Estudio electrofisiologico de las variactones en la inervacion de los musculos de la mano

Rey, R. C.; Sanz, Olga P.; Sica, R. E. P.

doi:10.1590/S0004-282X1984000100003

Resúmenes

Para investigar las probables variaciones en la inervación de los músculos intrínsecos de la mano y/o la anastomosis entre los nervios mediano y cubital, se estudiaron 24 manos, estimulando en forma percutánea a dichos nervios, registrándose en abductor polliçis brevis (APB), adductor digiti minimi (ADM) y primer interóseo dorsal (PID). Se halló una frecuente inervación del PID por el mediano. Se describe la técnica utilizada, comentando incidência, importancia y probable comportamiento en distintas patologias de las variaciones halladas.

An electrophysiological study was carried out searching for variations in the innervation of the muscles of the hand. For this purpose a simple and non time-consuming technique was designed for stimulating the ulnar and median nerves at the elbow and wrist. Recordings were performed with surface electrodes at the abductor pollicis brevis, adductor digiti minimi and first dorsal interosseus muscles. Several anomalous innervation patterns of the intrinsic muscles of the hand were found, and the innervation of the first dorsal interosseus by the median nerve was the most frequent.

Estudio electrofisiologico de las variactones en la inervacion de los musculos de la mano

Electrophysiological study of the variations in the innervation of the muscles of the hand

R. C. Rey^I; Olga P. Sanz^II; R. E. P. Sica^III

^IMédico Residente. Sección de Electronuerofisiología Clínica, División Neurologia, Hospital Ramos Mejía, Buenos Aires, Argentina

^IIMédico Assistente. Sección de Electronuerofisiología Clínica, División Neurologia, Hospital Ramos Mejía, Buenos Aires, Argentina

^IIIJefe de Sección. Sección de Electronuerofisiología Clínica, División Neurologia, Hospital Ramos Mejía, Buenos Aires, Argentina

RESUMEN

Para investigar las probables variaciones en la inervación de los músculos intrínsecos de la mano y/o la anastomosis entre los nervios mediano y cubital, se estudiaron 24 manos, estimulando en forma percutánea a dichos nervios, registrándose en abductor polliçis brevis (APB), adductor digiti minimi (ADM) y primer interóseo dorsal (PID). Se halló una frecuente inervación del PID por el mediano. Se describe la técnica utilizada, comentando incidência, importancia y probable comportamiento en distintas patologias de las variaciones halladas.

SUMMARY

An electrophysiological study was carried out searching for variations in the innervation of the muscles of the hand. For this purpose a simple and non time-consuming technique was designed for stimulating the ulnar and median nerves at the elbow and wrist. Recordings were performed with surface electrodes at the abductor pollicis brevis, adductor digiti minimi and first dorsal interosseus muscles. Several anomalous innervation patterns of the intrinsic muscles of the hand were found, and the innervation of the first dorsal interosseus by the median nerve was the most frequent.

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Trabajo de la Sección de Electronuerofisiología Clínica, División Neurologia, Hospital Ramos Mejía, Buenos Aires, Argentina.

Sección de Electroneurofisiología Clínica, División Neurologia, Hospital Ramos Mejía - Urquista 609 - 1221 Buenos Aires - Argentina.

1. BROOKS, H. - Variations in nerve supply of Flexor Brevis Pollicis. Anat. Physiol. 20:641, 1886.
2. GASSEL, L. - Sources of error motor nerve conduction studies. Neurolgy (Minneapolis) 14:825, 1964.
3. GRUBER, W. - Uber die Verbidung des Nervus medianus mit dem Nervus ulnaris am Unterarm des Saugethiere. Arch. anat. physiol. Wissensch. med. 37: 501, 1870.
4. GUTMAN, L. - Median-Ulnar nerve communications and carpal tunnel syndrome. J. Neurol. Neurosurg. Psychiat. 40:982, 1977.
5. HIRASAWA, K. - Untersuchungen uber das periphere Nervensystem Plexus brachialis und die Nerven der obern Extremitat. Arb. Anat. Inst. Kaiserlichen Univ. Kyoto. 2:135, 1931.
6. HOPF, H. & HENSE, W. - Anomalien der motorischen Innervation an der Hand. Electroencephalogr. Electromyogr. 5:220, 1974.
7. IYER, V. & FENICHEL, G. - Normal median nerve proximal latency in carpal tunnel syndrome: a clue to coexisting Martin-Gruber anastomosis. J. Neurol. Neurosurg. Psychiat. 39:449, 1976.
8. KIMURA, J. - Collision technique: physiological block of nerve impulses in studies of motor nerve conduction velocity. Neurology (Minneapolis) 26:680, 1976.
9. KIMURA, J.; MURPHY, M. & VARDA, D. - Electrophysiological study of anomalous innervation of intrinsic hand muscles. Arch. Neurol. (Chicago) 33: 842, 1976.
10. KOMAR, J.; SZEGVARI, M. & GLOVICZKY, Z. - Traumatischer Durchschanitt des N. medianus ohne komplette motorische Parese: Martin-Gruber Anastomose. Nervenarzt 49:697, 1978.
11. LAMBERT, E. - Diagnostic value of electrical stimulation of motor nerves. Electroencephalogr. clin. Neurophysiol. 22 (suppl):9, 1962.
12. MANNERFELT, L. - Studies on the hand in ulnar nerve paralysis: a clinical experimental investigation in normal and anormalous innervation. Acta orthop. scand. 87 (suppl):23, 1966.
13. MARINACCI, A. - The problem of unusual anomalous innervation of hand muscies: the value of electrodiagnosis in its evaluation. Bull. Los Angeles neurol. Soc. 29:133, 1964.
14. MARINACCI, A. & VON HAGEN, K. - Misleading «all median hand>>. Arch. Neurol. (Chicago) 12:80, 1965.
15. MARTIN, F. - Tal om Nervers Allmanna Engenskaper i Manniskans Kropp. L. Salvius, Stockholm, 1763.
16. MURPHEY, F.; KIRKLIN, J. & FINLAYSON, A. - Anomalous inervation o£ the intrinsic muscles of the hand. Surg. Gynecol. Obst. 83:15, 1946.
17. POLLOCK, L. DAVIS, L. - Peripheral Nerve Injuries. Paul B. Hoeber Inc., New York, 1932.
18. ROWNTREE, T. - Anomalous innervation of hand muscles. J. Bone Joint Surg. 31B :505, 1949.
19. SRINIVASAN, R. & RHODES, J. - The median-ulnar anastomosis (Martin-Gruber) in normal and congenitally abnormal fetuses. Arch. Neurol. (Chicago): 38:418, 1981.
20. STREIB, W. - Ulnar-to-median nerve anastomosis in the forearm: electromyographic studies. Neurology (Minneapolis) 29:1534, 1979.
21. WILBOURN, A. & LAMBERT, E. - The forearm median to ulnar nerve communication: electrodiagnostic aspects. (Abstract). Neurology (Minneapolis): 26: 368, 1976.

Fechas de Publicación

Publicación en esta colección
14 Ago 2012
Fecha del número
Mar 1984

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BROOKS, H. - Variations in nerve supply of Flexor Brevis Pollicis. Anat. Physiol. 20:641, 1886.

[2] 2. GASSEL, L. - Sources of error motor nerve conduction studies. Neurolgy (Minneapolis) 14:825, 1964.

[3] 3. GRUBER, W. - Uber die Verbidung des Nervus medianus mit dem Nervus ulnaris am Unterarm des Saugethiere. Arch. anat. physiol. Wissensch. med. 37: 501, 1870.

[4] 4. GUTMAN, L. - Median-Ulnar nerve communications and carpal tunnel syndrome. J. Neurol. Neurosurg. Psychiat. 40:982, 1977.

[5] 5. HIRASAWA, K. - Untersuchungen uber das periphere Nervensystem Plexus brachialis und die Nerven der obern Extremitat. Arb. Anat. Inst. Kaiserlichen Univ. Kyoto. 2:135, 1931.

[6] 6. HOPF, H. & HENSE, W. - Anomalien der motorischen Innervation an der Hand. Electroencephalogr. Electromyogr. 5:220, 1974.

[7] 7. IYER, V. & FENICHEL, G. - Normal median nerve proximal latency in carpal tunnel syndrome: a clue to coexisting Martin-Gruber anastomosis. J. Neurol. Neurosurg. Psychiat. 39:449, 1976.

[8] 8. KIMURA, J. - Collision technique: physiological block of nerve impulses in studies of motor nerve conduction velocity. Neurology (Minneapolis) 26:680, 1976.

[9] 9. KIMURA, J.; MURPHY, M. & VARDA, D. - Electrophysiological study of anomalous innervation of intrinsic hand muscles. Arch. Neurol. (Chicago) 33: 842, 1976.

[10] 10. KOMAR, J.; SZEGVARI, M. & GLOVICZKY, Z. - Traumatischer Durchschanitt des N. medianus ohne komplette motorische Parese: Martin-Gruber Anastomose. Nervenarzt 49:697, 1978.

[11] 11. LAMBERT, E. - Diagnostic value of electrical stimulation of motor nerves. Electroencephalogr. clin. Neurophysiol. 22 (suppl):9, 1962.

[12] 12. MANNERFELT, L. - Studies on the hand in ulnar nerve paralysis: a clinical experimental investigation in normal and anormalous innervation. Acta orthop. scand. 87 (suppl):23, 1966.

[13] 13. MARINACCI, A. - The problem of unusual anomalous innervation of hand muscies: the value of electrodiagnosis in its evaluation. Bull. Los Angeles neurol. Soc. 29:133, 1964.

[14] 14. MARINACCI, A. & VON HAGEN, K. - Misleading «all median hand>>. Arch. Neurol. (Chicago) 12:80, 1965.

[15] 15. MARTIN, F. - Tal om Nervers Allmanna Engenskaper i Manniskans Kropp. L. Salvius, Stockholm, 1763.

[16] 16. MURPHEY, F.; KIRKLIN, J. & FINLAYSON, A. - Anomalous inervation o£ the intrinsic muscles of the hand. Surg. Gynecol. Obst. 83:15, 1946.

[17] 17. POLLOCK, L. DAVIS, L. - Peripheral Nerve Injuries. Paul B. Hoeber Inc., New York, 1932.

[18] 18. ROWNTREE, T. - Anomalous innervation of hand muscles. J. Bone Joint Surg. 31B :505, 1949.

[19] 19. SRINIVASAN, R. & RHODES, J. - The median-ulnar anastomosis (Martin-Gruber) in normal and congenitally abnormal fetuses. Arch. Neurol. (Chicago): 38:418, 1981.

[20] 20. STREIB, W. - Ulnar-to-median nerve anastomosis in the forearm: electromyographic studies. Neurology (Minneapolis) 29:1534, 1979.

[21] 21. WILBOURN, A. & LAMBERT, E. - The forearm median to ulnar nerve communication: electrodiagnostic aspects. (Abstract). Neurology (Minneapolis): 26: 368, 1976.

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Brasil

Estudio electrofisiologico de las variactones en la inervacion de los musculos de la mano

Electrophysiological study of the variations in the innervation of the muscles of the hand

Resúmenes

Fechas de Publicación