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Medical Research Archives. Volume 5, Issue 3. March 2017. History of the Muscle of Cruveilhier Copyright 2017 KEI Journals

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Medical Research Archives. Volume 5, Issue 3. March 2017. History of the Muscle of Cruveilhier Copyright 2017 KEI Journals Medical Research Archives. Volume 5, Issue 3. March 2017. History of the muscle of Cruveilhier A Historical Review on the Muscle of Cruveilhier Authors Abstract M. Ashraf Aziza Despite the fact that the human thumb has been investigated intensely with reference to its functional morphology, Samuel S. Dunlapb controversies remain; for example, regarding the muscle of Janine M. Ziermanna* Cruveilhier (deep head of the flexor pollicis brevis). Originally described in 1749, the human flexor pollicis brevis (FPB) only Affiliations received special attention since Cruveilhier described it in 1834 a Howard University as having a superficial and a deep head. Since then the existence College of Medicine, Dept. of Cruveilhier’s deep head has been debated. By 1920 five views Anatomy, 520 W St NW, existed: 1. The deep head is not part of FPB because of its nerve Washington, DC, 20059, supply; 2. It became extinct and was replaced by a slip from the USA; oblique adductor pollicis; 3. It is a part of the “composite” FPB b and is synonymous with Henle’s "interosseous volaris primus”; 2062 Cobblestone Lane, 4. The deep head received ontogenetically myofibrils from the Reston, VA, 20191, USA; primordial flexores breves medius and from the adductor Corresponding author: (contrahentes) muscle plates; and 5. The deep head, “Henle’s muscle”, and oblique adductor pollicis are distinct muscles. In the 1960s Day and Napier revealed variations of the insertion Janine M. Ziermann and innervation of the deep head, but did not delineate their deep Department of Anatomy, head from the "Henle’s muscle" or the adductor pollicis. They Howard University hypothesized, that the shift of the deep head’s insertion from College of Medicine, ulnar to radial facilitated “true opposability” in anthropoids. We Washington, DC, 20059, revealed that there are still new aspects to the story of this USA muscle, including new interpretations / conclusions regarding its development and evolution. The history of the investigations Phone: +1 202 660 8447 around this muscle is a fascinating story showing the next generation of anatomists the importance of detailed observation Fax: +1 202 265 7055 combined with the knowledge of several fields (anthropology, developmental biology, functional morphology, etc.). We discuss Email: the muscles’ functional significance for the evolution of the [email protected] precision grip and why – with respect to surgery (replantation) - it is important to know the anatomical details of this muscle. Keywords: flexor pollicis brevis; nerve-muscle specificity; precision grip; 1 Copyright 2017 KEI Journals. All Rights Reserved. Medical Research Archives. Volume 5, Issue 3. March 2017. History of the muscle of Cruveilhier 1 Introduction arthrological and myological characteristics – including their neurological controls – were in Complexity and variability of the components place, early hominids transitioned from tool and actions of the versatile thumb have played use to tool manufacture phase – or a a crucial role during human evolution; this is combination of these skills (13; 18-20; 28). indicated by the fact that modern humans Habitual tool-use then triggered a responsive have more muscles attached to the thumb than change in pollical form and function leading in most primates (e.g., 1; 2; 3). Thumb to further enhancement and diversification of opposition is the fundamental prerequisite to all categories of gripping movements, the origin and refinement of the two central particularly the precision grip and/or handling grasping movements – i.e. the power and (9; 10; 13; 22; 30). Yet, the hominid thumb is precision grips – of the hominoid hand (4-13). far from being an extra-refined appendage The emancipation of the hominid hand from (see 30; 31). It is a mosaic of primitive and locomotion following the adoption of habitual derived features, reflecting stages in the hand bipedalism occurred before 4.4 million years evolution from support and locomotion on the ago (Mya) in Ardipithecus ramidus ground to a grasping structure in the trees, (australopithecines). According to Lovejoy et and, eventually, the organ of manipulation al. (14) this hominid fossil demonstrates (20; 29). Several specific locomotory facultative bipedal locomotion and the hands specializations of the thumb were lost (10; compare favorably with those of Homo. The 32) and their disappearance (or re-purposing) earliest known manufactured stone tools first led to incremental “prehensile-tactile appeared about 3.3 Mya (15; 16). Tool use activities”, i.e., exploratory behavior, and manufacturing facilitated the change from facilitated by manipulation activities. With predominantly power to precision grasping the gradual loss of locomotor anatomical movements, including their divergent forms constraints, the articulate human hand, with (13; 17-21). In fact, the anatomy of whole its versatile thumb, acquired a functional hand underwent modifications of varying universe under the direct control of higher degrees to permit incrementally precise cortical centers. The evolution of an area of manipulation of objects; these constituted the cortical processing might be the first step in essential attributes required for tool use and, design or abstraction as it implies that patterns in due course, tool manufacture (22-24). that are not present in the environment can be Furthermore, the individuation of finger internally processed as well (10). control, and enhanced, variegated articulatory thumb movements, permitted early humans to All hominid hand attributes required for tool engage not only in pulp-to-pulp opposition, manufacture and manipulation involve but also in fine manipulation called “precision complex sensory perceptions and versatile handling” (25). The latter involves pulp-to-tip individual actions of the digits (and their and tip-to-tip pinch control of fine objects. segments). Key to the execution of this are tactile/kinesthetic thumb movements, The hominid thumb underwent dramatic especially opposition. The latter is a series of alterations and its evolution has been the connected actions and has been defined by subject of several targeted investigations and Tubiana (2, pp69-70) as a “… combined reviews (e.g., 1; 20; 21; 26; 27-29). Once the movement involving all three segments of the fundamental epidermal, osteological, 2 Copyright 2017 KEI Journals. All Rights Reserved. Medical Research Archives. Volume 5, Issue 3. March 2017. History of the muscle of Cruveilhier thumb: the metacarpal segment moves in and Napier (48, 49) attempted to clarify the anteposition, then in adduction, a movement status of the deep head, but controversy has that is accompanied by … longitudinal persisted (56) and even Day and Napier rotation into pronation. The proximal phalanx proposed equivocal, even contradictory views flexes, pronates, and radially deviates; the regarding its true nature. Disagreements distal phalanx flexes to a variable degree and involve issues relating to its form, function, this flexion is accompanied by a slight innervation, development and phylogeny of pronation adapted to the requirements of the the deep head of Cruveilhier. grip. There is, in fact, not one single We decided to further explore and elaborate opposition but a whole range of oppositions on the deep head of Cruveilhier having in a fixed conical section … which allows a initially observed a larger percentage of huge variety of grips.” (see also 33; 34). ulnarward inserting cases than had been These movements are essentially pivoted on reported by Day and Napier (48). The origin the trapezio-metacarpal joint, but also include of the deep head of Cruveilhier is usually movements of the metacarpo-phalangeal and described as from the capitate (48; 53; 57-69) the interphalangeal thumb joints which are and additionally from the ligamentum carpi activated by a large number of extrinsic and radiatum (70: Fig. 94, p103). While re- intrinsic pollical muscles (35-41). The investigating the attachments and innervation dynamic foci of the other digits are also their of the deep head of FPB we discovered the joints: carpo-metacarpal, metacarpo- long fascinating history of this muscle. phalangeal and interphalangeal joints (10; 42; However, many newer anatomical textbooks 43). Joint actions of all digits are actuated by and atlases only describe the superficial head voluntary contractions of all or selected of the FPB, while the deep head is barely extrinsic and intrinsic muscles. acknowledged as a distinct thenar However, the thumb has the largest number of compartment muscle and in diagnoses of exclusive extrinsic and intrinsic muscles, nerve injuries (71), leading to confusion including several unique named ones which during education. facilitate the complex actions of its joints (1; The deep head of Cruveilhier is a functionally 2; 23; 41; 44-46). One muscle has played an and clinically significant muscle and medical important role in the origin of sophisticated students in particular should be aware of it precision grip and its diversification: the deep and its contribution to the subtle movements head of the flexor pollicis brevis (FPB) (20; of the thumb. Accurate anatomical 47-50), hereafter named the “deep head of information is required for surgeries as the re- Cruveilhier” (see 46; 51; 52; 53). Few human attachments of severed digits or even wrist muscles have experienced as checkered a and hand are now possible using enhanced, history as this one. First described 267 years fine surgical techniques – including
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