The origin structure of each finger in the flexor digitorum superficialis muscle

Abstract

Purpose

The flexor digitorum superficialis muscle (FDS) is considered the most important of the forearm flexors for maintaining elbow valgus stability. However, the relationships between the origin structure of each finger of the FDS and the anterior oblique ligament (AOL) of the ulnar collateral ligament and the common tendon (CT) in the proximal part, and morphological features are unclear. The purpose of this study was to clarify the relationships between the origin structure of each finger of the FDS and the AOL and the CT, as well as to clarify the morphological features of the muscle belly of each finger of the FDS.

Methods

This study examined 20 elbows. The origin of each finger was examined. Muscle mass, muscle fiber bundle length, and the pennation angle of each finger were also measured.

Results

In all cases, the third and fourth digits originated from the radius, the anterior common tendon (ACT), and the posterior common tendon (PCT). The second and fifth digits (18 elbows) or an independent fifth digit (2 elbows) originated from the ACT, the PCT, the AOL, and other soft tissues of the elbow. Muscle mass and muscle fiber bundle length in the muscle belly of the third and fourth digits were significantly heavier and longer, respectively, than in the muscle belly of the second and fifth digits.

Conclusion

Because the second and fifth digits or an independent fifth digit originated from the AOL, their contraction may cause tension in the AOL.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Agee J, McCarroll HR, Hollister A (1991) The anatomy of the flexor digitorum superficialis relevant to tendon transfers. J Hand Surg 16:68–69

    CAS  Article  Google Scholar 

  2. 2.

    Ahmad CS, Lee TQ, ElAttrache NS (2003) Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med 31:332–337. https://doi.org/10.1177/03635465030310030201

    Article  PubMed  Google Scholar 

  3. 3.

    Belbl M, Kunc V, Kachlik D (2020) Absence of flexor digitorum profundus muscle and variation of flexor digitorum superficialis muscle in a little finger: two case reports. Surg Radiol Anat. https://doi.org/10.1007/s00276-020-02420-y

    Article  PubMed  Google Scholar 

  4. 4.

    Buffi JH, Werner K, Kepple T, Murray WM (2015) Computing muscle, ligament, and osseous contributions to the elbow varus moment during baseball pitching. Ann Biomed Eng 43:404–415. https://doi.org/10.1007/s10439-014-1144-z

    Article  PubMed  Google Scholar 

  5. 5.

    Davidson PA, Pink M, Perry J, Jobe FW (1995) Functional anatomy of the flexor pronator muscle group in relation to the medial collateral ligament of the elbow. Am J Sports Med 23:245–250. https://doi.org/10.1177/036354659502300220

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Digiovine NM, Jobe FW, Pink M, Perry J (1992) An electromyographic analysis of the upper extremity in pitching. J Shoulder Elb Surg 1:15–25. https://doi.org/10.1016/s1058-2746(09)80011-6

    CAS  Article  Google Scholar 

  7. 7.

    Ellenbecker TS, Wilk KE, Altchek DW, Andrews JR (2009) Current concepts in rehabilitation following ulnar collateral ligament reconstruction. Sports Health 1:301–313. https://doi.org/10.1177/1941738109338553

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Felder A, Ward SR, Lieber RL (2005) Sarcomere length measurement permits high resolution normalization of muscle fiber length in architectural studies. J Exp Biol 208:3275–3279. https://doi.org/10.1242/jeb.01763

    Article  PubMed  Google Scholar 

  9. 9.

    Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF (1995) Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med 23:233–239. https://doi.org/10.1177/036354659502300218

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Frangiamore SJ, Moatshe G, Kruckeberg BM, Civitarese DM, Muckenhirn KJ, Chahla J, Brady AW, Cinque ME, Oleson ML, Provencher MT, Hackett TR, LaPrade RF (2018) Qualitative and quantitative analyses of the dynamic and static stabilizers of the medial elbow: an anatomic study. Am J Sports Med 46:687–694. https://doi.org/10.1177/0363546517743749

    Article  PubMed  Google Scholar 

  11. 11.

    Glousman RE, Barron J, Jobe FW, Perry J, Pink M (1992) An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency. Am J Sports Med 20:311–317. https://doi.org/10.1177/036354659202000313

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Hamilton CD, Glousman RE, Jobe FW, Brault J, Pink M, Perry J (1996) Dynamic stability of the elbow: electromyographic analysis of the flexor pronator group and the extensor group in pitchers with valgus instability. J Shoulder Elb Surg 5:347–354

    CAS  Article  Google Scholar 

  13. 13.

    Hoshika S, Nimura A, Takahashi N, Sugaya H, Akita K (2020) Valgus stability is enhanced by flexor digitorum superficialis muscle contraction of the index and middle fingers. J Orthop Surg Res 15:121. https://doi.org/10.1186/s13018-020-01640-7

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Hoshika S, Nimura A, Yamaguchi R, Nasu H, Yamaguchi K, Sugaya H, Akita K (2019) Medial elbow anatomy: a paradigm shift for UCL injury prevention and management. Clin Anat 32:379–389. https://doi.org/10.1002/ca.23322

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Jobe FW, Stark H, Lombardo SJ (1986) Reconstruction of the ulnar collateral ligament in athletes. J Bone Jt Surg [Am] 68:1158–1163

    CAS  Article  Google Scholar 

  16. 16.

    Lake SP, Castile RM, Borinsky S, Dunham CL, Havlioglu N, Galatz LM (2016) Development and use of an animal model to study post-traumatic stiffness and contracture of the elbow. J Orthop Res 34:354–364. https://doi.org/10.1002/jor.22981

    Article  PubMed  Google Scholar 

  17. 17.

    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    CAS  Article  Google Scholar 

  18. 18.

    Lieber RL (2010) Skeletal muscle structure, function, and plasticity: the physiological basis of rehabilitation, 3rd edn. Lippincott Williams & Wilkins, Baltimore

    Google Scholar 

  19. 19.

    Lin F, Kohli N, Perlmutter S, Lim D, Nuber GW, Makhsous M (2007) Muscle contribution to elbow joint valgus stability. J Shoulder Elb Surg 16:795–802. https://doi.org/10.1016/j.jse.2007.03.024

    Article  Google Scholar 

  20. 20.

    Morrey BF, Tanaka S, An KN (1991) Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Related Res 265:187–195

    Google Scholar 

  21. 21.

    Ohtani O (1979) Structure of the flexor digitorum superficialis. Okajimas Folia Anat Jpn 56:277–288

    CAS  Article  Google Scholar 

  22. 22.

    Otoshi K, Kikuchi S, Shishido H, Konno S (2014) The proximal origins of the flexor-pronator muscles and their role in the dynamic stabilization of the elbow joint: an anatomical study. Surg Radiol Anat 36:289–294. https://doi.org/10.1007/s00276-013-1168-3

    Article  PubMed  Google Scholar 

  23. 23.

    Park MC, Ahmad CS (2004) Dynamic contributions of the flexor-pronator mass to elbow valgus stability. J Bone Jt Surg Am 86-a:2268–2274

    Article  Google Scholar 

  24. 24.

    Pexa BS, Ryan ED, Myers JB (2018) Medial elbow joint space increases with valgus stress and decreases when cued to perform a maximal grip contraction. Am J Sports Med 46:1114–1119. https://doi.org/10.1177/0363546518755149

    Article  PubMed  Google Scholar 

  25. 25.

    Rebolledo BJ, Dugas JR, Bedi A, Ciccotti MG, Altchek DW, Dines JS (2017) Avoiding tommy john surgery: what are the alternatives? Am J Sports Med 45:3143–3148. https://doi.org/10.1177/0363546517692548

    Article  PubMed  Google Scholar 

  26. 26.

    Sacks RD, Roy RR (1982) Architecture of the hind limb muscles of cats: functional significance. J Morphol 173:185–195. https://doi.org/10.1002/jmor.1051730206

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Sisto DJ, Jobe FW, Moynes DR, Antonelli DJ (1987) An electromyographic analysis of the elbow in pitching. Am J Sports Med 15:260–263. https://doi.org/10.1177/036354658701500314

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Smith GR, Altchek DW, Pagnani MJ, Keeley JR (1996) A muscle-splitting approach to the ulnar collateral ligament of the elbow. Neuroanatomy and operative technique. Am J Sports Med 24:575–580. https://doi.org/10.1177/036354659602400503

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Udall JH, Fitzpatrick MJ, McGarry MH, Leba TB, Lee TQ (2009) Effects of flexor-pronator muscle loading on valgus stability of the elbow with an intact, stretched, and resected medial ulnar collateral ligament. J Shoulder Elb Surg 18:773–778. https://doi.org/10.1016/j.jse.2009.03.008

    Article  Google Scholar 

  30. 30.

    Ward SR, Eng CM, Smallwood LH, Lieber RL (2009) Are current measurements of lower extremity muscle architecture accurate? Clin Orthop Relat Res 467:1074–1082. https://doi.org/10.1007/s11999-008-0594-8

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge and thank those anonymous individuals who generously donated their bodies and so enabled this study to be performed. This study was supported by a Grant-in-Aid for Scientific Research (19K11358) from the Japan Society for the Promotion of Science (JSPS) and a Grant-in-Aid program from Niigata University of Health and Welfare (H30B05).

Author information

Affiliations

Authors

Contributions

KM: protocol/project development, data collection, data analysis, manuscript, writing/editing. ME: protocol/project development, data collection, data analysis, manuscript writing/editing. MI: data collection, manuscript writing/editing. FK: data collection, manuscript writing/editing. RH: data collection and manuscript writing/editing. IK: protocol/project development, data collection, data analysis, and manuscript writing/editing.

Corresponding author

Correspondence to Kanta Matsuzawa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All methods were carried out in accordance with the 1964 Declaration of Helsinki, and all cadavers were legally donated for research purposes to the Nippon Dental University of Life Dentistry at Niigata, Japan.

Informed consent

Informed consent was obtained from the families of all subjects.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Matsuzawa, K., Edama, M., Ikezu, M. et al. The origin structure of each finger in the flexor digitorum superficialis muscle. Surg Radiol Anat (2020). https://doi.org/10.1007/s00276-020-02522-7

Download citation

Keywords

  • Ulnar collateral ligament
  • Baseball
  • Valgus
  • Anatomy
  • Rehabilitation