nerve [9].

The musculotendinous junctions are found proximal to the proximal edge of the carpal tunnel. The flexor pollicis longus muscle is the most radial structure of the group discussed here; it originates from the radius and the interosseous membrane and emerges between the superficial and deep heads of the flexor pollicis brevis muscle where it inserts into the proximal phalanx of the thumb. The flexor digitorum superficialis muscle originates from the medial epicondyle of the distal humerus and the coronoid process and proximal diaphysis of the radius, divides into four independent muscle bellies in the mid-forearm, and passes through the carpal tunnel only as deep as the flexor retinaculum into the middle phalanges of the index, long ring, and small fingers.

In palmar flexion the median nerve, flexor tendons, and flexor retinaculum are thus closer to each other than in the neutral position. The space between these structures increases in wrist extension. In the carpal tunnel, the median nerve has remarkable passive excursions. 1 mm in a transverse direction. 4 mm in flexion [43]. A sheath-like structure with a space between the layers is closed proximally and distally. A parietal layer of loose connective tissue surrounds the median nerve [34] (Fig.

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A guide to laparoscpic surgery by Azad Najmaldin Pierre J. Guillou

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