Accessory fasciculi of the human pronator teres muscle: incidence, morphological characteristics and relation to the median nerve.
The purpose of this study is to determine the incidence of the accessory fasciculi of the pronator teres muscle and to evaluate the predispositional role of its morphological characteristics to median nerve entrapment. The accessory fasciculi of the pronator teres muscle have been found in 8.3% of 60 upper extremities which were studied. These fasciculi arose from the tendon of the brachialis muscle (5.0%), from the radial tendon of the biceps brachii muscle (3.3%), from the Gantzer's muscle (1.6%) or from the flexor digitorum superficialis muscle (1.6%). They were slips of origin of the deep head of the pronator teres muscle. They represented the deep head, when there was no other origin slip, or they were additional origin slips when the deep head also had a coronoid origin. Only the accessory fasciculi that represented the deep head and the accessory fasciculi located inside to the coronoid fasciculus were related directly to the median nerve. Three characteristics of these accessory fasciculi adjacent to the median nerve could be considered to be factors that predispose to the nerve entrapment: 1) the location dorsal to the superficial head of the pronator teres muscle, because it increases the area of contact with the median nerve; 2) the location between the superficial head and the coronoid fasciculus, because it reduces the space occupied by the median nerve; and 3) the tendinous nature of considerable segments of short accessory fasciculi because they are less extensible.