The Journal of hand surgery
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Interfascicular neurolysis was performed in nine patients with spontaneous anterior interosseous nerve palsy. In eight of these patients, an hourglass-like constriction in the fascicles forming the anterior interosseous nerve was found within the main trunk of the median nerve at 2-7.5 cm above the medial epicondyle. The clinical signs and symptoms of these eight patients were similar to those that have been described to isolated neuritis. While the etiology remains unknown, when spontaneous anterior interosseous nerve palsy is suspected to be caused by isolated neuritis, interfascicular neurolysis should be performed to confirm the lesion and to discover whether fascicular constriction is present.
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The anatomy of the palmar aponeurosis pulley has been well described, but its biomechanical function is not as well characterized. This study describes the functional importance of the palmar aponeurosis pulley by using efficiency parameters. We obtained data by generating load, excursion, and work efficiencies in the intact pulley system and compared these to the efficiencies obtained after sectioning the palmar aponeurosis pulley alone and in combination with the proximal annular pulleys. ⋯ Change in work is due not only to an increase in excursion, but also to the increased resistance that results from the acute angulation that the tendon must endure as it follows behind the remaining pulleys during flexion. Intergroup comparisons show a significant contribution by the palmar aponeurosis pulley. This study demonstrates a significant biomechanical role for the palmar aponeurosis pulleys and suggests that it be considered similar to the annular and cruciate flexor tendon pulleys in importance.