Rodrigo Guerra Sabongi

Universidade Federal de São Paulo

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Luiz Angêlo Vieira

Pontifícia Universidade Católica de São Paulo

Edie Benedito Caetano

Pontifícia Universidade Católica de São Paulo

Maurício Ferreira Caetano

Universidade de Sorocaba

João José Sabongi Neto

Universidade de Sorocaba

Carlos Henrique Fernandes

Universidade Federal de São Paulo

João Baptista Gomes dos Santos

Universidade Federal de São Paulo

Flávio Faloppa

Universidade Federal de São Paulo

Yuri da Cunha Nakamichi

Pontifícia Universidade Católica de São Paulo

Eduardo Baldy de Sousa Boni

Pontifícia Universidade Católica de São Paulo

Kelson Koiti Ogata

Pontifícia Universidade Católica de São Paulo

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Universidade Federal de São Paulo

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Pontifícia Universidade Católica de São Paulo

Universidade de São Paulo

Fundação de Apoio à Universidade Federal de São Paulo

Southern Illinois University School of Medicine

Heidelberg University

Associação Paulista de Medicina

Union des Industries Ferroviaires Européennes

Washington University in St. Louis

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Palmar Cutaneous Branch of Median Nerve: An Anatomical Study

International Journal of Morphology (2018)

Edie Benedito Caetano Luiz Angêlo Vieira Rodrigo Guerra Sabongi Caio Augusto Schlindwen Botelho Francisco Junqueira

The purpose of this study was to determine the origin, frequency and anatomical variations of the palmar cutaneous branch of the median nerve (PCBMN) and its clinical implications in surgical procedures such as decompression of the carpal tunnel and volar approach to the wrist. Dissection of 30 forearms from 18 adult male specimens (9 bilateral, 7 right limbs and 5 left limbs) were performed using 2.5X magnification loupe in order to better understand the PCBMN. Origin, number, length, positioning, anatomical relations and variations were recorded and analyzed. The PCBMN was identified in all dissected forearms, being the most distal branch of the median nerve in all forearms. The average origin was 4.8 cm (ranging 3.8 to 6.5 cm) proximal to the wrist flexion crease. Anatomical variations of the PCBMN are not rare and could endanger the nerve during surgical approach for the volar wrist and proximal palm. We did not find the PCBMN positioned ulnar to the fourth metacarpal axis as well as radial to the flexor carpi radialis tendon.

10.4067/s0717-95022018000200531

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Nervo interósseo anterior: estudo anatômico e implicações clínicas

Revista Brasileira de Ortopedia (2017)

Edie Benedito Caetano Luiz Angêlo Vieira João José Sabongi Neto Maurício Ferreira Caetano Rodrigo Guerra Sabongi

Analisar as relações anatômicas e as variações do nervo interósseo anterior e suas implicações clínicas. A paralisia completa do nervo interósseo anterior resulta na incapacidade de fletir as falanges distal do polegar e indicador; na incompleta, ocorre menor dano axonal e apenas o polegar ou o indicador são afetados. Este estudo baseou‐se na dissecção de 50 membros de 25 cadáveres, 22 eram do sexo masculino e três do feminino. A idade variou entre 28 e 77 anos, 14 da etnia branca e 11 não branca; 18 foram preparados por injeção intra‐arterial de uma solução de glicerina e formol a 10% e sete foram dissecados a fresco. O nervo interósseo anterior originou‐se do nervo mediano em média de 5,2 cm distal à linha intercondilar. Em 29 membros, originou‐se dos fascículos nervosos da região posterior do nervo mediano e em 21 membros, dos fascículos posterolaterais. Em 41 membros, o nervo interósseo anterior posicionava‐se entre as cabeças umeral e ulnar do músculo pronador redondo. Em dois membros, observou‐se a duplicação do nervo interósseo anterior. Em todos os membros, registramos que o nervo interósseo anterior se desprendia do nervo mediano proximalmente à arcada do músculo flexor superficial dos dedos. Em 24 antebraços a ramificação do nervo interósseo anterior ocorreu proximalmente à arcada do músculo flexor superficial dos dedos em 26, distalmente. As bandas fibrosas formadas pelas cabeças umeral e ulnar do músculo pronador redondo, a arcada fibrosa do músculo flexor superficial dos dedos e o músculo de Gantzer, quando hipertrofiado e posicionado anteriormente ao nervo interósseo anterior, podem comprimir o nervo contra estruturas profundas, alterar seu curso normal, por estreitar o espaço de sua passagem, causar alterações no músculo flexor longo do polegar e no flexor profundo dos dedos da mão. The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected. This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female. Age ranged from 28 to 77 years, 14 were white and 11 were non‐white; 18 were prepared by intra‐arterial injection of a solution of 10% glycerol and formaldehyde, and seven were freshly dissected cadavers. The anterior interosseous nerve arose from the median nerve, an average of 5.2 cm distal to the intercondylar line. In 29 limbs, it originated from the nerve fascicles of the posterior region of the median nerve and in 21 limbs, of the posterolateral fascicles. In 41 limbs, the anterior interosseous nerve positioned between the humeral and ulnar head of the pronator teres muscle. In two limbs, anterior interosseous nerve duplication was observed. In all members, it was observed that the anterior interosseous nerve arose from the median nerve proximal to the arch of the flexor digitorum superficialis muscle. In 24 limbs, the branches of the anterior interosseous nerve occurred proximal to the arch and in 26, distal to it. The fibrous arches formed by the humeral and ulnar heads of the pronator teres muscle, the fibrous arch of the flexor digitorum superficialis muscle, and the Gantzer muscle (when hypertrophied and positioned anterior to the anterior interosseous nerve), can compress the nerve against deep structures, altering its normal course, by narrowing its space, causing alterations longus and flexor digitorum profundus muscles.

10.1016/j.rbo.2017.06.017

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Citations (17)

Dentist's fees and dental health.

PubMed (1969)

Rodrigo Guerra Sabongi

Dental health

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Prevention is better than cure.

PubMed (1968)

Rodrigo Guerra Sabongi

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Anterior interosseous nerve: anatomical study and clinical implications

Revista Brasileira de Ortopedia (English Edition) (2018)

Edie Benedito Caetano Luiz Angêlo Vieira João José Sabongi Neto Maurício Ferreira Caetano Rodrigo Guerra Sabongi

The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected.This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female. Age ranged from 28 to 77 years, 14 were white and 11 were non-white; 18 were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde, and seven were freshly dissected cadavers.The anterior interosseous nerve arose from the median nerve, an average of 5.2 cm distal to the intercondylar line. In 29 limbs, it originated from the nerve fascicles of the posterior region of the median nerve and in 21 limbs, of the posterolateral fascicles. In 41 limbs, the anterior interosseous nerve positioned between the humeral and ulnar head of the pronator teres muscle. In two limbs, anterior interosseous nerve duplication was observed. In all members, it was observed that the anterior interosseous nerve arose from the median nerve proximal to the arch of the flexor digitorum superficialis muscle. In 24 limbs, the branches of the anterior interosseous nerve occurred proximal to the arch and in 26, distal to it.The fibrous arches formed by the humeral and ulnar heads of the pronator teres muscle, the fibrous arch of the flexor digitorum superficialis muscle, and the Gantzer muscle (when hypertrophied and positioned anterior to the anterior interosseous nerve), can compress the nerve against deep structures, altering its normal course, by narrowing its space, causing alterations longus and flexor digitorum profundus muscles.Analisar as relações anatômicas e as variações do nervo interósseo anterior e suas implicações clínicas. A paralisia completa do nervo interósseo anterior resulta na incapacidade de fletir as falanges distal do polegar e indicador; na incompleta, ocorre menor dano axonal e apenas o polegar ou o indicador são afetados.Este estudo baseou-se na dissecção de 50 membros de 25 cadáveres, 22 eram do sexo masculino e três do feminino. A idade variou entre 28 e 77 anos, 14 da etnia branca e 11 não branca; 18 foram preparados por injeção intra-arterial de uma solução de glicerina e formol a 10% e sete foram dissecados a fresco.O nervo interósseo anterior originou-se do nervo mediano em média de 5,2 cm distal à linha intercondilar. Em 29 membros, originou-se dos fascículos nervosos da região posterior do nervo mediano e em 21 membros, dos fascículos posterolaterais. Em 41 membros, o nervo interósseo anterior posicionava-se entre as cabeças umeral e ulnar do músculo pronador redondo. Em dois membros, observou-se a duplicação do nervo interósseo anterior. Em todos os membros, registramos que o nervo interósseo anterior se desprendia do nervo mediano proximalmente à arcada do músculo flexor superficial dos dedos. Em 24 antebraços a ramificação do nervo interósseo anterior ocorreu proximalmente à arcada do músculo flexor superficial dos dedos em 26, distalmente.As bandas fibrosas formadas pelas cabeças umeral e ulnar do músculo pronador redondo, a arcada fibrosa do músculo flexor superficial dos dedos e o músculo de Gantzer, quando hipertrofiado e posicionado anteriormente ao nervo interósseo anterior, podem comprimir o nervo contra estruturas profundas, alterar seu curso normal, por estreitar o espaço de sua passagem, causar alterações no músculo flexor longo do polegar e no flexor profundo dos dedos da mão.

Posterior interosseous nerve

Radial nerve

10.1016/j.rboe.2018.07.010

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Citations (26)

Anatomical study of the transfer of flexor digitorum superficialis nerve branch of median nerve to restore wrist extension and forearm pronation

Einstein (São Paulo) (2019)

Edie Benedito Caetano Luiz Angêlo Vieira Cristina Schmitt Cavalheiro Marcel Henrique Arcuri Rodrigo Guerra Sabongi

To analyze the anatomical variations of the innervation of the flexor digitorum superficialis muscle and to determine if the branch of the median nerve that supply this muscle is connected to the branches to the extensor carpi radialis brevis and the pronator teres muscles, without tension, and how close to the target-muscles the transfer can be performed.Fifty limbs of 25 cadavers were dissected to collect data on the anatomical variations of the branches to the flexor digitorum superficialis muscle.This muscle received innervation from the median nerve in the 50 limbs. In 22 it received one branch, and in 28 more than one. The proximal branch was identified in 22 limbs, and in 12 limbs it shared branches with other muscles. The distal branch was present in all, and originated from the median nerve as an isolated branch, or a common trunk with the anterior interosseous nerve in 3 limbs, and from a common trunk with the flexor carpi radialis muscle and anterior interosseous nerve in another. It originated distally to the anterior interosseous nerve at 38, in 5 on the same level, and in 3 proximal to the anterior interosseous nerve. In four limbs, innervation came from the anterior interosseous nerve, as well as from the median nerve. Accessory branches of the median nerve for the distal portion of the flexor digitorum superficialis muscle were present in eight limbs.In 28 limbs with two or more branches, one of them could be connected to the branches to the extensor carpi radialis brevis and pronator teres muscles without tension, even during the pronation and supination movements of the forearm and flexion-extension of the elbow.

Radial nerve

Flexor muscles

10.31744/einstein_journal/2019ao4489

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Anastomose de Riché-Cannieu: estrutura, função e significância clínica

Revista Brasileira de Ortopedia (2018)

Edie Benedito Caetano Luiz Angêlo Vieira João José Sabongi Neto Maurício Ferreira Caetano Rodrigo Guerra Sabongi

Objective To define the anatomy pattern and the incidence of Riché-Cannieu anastomosis, that is, median and ulnar communication in the palmar aspect of the hand. Materials Methods A total of 80 anatomical dissections were performed on 60 hands of 30 cadavers from 1979 to 1982, and on 20 hands from 2012 to 2015. All of these procedures were performed at the Department of Anatomy of our institution. The incidence of Riché-Cannieu anastomosis and the innervation of the thenar muscles were studied. Results Riché-Cannieu anastomosis was identified in every dissected hand (100%). The extramuscular Riché-Cannieu anastomosis was recorded in 57 hands, and the intramuscular, in 19 hands. The association of extra- and intramuscular Riché-Cannieu anastomoses occurred in four hands. The ulnar component always originated from the deep branch. The anastomotic branch arising from the median nerve originated from the motor thenar branch (recurrent branch) of the median nerve in most of the observations. The median-ulnar double innervation only to the deep head of the flexor pollicis brevis was identified in 29 of 80 hands. The double innervation only of the superficial head of the flexor pollicis brevis was found in 13 hands. In 12 hands, the deep head of the flexor pollicis brevis was absent. The double innervation of the superficial and deep heads of the flexor pollicis brevis occurred in 14 hands. The oblique head of the adductor pollicis received double innervation in 12 hands. The deep head of the flexor pollicis brevis and the oblique head of adductor pollicis were doubly-innervated in nine hands. The transverse head of the adductor pollicis received double innervation in two hands. Double innervation of the deep head of the flexor pollicis brevis and the transverse head of the adductor pollicis were found in one hand. Conclusion According to the present study, Riché-Cannieu anastomosis should be considered a normal anatomical neural connection, not an anatomical variation. Knowledge of this anastomosis is essential because the presence of such neural communication may result in confusing clinical, surgical, and electromyographic findings in cases of median or ulnar damage or entrapment.

Adductor pollicis muscle

10.1016/j.rbo.2017.12.019

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TRANSFER OF NERVE BRANCHES OF THE FLEXOR CARPI RADIALIS TO THE POSTERIOR INTEROSSEOUS NERVE

Figshare (2018)

Edie Benedito Caetano Luiz Angêlo Vieira Rodrigo Guerra Sabongi Luca Martinez Correio Kelson Koiti Ogata

ABSTRACT Objective: The objective of this paper was to study the anatomical variations of the flexor carpi radialis muscle (FCR) and determine in cadaver limbs whether the FCR nervous branch can be connected to the posterior interosseous nerve (PIN) without tension and how close to the target muscles the transfer can be performed. Method: Thirty cadaveric upper limbs were dissected. Results: The FCR received exclusive innervation of the median nerve, distally to the intercondylar line of the humerus. In 5 limbs, an isolated branch was found and in 25, a common trunk with other nervous branches occurred. We investigated whether the branch for the FCR was long enough to be transferred to the PIN. The diameter of the nerve branch for the FCR corresponded on average to 50% of the PIN. Conclusion: In 12 limbs, the branch destined to the FCR could be connected to the PIN, distally to the nerve branches to the supinator muscle even during the movements of the forearm and the elbow. In 18 specimens, it was necessary to mobilize the PIN for this innervation. Level of Evidence IV, Case Series.

Posterior interosseous nerve

Radial nerve

10.6084/m9.figshare.7245047

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Circular saw misuse is related to upper limb injuries: a cross-sectional study

Clinics (2019)

Rodrigo Guerra Sabongi Jaime Piccaro Erazo Vinícius Ynoe de Moraes Carlos Henrique Fernandes João Baptista Gomes dos Santos

Circular saw misuse is related to upper limb injuries: a cross-sectional study Rodrigo Guerra Sabongi 0 0 0 0 -0 0 0 0 -0 0 0 0 -0 0 0 0 ,* Jaime Piccaro Erazo 0 0 0 0 -0 0 0 0 -0 0 0 0 -0 0 0 0 , Vinicius Ynoe de Moraes 0 0 0 0 -0 0 0 0 -0 0 0 0 -0 0 0 0 , Carlos Henrique Fernandes0 0 0 0 -0 0 0 0 -0 0 0 0 -0 0 0 0 , Joa ˜o Baptista Gomes dos Santos0 0 0 0 -0 0 0 0 -0 0 0 0 -0 0 0 0 , Fla ´vio Faloppa0 0 0 0 -

Cross-sectional study

10.6061/clinics/2019/e1076

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Flexor Pollicis Brevis Muscle. Anatomical Study and Clinical Implications

The Open Orthopaedics Journal (2017)

Edie Benedito Caetano Yuri da Cunha Nakamichi Renato Alves de Andrade Maico Minoru Sawada Maurício Tadeu Nakasone

This paper reports anatomical study of nature, incidence, innervation and clinical implications of Flexor Pollicis Brevis muscle (FPB).The anatomical dissection of 60 limbs from 30 cadavers were performed in the Department of Anatomy of Medical School of Catholic University of São Paulo.The superficial head of FPB has been innervated by the median nerve in 70% and in 30% it had double innervation. The deep head of FPB were absent in 14%, in 65%, occurred a double innervation. In 17.5% by deep branch of ulnar nerve and in 3.6% by recurrent branch of median nerve.The pattern of innervation more frequent in relationship to the flexor pollicis brevis muscle and should be considered as a normal pattern is that superficial head receives innervation of branches of median nerve and the deep head receives innervation of ulnar and median nerve.

10.2174/1874325001711011321

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Citations (4)