What is another term for bicipital aponeurosis?
Bicipital aponeurosis or lacertus fibrosus is an aponeurosis from the tendon of biceps brachii muscle in the cubital fossa.
What does bicipital aponeurosis mean?
The bicipital aponeurosis is a fascial expansion which aris- es from the distal tendon of biceps brachii muscle. [1] It is an important structure for the protection of the median nerve and brachial artery.
What is the grace of God tendon?
Historically, when (venous) blood-letting was practiced, the bicipital aponeurosis (the ceiling of the cubital fossa) was known as the "grace of God" tendon because it protected the more important contents of the fossa (i.e., the brachial artery and the median nerve).
What forms bicipital aponeurosis?
The bicipital aponeurosis originates from the distal insertion of the biceps brachii, and inserts into the deep fascia of the forearm. The biceps tendon inserts on the radial tuberosity, and the bicipital aponeurosis lies medially to it.
What do you mean by aponeurosis?
aponeurosis, a flat sheet or ribbon of tendonlike material that anchors a muscle or connects it with the part that the muscle moves. The aponeurosis is composed of dense fibrous connective tissue containing fibroblasts (collagen-secreting spindle-shaped cells) and bundles of collagenous fibres in ordered arrays.
What is the difference between tendon and aponeurosis?
An aponeurosis looks quite different than a tendon. An aponeurosis is made of layers of delicate, thin sheaths. Tendons, in contrast, are tough and rope-like. An aponeurosis is made primarily of bundles of collagen fibers distributed in regular parallel patterns, which makes an aponeurosis resilient.
What does by the grace of God mean?
The definition of grace could be “God's life, power and righteousness given to us by unmerited favor.” It is through grace that God works effective change in our hearts and lives. Grace gives us a new life which is not condemned by God.
How do you walk in the grace of God?
These are 9 practical ways to walk by grace.God's grace helps you live freely. ... The grace of God makes you thankful. ... Walking in the confidence of God's love. ... The grace of God gives us strength. ... You live intentionally. ... Obey God and live a Godly life. ... You can walk in forgiveness. ... Know who you are.More items...
What does only by the grace of God mean?
phrase. If you are talking about someone who is in a bad situation and you say 'There but for the grace of God go I', you mean that you are lucky not to be in the same situation as them and you feel sympathy for them. See full dictionary entry for grace.
What lies under the bicipital aponeurosis?
The median nerve, along with the brachial artery, runs beneath the bicipital aponeurosis at the level of the elbow. After giving some branches to the pronator teres, the median nerve then goes deep to this muscle.
What is aponeurosis and its function?
Aponeuroses are connective tissues found on the surface of pennate muscles and are in close association with muscle fascicles. In addition to transmitting muscle forces to the external tendon, aponeurosis has been hypothesized to influence the direction of muscle shape change during a contraction.
What lies superficial to the bicipital aponeurosis?
It represents a medial expansion of biceps brachii tendon. Superficial to the bicipital aponeurosis lies the median cubital vein (2). The aponeurosis separates the vein from the underlying brachial artery (3).
What is aponeurosis and its function?
Aponeuroses are connective tissues found on the surface of pennate muscles and are in close association with muscle fascicles. In addition to transmitting muscle forces to the external tendon, aponeurosis has been hypothesized to influence the direction of muscle shape change during a contraction.
What lies under the bicipital aponeurosis?
The median nerve, along with the brachial artery, runs beneath the bicipital aponeurosis at the level of the elbow. After giving some branches to the pronator teres, the median nerve then goes deep to this muscle.
What lies superficial to the bicipital aponeurosis?
It represents a medial expansion of biceps brachii tendon. Superficial to the bicipital aponeurosis lies the median cubital vein (2). The aponeurosis separates the vein from the underlying brachial artery (3).
What muscle is between elbow and shoulder?
biceps muscleThe biceps muscle is located at the front of your upper arm. The muscle has two tendons that attach it to the bones of the scapula bone of the shoulder and one tendon that attaches to the radius bone at the elbow. The tendons are tough strips of tissue that connect muscles to bones and allow us to move our limbs.
Where is the bicipital aponeurosis located?
The bicipital aponeurosis (arrow) is identified medial to the biceps brachii tendon. It is elevated and incised (Fig. 87.5A and B ).
Why is the biceps tendon under more tension in pronation than supination?
The biceps tendon is under more tension in pronation than supination because the insertion on the radius is rotated away during pronation. Supinate the forearm and test to see if the biceps tendon is still tight and is the cause of elbow flexion contracture before releasing.
What is the ligament that compresses the pronator teres?
Compression near the lacertus fibrosus ( bicipital aponeurosis, superficial forearm fascia), the Struthers ligament (thickened or aberrant origin of pronator teres from distal humerus), the pronator teres, and the FDS.
Why is the superficialis arch incised?
This arch is incised because it may be a source of compression, particularly if it is thickened ( Fig. 15-13 ). Careful dissection just distal to the arch is continued, with attention directed at finding anatomic variants such as accessory muscles. Any site of compression is relieved.
What tendon is released during myotomy?
The release of the biceps tendon (black arrow) exposes the brachialis. A partial or complete myotomy of the brachialis (white arrow) can be performed depending on the degree of contracture ( Fig. 87.7A and B ).
Which nerve supplies the flexor pollicis longus?
The anterior interosseous nerve branch also supplies the flexor pollicis longus in the mid to distal forearm and the pronator quadratus in the distal forearm.
Which nerve runs deep to the brachioradialis?
The radial nerve lies deep to the brachioradialis and the lateral antebrachial cutaneous nerve runs medial to the brachioradialis. Both need to be protected during this step.
What is the purpose of the study of the bicipital aponeurosis?
The aim of this study was to analyze the anatomic variations of the bicipital aponeurosis (BA) (lacertus fibrosus) and its implications for the compression of the median nerve, which is positioned medially to the brachial artery, passing under the bicipital aponeurosis.
What is the BA muscle?
The BA is composed of fibers from the short and long heads of the biceps brachii muscle . The thickened BA can compress the median nerve against deep structures and alter the normal course of the nerve, therefore being one of the potential locations for nerve compression by narrowing the nerve passage space and thus causing motor and sensory symptoms.
What is the pronator teres syndrome?
Regardless of where nerve compression occurs in the elbow region, it is generically called the pronator teres syndrome, since it is between the two heads of this muscle that compression occurs more frequently. 7, 8, 9 Some authors disagree with the fact that compressions in locations other than between the humeral and ulnar heads of the pronator teres muscle are also referred to as pronator teres syndrome. 2, 10 Tubbs et al. 10 consider this denomination to be incorrect when compression occurs at Struthers ligament, the BA, or the arch of the superficial flexor muscles, and suggest that the correct name would be proximal compressive neuropathy of the median nerve rather than pronator teres syndrome.
What are the short and long heads of the biceps brachii muscle?
The short and long heads of the biceps brachii muscle were identified in all limbs. In 55 limbs, both the short and long heads contributed to the BA; the most significant contribution was always from the short head ( Fig. 1 A ). The BA was attached to the antebrachial fascia, covered the flexor-pronator group, and was inserted into the proximal third of the ulna. In three limbs (one bilateral case), it was observed that the long and short heads were completely separated: the short head continued with the BA and the long head, with the bicipital tendon ( Fig. 1 B). The length of the BA, from its origin to its insertion, ranged from 4.5 to 6.2 cm, and its width ranged from 0.5 to 2.5 cm In most cases it had a rectangular conformation ( Fig. 2 A ), while in some cases it was trapezoidal ( Fig. 2 B). The BA was thickened in 44 limbs; in 27, it was resting directly on the median nerve ( Fig. 3 A and B) and in 17, a high insertion of the humeral head of the pronator teres muscle was observed, so that the muscle was interposed between the BA and the median nerve ( Fig. 4 A and B ). In one limb of a cadaver with hypertrophied muscles, it was observed that the thickened BA caused an indentation on the median nerve ( Fig. 5 A ). In 14 limbs, the BA was very narrow and thin ( Fig. 5 B). The presence of an accessory head of the biceps brachii muscle ( Fig. 6 A and B) was observed in five limbs, but did not interfere with the formation of the BA. The bicipital tendon was identified in all cases, forming an alterable angle with the BA. In two limbs, the absence of the BA was recorded, one of which was replaced by a fibromuscular component that originated in the biceps brachii and extended distally to be inserted into the flexor digitorum superficialis muscle ( Fig. 7 A ), while in the other the aponeurosis was formed by the brachialis muscle ( Fig. 7 B). The presence of an accessory aponeurosis of the brachialis muscle, located proximally to the BA, was identified in three limbs, one bilateral ( Fig. 8 A and B ).
What muscle contributes to the formation of the BA?
In 55 limbs, short and long heads of the biceps muscle contributed to the formation of the BA, and the most significant contribution was always from the short head. In three limbs, only the short head contributed to the formation of the BA. In two limbs, the BA was absent. The length of the bicipital aponeurosis from its origin to its insertion ranged from 4.5 to 6.2 cm and its width, from 0.5 to 2.6 cm. In 42 limbs, the BA was thickened; of these, in 27 it was resting directly on the median nerve, and in 17 a high insertion of the humeral head of the pronator teres muscle was found, and the muscle was interposed between the BA and the median nerve.
How many cadavers are there in the study of the median nerve?
This study is aimed at analyzing, through anatomical dissections of 60 limbs of 30 cadavers, the relationship between the BA and the median nerve and thus contributing to a better understanding of the possible role of the BA in nerve compression at this site.
What causes compression of the median nerve in the elbow?
Compression of the median nerve in the elbow region is a condition usually caused by the presence of fibrous bands, which can be observed at four anatomical sites in the following order of frequency 7: between the superficial and deep heads of the pronator teres muscle; in the arcade formed by the proximal insertions of the superficial flexor muscle; in the BA; and in Struthers ligament, associated or unassociated with the humeral supracondylar process. Clinically, it is not easy to identify the exact location of the compression. Tinel's sign may be useful to identify the location of the compression. The results of electrophysiological tests are consistent with nerve compression in the elbow region, suggesting (but not confirming) the exact location of the compression. Identification of the structure responsible for nerve compression is only possible through surgical exploration of the nerve in the antecubital fossa. 2, 6, 9