Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 61280

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Readers' Comments (0) Article in PDF Audio Visual Citation Manager Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
The frequency of publication supports many aspiring authors from India and other countries.
It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 278 - 281

Morphological Variations in the origin and insertion of Lumbricals of the Upper Limb in Cadavers

ASHWINI M MUTALIK

Dept of Anatomy, S. N. Medical College, Bagalkot

Correspondence Address :
Ashwini M. Mutalik, Asst. Professor, Dept of Anatomy, S. N.
Medical College, Bagalkot
Email: dr.ashwinimutalik@gmail.com, Phone: 9900130146

Abstract

The human hand represents a revolution in evolution. The muscles of the lumbricals though small in size, have a significantly greater role to play in the intricate movements of the fingers. These muscles show anomalous origins and insertions. Hence, this study was an effort to know more about these muscles, as it is of significant value in the design of surgical procedures.

This study was conducted on 30 (both in the male and female populations) cadavers which were available from the Department of Anatomy. Dissection was carried out according to the Cunningham’s manual of practical anatomy.

In the present study, many split insertions and misplaced insertions and even the absence of these muscles were noted. Apart from the anomalies in the attachments, the length, breadth, width and tendon length of all these intrinsic muscles were studied and noted.

In this study, the values of length, breadth, width and tendon length of all the lumbricals, was measured. On applying the test of significance, these values were found to be statistically significant.

Keywords

Lumbricals, split insertions, misplaced insertions…etc

How to cite this article :

ASHWINI M MUTALIK.. MORPHOLOGICAL VARIATIONS IN THE ORIGIN AND INSERTION OF LUMBRICALS OF THE UPPER LIMB IN CADAVERS. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Feb 21 ]; 5:278-281. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=278-281&id=1282

The human hand is a prehensile organ, it is endowed with grasping and precision movements for skilled work and it acts as a chief tactile apparatus. This is contributed by a high degree of neuromuscular co-ordination and a larger cortical representation of the hand in the sensory motor cortex of the brain. Thus, the human hand represents a revolution in evolution.

Indeed, the lumbricals of the hand, by producing flexion at the metacarpophalangeal joints and at the extension at the interphalangeal joints, help in writing, stitching and any other forms of precision work. Hence, philosophically it may be said that the actions of the lumbricals of the hand are the indices of civilization of a race (1).

The lumbrical muscles, especially the 1st and 2nd ones, are used as muscle flaps for the coverage of the median nerve and its palmar branches (2). Hypertrophy of the lumbrical muscles causes compression of the radial and ulnar collateral arteries, leading to chronic sub-ischaemia (3).

The lumbricals of the upper limb are four small muscles resembling the shape of earthworms and hence they are named so. They are numbered from the lateral to the medial side. The lumbricals take their origin in the palm from the four tendons of the flexor digitorum profundus and pass distally along the radial side of the corresponding metacarpo-phalangeal joint, in front of the deep transverse metacarpal ligament. Each muscle forms a narrow tendon and runs in a fascial canal, and on reaching the dorsal surface of the proximal phalanx, joins the radial margin of the dorsal digital expansion as the distal wing tendon. The first and second lumbricals are unipennischaemia (3).ate, and are supplied by the median nerve, while the third and fourth lumbricals are bipennate and are supplied by a deep branch of the ulnar nerve (1).
Variations in the attachments of the lumbricals are common. In a study which was conducted byMehta. H. J (1961), it was noted that the lumbricals had an occasional origin in the forearm or from a metacarpal or from the superficial instead of the deep flexor tendonsand that the third and fourth lumbricals originated from a single tendon instead of two (4). (Table/Fig 1)

Another study which was done by Kurzumi M (2002) revealed that the lumbrical muscles originated from the intermediate tendon of the deep layer of the flexor digitorum superficialis for the index finger (5). (Table/Fig 2)

A muscle arouse from the anomalous flexor pollicis longus tendon in the region of the metacarpo phalangeal joint, passed across the narrowed first web space, joined the lumbrical belly of the index and inserted into the extensor hood of that digit. Because of its attachments and action, this muscle was given the name, ‘musculus lumbricalis pollicis’ (6) (Lister G 1991).

The first lumbrical was noted in a study by Singh J (2001), as a bipennate with an additional origin, extending from the distal part of the forearm. Its first origin arose from the flexor digitorum profundus in the hand, distal to the flexor retinaculum (7). Lumbricals often show split insertions. Basu S (1960), from his study, reported fairly numerous instances in which a lumbrical tendon split to go to the adjacent sides of the two fingers, or less frequently inserted entirely on the ulnar side of the adjacent digit (8). (Table/Fig 3)Singh JD (1975) found that the 3rd or 4th or both the lumbricals divided into two tendons which joined the extensor expansions of the adjacent fingers i.e. showing split insertions. In misplaced insertions, the 3rd or 4th lumbricals, instead of joining the extensor expansion on the radial side of the corresponding finger, joined one on the ulnar side of the adjacent finger, thus resulting in two lumbrical insertions in the adjacent finger and none in the corresponding finger (9).

The lumbricals also show variations in being unipennate or bipennate. If the first lumbrical is bipennate instead of unipennate, then the two heads arise from the flexor digitorum profundus and the flexor pollicis longus (10) (Goldberg S 1970). (Table/Fig 4)A rare variation of a unipennate fourth lumbrical muscle of the right hand was observed. At the level of the 5th metacarpophalangeal joint, its tendon divided into one radial and one ulnar slip. Both heads surrounded the tendons of the flexor digitorum superficialisand the profundus muscles, and found their insertion into the flexor digitorum superficialis tendon, as well as their bony attachment found its insertion into the proximal phalanx and even more into the middle phalanx (11) (Windisch G 2000).

Studies done by Braithwaite F (1948) quoted evidence that more than four lumbricals occurred frequently and that the third was most frequently missing (12). In another study, there were no instances of an additional lumbrical muscle and they found that it was the fourth lumbrical which is missing more frequently and not the third one (8). In another study which was conducted, it was noted that the fourth lumbrical was missing more frequently (5).

Material and Methods

Source of the data
This study was done on 30 cadavers which were available from the Department of Anatomy.

Method
The dissection was carried out according to the Cunningham’s manual of practical anatomy as follows: A longitudinal incision was taken from the distal end of the flexor retinaculum, up to the level of the metacarpophalangeal joint of the middle finger. The skin, the superficial fascia, the deep fascia and the flexor retinaculum were dissected and reflected. Then, the palmar aponeurosis and the slips which pass from its distal margin to each of the fingers was dissected and reflected. Then, the tendons of the flexor digitorum superficialis and the flexor digitorum profundus were reflected distally. The lumbrical muscles which were situated at the distal end of the flexor digitorum profundus tendons were carefully observed. The lumbrical muscles were followed to their tendons which pass with the proper digital vessels and nerves to the lateral side of the base of each finger and later, the tendons of each of the lumbrical muscles were traced up to their insertion. (Table/Fig 5)

Observations
The following parameters were noted:
1. Site of origin and insertion of the lumbricals. 2. The architecture of the muscles was noted i.e. unipennate or bipennate pattern. 3. The length, breadth and width of the muscle bellies of the lumbricals were measured. 4. The tendon lengths of all the lumbricals were also measured.

Results

(Table/Fig 6)In the present study, the right hand lumbricals [43.3% (13)] were normal, 26.6% (8) hands showed a proximal origin from the tendons of the flexor digitorum profundus and 3.3% (1) of the second lumbricals were bipennate. 6.6% (2), of the fourth lumbrical tendons were inserted on the ulnar side of the ring finger, 16.6% (4), of the third lumbricals showed split insertion and in 3.3% (1), the lumbricals were inserted on the medial side of the middle finger. On the left hand, 53.3% (16) of the lumbricals were normal. The second lumbrical was bipennate in 3.3% (1), 16.6% (4) showed a proximal origin from the tendons of the flexor digitorum profundus, 10% (3), of the third lumbricals showed split insertion and 3.3% (1), of the fourth lumbricals showed split insertion, while 13.3% (4), of the fourth lumbricals were inserted on the ulnar side of the ring finger. (Table/Fig 7)

Discussion

The pre-eminent position that man enjoys amongst the animals, is partly due to the functional specialization of the human hand that can perform very intricate and highly skilled precision movements. In the present study, it was found that 3.3% (1) of the 2nd lumbricals in both the hands were bipennate. It was also found by Siegel DB (1995), that in cases of the carpal tunnel syndrome and in those in which repetitive hand motions were performed, the lumbricals had a significantly larger and proximal origin in the carpal tunnel, which could be the the cause of the carpal tunnel syndrome (13). In the present study, it was observed that 26.6% (8) of the cadavers in the right hand and 16.6% (5) in the left hand, had the proximal origin of the lumbricals, especially from the flexor digitorum profundus and the flexor digitorum superficialis.

A study was conducted by Joshi SD (2005) on 70 normal hands to know the functional significance and variations of the lumbricals. It was found that 50% cases of the first lumbrical was bulky, 45% of the 2nd lumbrical was bipennate and 20% showed proximal attachment (14).

In a study which was conducted on the variations in the lumbricals, it was found that the absence of the 4th lumbrical was very common and that it was absent in 3% of the cases. In contrast to this study, the authors revealed 1.4% and 5.3% of the cases to have the absence of the 4th lumbrical.

Misplaced insertions i.e. the lumbrical being inserted to the ulnar side of the adjacent extensor expansion, is also not uncommon. Similar findings, that is, 3.3% of the 3rd lumbrical and 6.6% of the 4th lumbrical in the right hand and 13.3% of the 4th lumbrical in the left hand, showed misplaced insertions in the present study.

Conclusion

In the present study, the values of length, breadth, width and tendon length of all the lumbricals of the right and left side hands were compared. On applying the test of significance, these values were found to be statistically significant. 1. The length of the 1st lumbrical of the left hand was more than that of the right hand (P = 0.049). 2. The breadth of the 4th lumbrical of the left hand was more than that of the right hand. (P = 0.044)

Acknowledgement

With a profound sense of gratitude and humbleness, I express my most sincere thanks to Dr.G.B.Rairam, HOD, my mentor Dr.G.C.Javalagi and all my colleagues under whose constant guidance, inspiration, encouragement and supervision, I could successfully complete my present study in the Department of Anatomy of S. Nijalingappa Medical College, Bagalkot. I am thankful to my loving parents, in-laws, daughters and son, who have been the wind below my wings. I certainly owe thanks to my friend, Ms. Surekha Kamble, who helped me directly or indirectly in accomplishing this work. I thankfully acknowledge the help of the technical and menial staff of the Department of Anatomy for their co-operation. My husband, Mr. V. J. Markod, deserves to be thanked in more ways than one, whose role has been all the more credit worthy.

References

1.
Datta AK. Essentials of Human Anatomy. 2nd Ed. Calcutta: Current Books International 1995.
2.
Koncilia H, Kuzbari R, Worseg A, Tschabitscher M, Holle J. The lumbrical muscle flap: anatomic study and clinical application. J Hand Surg [Am]. 1998; 23(1):111-9.
3.
Chaudruc JM, Florenza F, Riviere C, Arnaud JP. White finger and hypertrophy of the lumbrical muscles. Chir Main. 2000 Sep; 19(4):232- 4.
4.
Mehta H.J, and Gardner WU. A study of lumbrical muscles in the human hand. Am. J. Anat 1961; 109: 227.
5.
Kurzumi M, Karwai K, Honma S, Kodama K. Anomalous lumbrical muscles arising from the deep surface of flexor digitorum superficialis muscles in man. Ann Anat. 2002; 184(4):387-92.
6.
Lister G. Musculus lumbricalis pollicis. J Hand Surg [Am]. 1991; 16(4): 622-5.
7.
Singh G, Bay BH, Yip GW, Tay S. Lumbrical muscle with an additional origin in the forearm. ANZ J Surg 2001; 71: 301-2.
8.
Basu S, Hazary SS. Variations of the lumbrical muscle of the hand. Anat. Rec., 1960; 136; 501-4.
9.
Singh JD, Raju PB, Singh Shamer. Anomalous insertion of Hand Lumbricals. J Anat Soc India 1975; 24(3): 122-5.
10.
Goldberg S. The origin of the lumbrical muscles in the hand of the South African native. The Hand 1970; 2: 168–71.
11.
Windisch G. The fourth lumbrical muscle in the hand: A variation of insertion on the fifth finger. Surg Radiol Anat. 2000; 22 (3-4): 213-5.
12.
Braithwaite F, Channel GD, Moore FT, Whillis J. The applied anatomy of the lumbrical and interosseous muscles of the hand. Guy’s Hosp. Reports, 1948; 97: 185–95.
13.
Siegel DB, Kuzma G, Eakins D. Anatomic investigation of the role of lumbricals muscle in carpal tunnel syndrome. J. Hand Surg (Am) 1995; 20(5): 860-3.
14.
Joshi SD, Joshi SS, Athavale SA. Lumbrical Muscles and Carpal Tunnel. J Anat Soc India 2005; 54(1): 12-5.

DOI and Others

JCDR/2011/1282

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com