An unusual case of accessory head of coracobrachialis muscle involving lateral cord of brachial plexus and its clinical significance.

Knowledge of anatomical variations in the peripheral nervous system is key in the interpretation of unusual clinical signs or during physical or diagnostic imaging. This case study is a description of an anatomical variation between the coracobrachialis muscle and brachial plexus. In a routine dissection in the human anatomy laboratory, we were faced with an anatomical variation in the coracobrachialis muscle, observed in the upper right limb of a male cadaver. The coracobrachialis muscle had a common origin at the apex of the coracoid process and then divided into two heads. The lateral head followed its normal course until insertion into the middle third of the humerus, while the medial head involved the lateral cord of the brachial plexus before insertion into the intermuscular septum in the proximal third of the humerus. Atypical anatomical variations have clinical and surgical implications in procedures such as brachial plexus block and lateral cord compression. In these cases the result could be paralysis of the flexor musculature of the forearm and hypoesthesia of the forearm.

Estudio morfológico y biométrico de los vínculos de los tendones de los músculos flexores superficial y profundo de los dedos de la mano humana / Anatomic and biometric study of the vincula of the tendons of flexor digitorum superficialis and profundus muscles of the human hand

Los vínculos son estructuras especializadas inherentes a los tendones flexores de los dedos, y tienen gran importancia en la nutrición de los mismos, además de facilitar la flexión de los dedos después de una transección distal del tendón (es), permitiendo que éste (os) actuen indirectamente a través de las articulaciones interfalángicas. El presente estudio tuvo como objetivo revisar aspectos morfofuncionales de los vínculos largos y cortos de los músculos flexores de los dedos de la mano. El trabajo fue realizado en 60 manos de cadáveres formolizados de individuos adultos, brasileños, con una edad promedio de 53,1±17,8 años. Los vínculos cortos fueron encontrados en 100 % de los casos, tanto en los músculos flexores superficiales de los dedos como en los profundos, siempre en número de uno en cada tendón y su localización siempre estuvo en la extremidad del tendón, antes de la inserción de éste en la articulación interfalángica proximal. Los vínculos largos presentaron gran variación morfológica, con una presencia promedio de 61,3 % en los tendones del músculo flexor superficial y de 77,9 % en el músculo flexor profundo. El número de vínculos por tendón varió aún más, no siendo posible identificar un patrón independientemente del músculo. En relación a la localización de los vínculos largos, en los tendones del músculo flexor superficial de los dedos, están insertos en la vaina fibrosa de la falange proximal, con un trayecto oblicuo y próximo a la articulación interfalángica proximal; los vínculos de los tendones del músculo flexor profundo estaban localizados en su mayoría (86,7 %) entre los tendones a nivel de la articulación interfalángica proximal, presentando un trayecto rectilíneo entre esos dos tendones, mientras que en 13,3 % estuvieron localizados muy próximos a la abertura del tendón del músculo flexor superficial para el paso del tendón del músculo flexor profundo. Los vínculos son estructuras escenciales en la mantención de la nutrición y de los movimientos de los dedos aún en presencia de lesiones, por lo tanto, es importante tener una comprensión clara de ellos para una correcta evaluación clínica pensando en la reparación, reconstrucción y rehabilitación de las disfunciones de la mano.

The vincula are specialized structures inherent in the flexor tendons of the fingers, and are of great importance in their nutrition. In addition they facilitate flexion of the fingers following a distal transection of this tendon, allowing it to operate indirectly across the interphalangeal joints. The aim of the present study was to describe anatomic and biometric aspects of the long and short vincula of the flexor muscles of the fingers. The work was carried out in hands of 60 adult Brazilian corpses, of both sexes, with an average age between 17.8±53.1 years. The short vincula were found in 100 % of cases of flexor digitorum superficialis tendons and flexor digitorum profundus muscles, and only one in each tendon, with its location always at the extremity of the tendon, prior to insertion in the proximal interphalangeal joint. The long vincula presented great morphological variation, with an average presence of 61.3 % in tendons of the flexor digitorum superficialis and 77.9 % in the flexor digitorum profundus muscle. Furthermore, the number of vincula per tendon changed, and it was not possible to identify a pattern independently of the muscle. With respect to the location of the long vincula, in the flexor superficial tendons they are inserted in the fibrous sheath of the proximal phalanx, with an oblique course and next to the proximal interphalangeal joint. The vincula of the tendons of the flexor digitorum profundus were located (86.7 %) between both tendons to level of the proximal interphalangeal joint, presenting a rectilinear course between these two tendons, whereas in 13.3 % they were located very close to the opening of the flexor superficialis muscle tendon for passage of the flexor digitorum profundus muscle tendon. The vincula are essential structures in nutrition and finger motion even when injuries are present. It is therefore, important to have a clear understanding of these structures forproper clinical evaluation in the repair, reconstruction and rehabilitation of hand dysfunctions.

[Gait analysis and quality of life evaluation after gait training in patients with spinal cord injury]. / Analisis de la marcha y evaluación de la calidad de vida después del entrenamiento de la marcha en pacientes con lesion medular.

INTRODUCTION: Over recent years it has become possible to retrain motor activity among patients with partial spinal cord injury, especially for walking. AIM. To assess the impact of gait training on a treadmill with body weight support, regarding temporospatial parameters and quality of life. PATIENTS AND METHODS: Twelve patients of both sexes were evaluated. They had been diagnosed with partial spinal cord injury of traumatic origin at least 12 months earlier. They were able to walk and their motor function below the level of the injury was partially preserved and classified as level C or D. After the initial evaluation, the participants were trained on a treadmill with body weight support, with two sessions per week lasting 30 minutes each, over a four-month period, thus totaling 30 sessions. The patients' temporospatial gait parameters and quality of life were analyzed before and after the training. RESULTS: There were improvements in all the temporospatial parameters evaluated (p < 0.0001), but no changes in quality of life were seen (p > 0.05). CONCLUSION: Treadmill training with body weight support among patients with spinal cord injury was effective in improving the temporospatial gait parameters, but without changing their quality of life.