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During routine dissection classes to under graduate medical students, we observed an anomalous flexor carpi ulnaris muscle associated with abnormal ulnar nerve and ulnar artery in the distal part of forearm. There was an additional belly arising from the lower part of the flexor carpi ulnaris muscle and crossed ulnar nerve and vessels, median nerve and ended in a broad aponeurosis which crossed the tendons of flexor digitorum superficialis and merged with the deep fascia and flexor retinaculum. The ulnar nerve and ulnar artery divided into their terminal branches in the lower part of the forearm. However, the distribution of the terminal branches of both ulnar nerve and artery were normal. An understanding of these unusual findings may be clinically relevant in describing the anterior compartment of the forearm.

Durante una disección de rutina en clases para estudiantes de Medicina, se observó una anomalía del músculo flexor ulnar del carpo asociado con una variación del nervio y arteria ulnar, en la parte distal del antebrazo. Un vientre adicional derivado de la parte inferior del músculo flexor ulnar del carpo cruzaba el nervio ulnar y vasos ulnares, nervio mediano y terminaba en una amplia aponeurosis la cual cruzaba los tendones del músculo flexor superficial de los dedos y se fusionaba con la fascia profunda y el retináculo flexor. El nervio ulnar y la arteria ulnar se dividían en sus ramas terminales, en la parte inferior del antebrazo. Sin embargo, la distribución de las ramas terminales tanto del nervio ulnar como de la arteria ulnar eran normales. La comprensión de estos inusuales hallazgos pueden ser clínicamente relevantes para describir el compartimiento anterior del antebrazo.

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O autor apresenta 20 casos de paralisia alta do plexo braquial, acometendo as raízes C5, C6 ± C7, tratadas pela neurotização dos fascículos do nervo musculocutâneo que inervam o músculo bíceps braquial por fascículos do nervo ulnar para recuperação da flexão do cotovelo (Técnica de Oberlin).A neurorrafia pode ser executada sem enxertos nervosos de interposição. Em todos os paciente aferiu-se resultado positivo, com início da recuperação funcional aos 5,5 ± 1,7 meses pós- operatórios e flexão do cotovelo contra resistência aos 14,7 ± 5,5 meses depois da cirurgia.A seqüela provocada pela secção dos fascículos doadores do nervo ulnar foram clinicamente desprezíveis quando comparadas ao beneficio proporcionado. O sucesso alcançado pelo procedimento cirúrgico se deu, principalmente, pelo curto espaço de tempo entre o acidente e a cirurgia. Os resultados descritos estão de acordo com os da literatura e reafirmam que a neurotização "Ulnar-Biceps" e o procedimento de escolha para o tratamento cirúrgico das paralisias altas do plexo braquial.

The author presents 20 cases of upper brachial plexus palsies, concerning C5, C6 ± C7 roots, treated by neurotization of the musculocutaneus nerve fascicles innervating the biceps brachial muscle with ulnar nerve fascicles to recover elbow flexion (Oberlin's Technique). The neurorraphy could be executed without interposition of nerve grafts. All the patients had positive result, with beginning of the functional recovery at 5.5 ± 1.7 of postoperative month sandel bow flexi on again stresistance at 14.7 ± 5.5 months after the surgery. The sequel provoked by the sectioned donor fascicles of the ulnar nerve is clinically worthless when compared with the benefit produced. The success reached by the surgical procedure can be mainly given by short gap of time between accident and surgery. The described results are in accordance with the literature and reaffirm that the Ulnar-Biceps neurotization is the first choice procedure for the surgical treatment of the upper brachial plexus palsies.

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Communications between nerves are relatively common, and individual variations in their anatomical organization have been described. Knowledge of the prevalence of such variations is necessary when estabilishing the diagnosis of neuropathies and surgical landmarks. In this study, 64 anterior forearm regions of cadavers of blacks and whites of both sexes, were dissected to examine the communications between the median and ulnar nerves (Martin-Gruber anastomosis). This anastomosis was found in five cases (7,8%), one of which was bilateral. There were no significant gender or racial differences in the incidence of this connection. The anastomosis in Brazilians observed here, the impoprtance of an adequate investigation of these connections needs to be underscored. Understanding the existence of this variations, its location and its possible presentation is important for correct patient assistance.

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The ulnar-to-median nerve anastomosis in the forearm is a very rare occurrence, not mentioned in many anatomical text books. We found only 4 cases cited in medical literature. Here we describe 2 new cases, for which diagnosis was suspected when the compound muscle action potential of the abductor pollicis brevis muscle (APB), obtained by maximal stimulation of the median nerve at the elbow, was lower than that obtained at the wrist. The diagnosis was confirmed by stimulation of the ulnar nerve at the elbow, which evoked a compound muscle action potential of the APB with a clear negative initial deflection without volume-conducted potential.

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An analysis of 39 patients (40 hands) who underwent an extensor indicis proprius opponensplasty was carried out. Of these, 29 hands had simultaneous adjuvant surgery to correct other deformities. The mean follow-up period was 33.8 months. Excellent or good results were seen in 87.5%, fair in 10% and poor in 2.4% hands.

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