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Structure of the Flexor Digitorum Superficialis

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Structure of the Flexor Digitorum Superficialis Okajimas Folia Anat. Jpn., 56(5) : 277-288, December 1979 Structure of the Flexor Digitorum Superficialis By OSAMU OHTANI Department of Anatomy, Okayama University Medical School, Okayama 700, Japan (Director : Prof. Dr. H. Outi) —Received for Publication, March 9, 1979— Key Words: Flexor digitorum superficialis, Striated muscle, Forearm musculature. Summary. Fifty-two forearms of 26 Japanese adult cadavers were examined. The flexor digitorum superficialis can be separated into two layers: a superficial layer and a deep layer. The superficial layer is composed of the radial head and the superficial part of the humeroulnar head. It forms two muscle bellies which give rise to the tendons for the third and fourth digits, respectively. The deep layer is composed of the deep part of the humeroulnar head. After forming an inter- mediate tendon, the deep layer also divides into two fleshy bellies which give rise to the tendons for the second and fifth digits, respectively. Based on the mode of occurrence of the communicating muscle fasciculi between the superficial layer and the deep layer, the flexor digitorum superficialis can be classified into four types. Type I muscle has no communicating fasciculus (4/52, 7.7%). Type II muscle has a communicating muscle fasciculus between the intermediate tendon and the muscle belly for the fourth digit (muscle fasciculus A) (29/52, 55.8%). Type III muscle has the muscle fasciculus A as well as another communicating muscle fasciculus between the intermediate tendon and the belly for the third digit (muscle fasciculus B) (18/52, 34.6%). Type IV muscle has the muscle fasciculus B only (1/52, 1.9%). Six other kinds of variations were also recognized. The flexor digitorum superficialis is innervated by four to five branches from the median nerve. These are usually grouped into uppermost, middle and distal branches. In one case, a small part of the humeroulnar head was innervated by a slender branch from the ulnar nerve. Introduction authors such as Le Double (1897), Graeper (1917), Mainland (1927), Iwami (1951), The organization of the flexor digi- Chowdhary (1951), Takeshige et al. (1959), torum superficialis has been studied by Mori (1964), Dahlgard and Kawth (1965), many workers such as Wood (1867), Ko and Takahashi (1965), Jones (1966), Rauber-Kopsch (1955), Inoue (1935) and Dylevsky (1968), Vichare (1970), Rojek Frohse and Fraenkel (1908). Its anomalies Solarska and Solarski (1971), Shrewsbury have also been reported by various and Kuczynski (1974), Hayes (1974), Carr 277 278 0. Ohtani et al. (1977), etc. from the soacalled oblique line) of the Such descriptions, however, were not radius just medial and distal to the inser- sufficiently comprehensive to satisfy our tion of the spinator and the pronator teres. observations in the course of routine The muscle belly of the flexor digi- student dissection. The author therefore torum superficialis can be separated into investigated the flexor digitorum super- two Myers : a superficial layer and a ficialis in Japanese subjects and attempted deep layer. The superficial layer is com- to make a morphological classification. posed of two muscle bellies, which are closely associated with one another but can be easiry separated. The greater Materials and Methods part of the superficial layer of the hu- meroulnar head forms a muscle belly The flexor digitorum superficialis which gives rise to the tendon for the muscles of 26 Japanese adult cadavers, fourth digit. The remainder of the super- or 52 forearms which were left undis- ficial part of the humeroulnar head and the sected in the course of routine student radial head unite to form a muscle belly dissection in 1976, were used. The bel- which gives rise to the tendon for the lies of each muscle were carefully third digit. When these two heads con- separated from one another according to verge to unite in the upper part of the the positions of the tendons, directions forearm, an aponeurotic membrane bridges of the muscle fasciculi, their origins and between the two heads. Behind this fibrous their insertions. The whole muscle with its vessels and nerves was then severed arch pass the median nerve and the ulnar artery. The deep layer arises as the at its origins and its tendons destined deep part of the humeroulnar head. It for the digits in the lower part of the forms a cylinder-like belly near its origin, forearm or at its insertions, respectively. becomes gradually flattened and in the The muscle was finally carefully dis- middle of the forearm forms an interme- sected out and the nerves were followed diate tendon. From this tendon originate up to each muscle bundle. two distal bellies which give rise to the tendons for the second and fifth digits, Results and Discussion respectively. This represents the simplest organiza- Organization : The flexor digitorum tion of the flexor digitorum superficialis. superficialis stretches across the forearm However, two kinds of communicating between the medial epicondyle of the fasciculi (A and B) are often observed humerus and the anterior border of the between the superficial layer and the radius. It is covered by the palmaris deep layer. Fasciculus A arises from longus, the flexor carpi radialis and the the ulnar border of the intermediate flexor carpi ulnaris. The large, thick, tendon, usually at its upper part, and somewhat cylinder-like humeroulnar head runs obliquely to unite with the ulnar arises from the medial epicondyle of the border of the muscle belly for the fourth humerus by means of the common flexor digit. This fasciculus was found in 47 tendon, and from the ulnar colateral out of 52 muscles examined (90.4%). ligament and the medial border of the Fasciculus B, which is generally smaller coronoid process. The thin but broad and lower in origin than the former, radial head arises from about the upper arises from the radial border of the two thirds of the anterior border (mainly intermediate tendon and fuses with the Structure of the Flexor Digitorum Superficialis 279 Fig. 1. Schematic representation of the four types of flexor digitorum superficialis viewed from the posterior side. Type I has no communicating muscle fasciculus between the superficial layer (muscle belly for the 3rd and 4th digit) and the deep layer (muscle belly for the 2nd and 5th digits). Type II has the communicating muscle fasciculus A (A) between the intermediate tendon (IT) of the deep layer and the belly for the 4th digit. Type III has the communicating muscle fasciculus A as well as the communicating muscle fasciculus B (B) between the intermediate tendon of the deep layer and the muscle belly for the 3rd digit. Type IV has the communicating muscle fasciculus B (B) only. 280 0. Ohtani deep aspect of the muscle belly for the Type I: ThisRis the simplest type as third digit. This fasciculus occurred in indicated above, there being no com- 19 out of 52 muscles (36.5%). municating fasciculi between the super- Based on the occurrence of these two ficial layer and the deep layer. communicating fasciculi, the flexor digi- Type II : This type has only fasciculus torum superficialis can be classified into A. four types. Type III : This type has both fasciculus Fig. 2. The most usual pattern of innervation of the flexor digitorum superficialis viewed from the posterior side. 2-A : type I (left side), 2-B: type II (right side), 2-C type III (left side). CHU : caput humeroulnare, CR : caput radiale, IT : intermediate tendon of the deep layer, A: communicating muscle fasciculus A, B: communicating muscle fasciculus B, Npd : upper- most branch from the median nerve to the proximal belly of the deep layer, Npl : branch from Npd to the palmaris longus, Nsf : middle branch from the median nerve distributed in the superficial layer, fasciculus A, belly for the 2nd digit, and fasciculus B, Nr : separate branch to the muscle belly for the 3rd digit, Ndd : distal branch from the median nerve to the distal belly of the deep layer, i. e. the distal belly for the 2nd digit. Structure of the Flexor Digitorum Superficialis 281 A and fasciculus B. At about the junction of the middle Type IV : This type has fasciculus B and lower thirds of the forearm, one or only. two distal branches (Ndd in the text- These four types are illustrated sche- figures) arise from the median nerve and matically in Fig. 1. In the present study, pass into the distal belly of the deep type II was the most common (29/52, layer, mainly in the distal belly for the 55.8%), followed by type III (18/52, 34.6 second digit (Figs. 2-A, B, C). %). The other types, I (4/52, 7.7%) and In one case, a slender branch from the IV (1/52, 1.9%), were rare. The correla- ulnar nerve supplied a small part of the tion between the occurrence of fasciuli deep layer of the humeroulnar head. A and B was insignificant : the X2 value The other part of this muscle, however, for the 2 x 2 table was as small as 0.65 was innervated by the median nerve. without Yates' correction. No significant Fuchino (1960) has reported that at the differences in occurrence were detected middle of the forearm the upper part of between the sexes, or between the right the muscle belly for the index finger of and left muscles. the flexor digitorum superficialis is some- Innervation : The flexor digitorum times innervated by a branch from the superficialis is usually innervated by four ulnar nerve (12%). In our case, however to five branches from the median nerve. only a small part of the humeroulnar The uppermost one (Npd in the text- head was innervated by the ulnar branch figures) arises before the median nerve (Fig.
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