ABSTRACT
Several accessory muscles in the upper and lower limb have been described in the medical
literature. Most are asymptomatic and represent incidental findings at imaging. In
some instances, however, these muscles may become clinically relevant producing palpable
swelling, entrapment of neurovascular structures, or exercise-related pain. The diagnosis
of accessory muscles is based on recognition of their typical location and on cross-sectional
imaging features. Familiarity with their most common location and knowledge of the
possible clinical syndromes caused by these supernumerary structures may aid in diagnosis
and treatment.
KEYWORDS
Muscle anatomy - accessory muscles - ultrasound - magnetic resonance imaging
REFERENCES
1
Sookur P A, Naraghi A M, Bleakney R R, Jalan R, Chan O, White L M.
Accessory muscles: anatomy, symptoms, and radiologic evaluation.
Radiographics.
2008;
28(2)
481-499
2
Landry Jr S O.
The phylogenetic significance of the chondro-epitrochlearis muscle and its accompanying
pectoral abnormalities.
J Anat.
1958;
92(1)
57-61
3
Miguel M, Llusá M, Ortiz J C, Porta N, Lorente M, Götzens V.
The axillopectoral muscle (of Langer): report of three cases.
Surg Radiol Anat.
2001;
23(5)
341-343
4
Dharap A.
An unusually medial axillary arch muscle.
J Anat.
1994;
184(Pt 3)
639-641
5
Rizk E, Harbaugh K.
The muscular axillary arch: an anatomic study and clinical considerations.
Neurosurgery.
2008;
63(4, suppl 2)
316-319
discussion 319-320
6
Hewitt R L.
Acute axillary-vein obstruction by the pectoralis-minor muscle.
N Engl J Med.
1968;
279(11)
595-596
7
Flaherty G, O'Neill M N, Folan-Curran J.
Case report: bilateral occurrence of a chondroepitrochlearis muscle.
J Anat.
1999;
194(Pt 2)
313-315
8
Loukas M, Louis Jr R G, Kwiatkowska M.
Chondroepitrochlearis muscle, a case report and a suggested revision of the current
nomenclature.
Surg Radiol Anat.
2005;
27(4)
354-356
9
Spinner R J, Carmichael S W, Spinner M.
Infraclavicular ulnar nerve entrapment due to a chondroepitrochlearis muscle.
J Hand Surg [Br].
1991;
16(3)
315-317
10
O'Driscoll S W, Horii E, Carmichael S W, Morrey B F.
The cubital tunnel and ulnar neuropathy.
J Bone Joint Surg Br.
1991;
73(4)
613-617
11
Jeon I H, Fairbairn K J, Neumann L, Wallace W A.
MR imaging of edematous anconeus epitrochlearis: another cause of medial elbow pain?.
Skeletal Radiol.
2005;
34(2)
103-107
12
Husarik D B, Saupe N, Pfirrmann C W, Jost B, Hodler J, Zanetti M.
Elbow nerves: MR findings in 60 asymptomatic subjects—normal anatomy, variants, and
pitfalls.
Radiology.
2009;
252(1)
148-156
13
Masear V R, Hill Jr J J, Cohen S M.
Ulnar compression neuropathy secondary to the anconeus epitrochlearis muscle.
J Hand Surg [Am].
1988;
13(5)
720-724
14
Jones M, Abrahams P H, Sañudo J R, Campillo M.
Incidence and morphology of accessory heads of flexor pollicis longus and flexor digitorum
profundus (Gantzer's muscles).
J Anat.
1997;
191(Pt 3)
451-455
15
al-Qattan M M.
Gantzer's muscle. An anatomical study of the accessory head of the flexor pollicis
longus muscle.
J Hand Surg [Br].
1996;
21(2)
269-270
16
Tabib W, Aboufarah F, Asselineau A.
Compression of the anterior interosseous nerve by Gantzer's muscle[in French].
Chir Main.
2001;
20(3)
241-246
17
Degreef I, De Smet L.
Anterior interosseous nerve paralysis due to Gantzer's muscle.
Acta Orthop Belg.
2004;
70(5)
482-484
18
Zeiss J, Guilliam-Haidet L.
MR demonstration of anomalous muscles about the volar aspect of the wrist and forearm.
Clin Imaging.
1996;
20(3)
219-221
19
Schuurman A H, van Gils A PG.
Reversed palmaris longus muscle on MRI: report of four cases.
Eur Radiol.
2000;
10(8)
1242-1244
20
Depuydt K H, Schuurman A H, Kon M.
Reversed palmaris longus muscle causing effort-related median nerve compression.
J Hand Surg [Br].
1998;
23(1)
117-119
21
Timins M E.
Muscular anatomic variants of the wrist and hand: findings on MR imaging.
AJR Am J Roentgenol.
1999;
172(5)
1397-1401
22
Harvie P, Patel N, Ostlere S J.
Prevalence and epidemiological variation of anomalous muscles at Guyon's canal.
J Hand Surg Br.
2004;
29(1)
26-29
23
Harvie P, Patel N, Ostlere S J.
Ulnar nerve compression at Guyon's canal by an anomalous abductor digiti minimi muscle:
the role of ultrasound in clinical diagnosis.
Hand Surg.
2003;
8(2)
271-275
24
Dimitriou C, Natsis K.
Accessory abductor digiti minimi muscle causing ulnar nerve entrapment at the Guyon's
canal: a case report.
Clin Anat.
2007;
20(8)
974-975
25
Spiess A M, Gursel E.
Entrapment of the ulnar nerve at Guyon's canal by an accessory abductor digiti minimi
muscle.
Plast Reconstr Surg.
2006;
117(3)
1060-1061
26
Al-Qattan M M.
Ulnar nerve compression at the wrist by the accessory abductor digiti minimi muscle:
wrist trauma as a precipitating factor.
Hand Surg.
2004;
9(1)
79-82
27
Elias L S, Schulter-Ellis F P.
Anomalous flexor superficialis indicis: two case reports and literature review.
J Hand Surg [Am].
1985;
10(2)
296-299
28
Kostakoğlu N, Borman H, Keçik A.
Anomalous flexor digitorum superficialis muscle belly: an unusual case of mass in
the palm.
Br J Plast Surg.
1997;
50(8)
654-656
29
Schön R, Kraus E, Boller O, Kampe A.
Anomalous muscle belly of the flexor digitorum superficialis associated with carpal
tunnel syndrome: case report.
Neurosurgery.
1992;
31(5)
969-970
discussion 970-971
30
Sanger J R, Krasniak C L, Matloub H S, Yousif N J, Kneeland J B.
Diagnosis of an anomalous superficialis muscle in the palm by magnetic resonance imaging.
J Hand Surg [Am].
1991;
16(1)
98-101
31
Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi L E.
US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs.
Radiographics.
2000;
20(Spec No.)
S199-S213
32
Pirola E, Hébert-Blouin M N, Amador N, Amrami K K, Spinner R J.
Palmaris profundus: one name, several subtypes, and a shared potential for nerve compression.
Clin Anat.
2009;
22(6)
643-648
33
Gama C.
Extensor digitorum brevis manus: a report on 38 cases and a review of the literature.
J Hand Surg [Am].
1983;
8(5 Pt 1)
578-582
34
Rodríguez-Niedenführ M, Vázquez T, Golanó P, Parkin I, Sañudo J R.
Extensor digitorum brevis manus: anatomical, radiological and clinical relevance.
A review.
Clin Anat.
2002;
15(4)
286-292
35
Dostal G H, Lister G D, Hutchinson D, Mogan J V, Davis P H.
Extensor digitorum brevis manus associated with a dorsal wrist ganglion: a review
of five cases.
J Hand Surg [Am].
1995;
20(1)
35-37
36
Ouellette H, Thomas B J, Torriani M.
Using dynamic sonography to diagnose extensor digitorum brevis manus.
AJR Am J Roentgenol.
2003;
181(5)
1224-1226
37
Anderson M W, Benedetti P, Walter J, Steinberg D R.
MR appearance of the extensor digitorum manus brevis muscle: a pseudotumor of the
hand.
AJR Am J Roentgenol.
1995;
164(6)
1477-1479
38
Tubbs R S, Salter E G, Oakes W J.
Dissection of a rare accessory muscle of the leg: the tensor fasciae suralis muscle.
Clin Anat.
2006;
19(6)
571-572
39
Chason D P, Schultz S M, Fleckenstein J L.
Tensor fasciae suralis: depiction on MR images.
AJR Am J Roentgenol.
1995;
165(5)
1220-1221
40
Montet X, Sandoz A, Mauget D, Martinoli C, Bianchi S.
Sonographic and MRI appearance of tensor fasciae suralis muscle, an uncommon cause
of popliteal swelling.
Skeletal Radiol.
2002;
31(9)
536-538
41
Stoane J M, Gordon D H.
MRI of an accessory semimembranosus muscle.
J Comput Assist Tomogr.
1995;
19(1)
161-162
42
Duc S R, Wentz K U, Käch K P, Zollikofer C L.
First report of an accessory popliteal muscle: detection with MRI.
Skeletal Radiol.
2004;
33(7)
429-431
43
Sobel M, Levy M E, Bohne W H.
Congenital variations of the peroneus quartus muscle: an anatomic study.
Foot Ankle.
1990;
11(2)
81-89
44
Chepuri N B, Jacobson J A, Fessell D P, Hayes C W.
Sonographic appearance of the peroneus quartus muscle: correlation with MR imaging
appearance in seven patients.
Radiology.
2001;
218(2)
415-419
45
Saupe N, Mengiardi B, Pfirmann C WA, Vienne P, Seifert B, Zanetti M.
Anatomic variants associated with peroneal tendon disorders: MR imaging findings in
volunteers with asymptomatic ankles.
Radiology.
2007;
242
509-517
46
Donley B G, Leyes M.
Peroneus quartus muscle. A rare cause of chronic lateral ankle pain.
Am J Sports Med.
2001;
29(3)
373-375
47
Sobel M, Geppert M J, Olson E J, Bohne W H, Arnoczky S P.
The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of
diagnosis, and classification of injury.
Foot Ankle.
1992;
13(7)
413-422
48
Witvrouw E, Borre K V, Willems T M, Huysmans J, Broos E, De Clercq D.
The significance of peroneus tertius muscle in ankle injuries: a prospective study.
Am J Sports Med.
2006;
34(7)
1159-1163
49
Peterson D A, Stinson W, Lairmore J R.
The long accessory flexor muscle: an anatomical study.
Foot Ankle Int.
1995;
16(10)
637-640
50
Sammarco G J, Stephens M M.
Tarsal tunnel syndrome caused by the flexor digitorum accessorius longus. A case report.
J Bone Joint Surg Am.
1990;
72(3)
453-454
51
Cheung Y Y, Rosenberg Z S, Colon E, Jahss M.
MR imaging of flexor digitorum accessorius longus.
Skeletal Radiol.
1999;
28(3)
130-137
52
Seipel R, Linklater J, Pitsis G, Sullivan M.
The peroneocalcaneus internus muscle: an unusual cause of posterior ankle impingement.
Foot Ankle Int.
2005;
26(10)
890-893
53
Mellado J M, Rosenberg Z S, Beltran J, Colon E.
The peroneocalcaneus internus muscle: MR imaging features.
AJR Am J Roentgenol.
1997;
169(2)
585-588
54
Lorentzon R, Wirell S.
Anatomic variations of the accessory soleus muscle.
Acta Radiol.
1987;
28(5)
627-629
55
Yu J S, Resnick D.
MR imaging of the accessory soleus muscle appearance in six patients and a review
of the literature.
Skeletal Radiol.
1994;
23(7)
525-528
56
Palaniappan M, Rajesh A, Rickett A, Kershaw C J.
Accessory soleus muscle: a case report and review of the literature.
Pediatr Radiol.
1999;
29(8)
610-612
57
Paul M A, Imanse J, Golding R P, Koomen A R, Meijer S.
Accessory soleus muscle mimicking a soft tissue tumor. A report of 2 patients.
Acta Orthop Scand.
1991;
62(6)
609-611
58
Bianchi S, Abdelwahab I F, Oliveri M, Mazzola C G, Rettagliata P.
Sonographic diagnosis of accessory soleus muscle mimicking a soft tissue tumor.
J Ultrasound Med.
1995;
14(9)
707-709
59
Cheung Y, Rosenberg Z S.
MR imaging of the accessory muscles around the ankle.
Magn Reson Imaging Clin N Am.
2001;
9(3)
465-473
Carlo MartinoliM.D.
Department of Radiology, Cattedra di Radiologia–DISC
Largo Rosanna Benzi 8, I-16132 Genova, Italy
eMail: carlo.martinoli@libero.it