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Brachium and Cubital Fossa
Anatomy Guy Dissection Sheet 1/15/2012 Brachium and Cubital Fossa Dr. Craig Goodmurphy Anatomy Guy Major Dissection Objectives – Anterior Compartment 1. Maintain the superficial veins but work the fascia of the brachium off the anterior compartment noting the intermuscular septae 2. Clean and identify the three muscle of the anterior arm and their attachments 3. Mobilize the contents of the brachial fascia as it extends from the axillary fascia to the elbow noting the median, ulnar and medial brachial and medial antebrachial cutaneous nerves 4. Follow the musculocutaneous nerve as it passes through the coracobrachialis and between the biceps and brachialis noting motor branches and the lateral antebrachial cutaneous nerve Major Dissection Objectives – Cubital Fossa & Posterior Compartment 6. Mobilize the cubital fossa veins and review the boundaries 7. Clean the biceps tendon and reflect the aponeurosis 8. Locate the contents of the fossa including the bifurcation of the brachial artery, median nerve and floor muscles 9. Have a partner elevate the arm to dissect posteriorly and remove the skin and fascia 10. Locate the three heads of the triceps and their attachments 11. Locate the profunda brachii artery and radial nerve at the triangular interval and between the brachialis and brachioradialis muscles Eastern Virginia Medical School 1 Anatomy Guy Dissection Sheet 1/15/2012 Brachium and Cubital Fossa Pearls & Problems Don’t 1. Cut the biceps muscle just mobilize it Do 2. Follow the cords and tubes from known to unknown as you clean them Do 3. Remove the duplicated deep veins but save the unpaired superficial veins Do 4. -
Elbow Checklist
Workbook Musculoskeletal Ultrasound September 26, 2013 Shoulder Checklist Long biceps tendon Patient position: Facing the examiner Shoulder in slight medial rotation; elbow in flexion and supination Plane/ region: Transverse (axial): from a) intraarticular portion to b) myotendinous junction (at level of the pectoralis major tendon). What you will see: Long head of the biceps tendon Supraspinatus tendon Transverse humeral ligament Subscapularis tendon Lesser tuberosity Greater tuberosity Short head of the biceps Long head of the biceps (musculotendinous junction) Humeral shaft Pectoralis major tendon Plane/ region: Logitudinal (sagittal): What you will see: Long head of biceps; fibrillar structure Lesser tuberosity Long head of the biceps tendon Notes: Subscapularis muscle and tendon Patient position: Facing the examiner Shoulder in lateral rotation; elbow in flexion/ supination Plane/ region: longitudinal (axial): full vertical width of tendon. What you will see: Subscapularis muscle, tendon, and insertion Supraspinatus tendon Coracoid process Deltoid Greater tuberosity Lesser tuberosity Notes: Do passive medial/ lateral rotation while examining Plane/ region: Transverse (sagittal): What you will see: Lesser tuberosity Fascicles of subscapularis tendon Supraspinatus tendon Patient position: Lateral to examiner Shoulder in extension and medial rotation Hand on ipsilateral buttock Plane/ region: Longitudinal (oblique sagittal) Identify the intra-articular portion of biceps LH in the transverse plane; then -
The Square Flap Technique for Burn Contractures: Clinical Experience and Analysis of Length Gain
Annals of Burns and Fire Disasters - vol. XXXI - n. 4 - December 2018 THE SQUARE FLAP TECHNIQUE FOR BURN CONTRACTURES: CLINICAL EXPERIENCE AND ANALYSIS OF LENGTH GAIN DOUBLE LAMBEAU RHOMBOÏDE POUR BRIDE SÉQUELLAIRE DE BRÛ- LURE: EXPÉRIENCE PRATIQUE ET ANALYSE DE LA LONGUEUR GAGNÉE Hifny M.A. Department of Plastic Surgery, Faculty of Medicine, Qena University Hospital, South Valley University, Egypt SUMMARY. Post-burn contractures, affecting the joints especially, are demanding problems. Many surgical techniques have been designated for burn contracture release. The aim of this study is to investigate the efficiency of the square flap technique to release a post-burn scar contracture, and assess the post-operative length gain that can be achieved by simple mathematical calculation. In this study, sixteen patients with linear contracture bands were treated with the square flap tech- nique. The anatomical distribution of the contractures was: axilla, cubital fossa, flank, perineum and popliteal fossa. Scar maturity ranged from 4 months - 9 years. Square flap width and contracture band length before and immediately after surgery were recorded by simple mathematical calculation. Flap complication was assessed. Patient satisfaction was also assessed during the follow-up period. All square flaps were effective in lengthening the contracture bands. The length of the contracture that was released ranged from 2 to 6 cm. The gain in length provided with this technique ranged from 212 to 350%, average 247%, and adequate contracture release was achieved in all cases postoperatively. All square flaps healed uneventfully except for one (6%), which demonstrated limited epidermolysis that healed by secondary intention. The fol- low-up interval ranged from 6 months to 1.5 years. -
Unusual Cubital Fossa Anatomy – Case Report
Anatomy Journal of Africa 2 (1): 80-83 (2013) Case Report UNUSUAL CUBITAL FOSSA ANATOMY – CASE REPORT Surekha D Shetty, Satheesha Nayak B, Naveen Kumar, Anitha Guru. Correspondence: Dr. Satheesha Nayak B, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Madhav Nagar, Manipal, Karnataka State, India. 576104 Email: [email protected] SUMMARY The median nerve is known to show variations in its origin, course, relations and distribution. But in almost all cases it passes through the cubital fossa. We saw a cubital fossa without a median nerve. The median nerve had a normal course in the upper part of front of the arm but in the distal third of the arm it passed in front of the medial epicondyle of humerus, surrounded by fleshy fibres of pronator teres muscle. Its course and distribution in the forearm was normal. In the same limb, the fleshy fibres of the brachialis muscle directly continued into the forearm as brachioradialis, there being no fibrous septum separating the two muscles from each other. The close relationship of the nerve to the epicondyle might make it vulnerable in the fractures of the epicondyle. The muscle fibres surrounding the nerve might pull up on the nerve and result in altered sensory-motor functions of the hand. Since the brachialis and brachioradialis are two muscles supplied by two different nerves, this continuity of the muscles might result in compression/entrapment of the radial nerve in it. Key words: Median nerve, cubital fossa, brachialis, brachioradialis, entrapment INTRODUCTION The median nerve is the main content of and broad tendon which is inserted into the cubital fossa along with brachial artery and ulnar tuberosity and to a rough surface on the biceps brachii tendon. -
Pleurectomy Through the Triangle of Auscultation
Thorax: first published as 10.1136/thx.37.12.945 on 1 December 1982. Downloaded from Thorax 1982;37:945-946 Pleurectomy through the triangle of auscultation OJ LAU, S SHAWKAT From the Thoracic Surgical Unit, Preston Hall Hospital, Aylesford, Kent The aetiology of primary spontaneous pneumothorax is Outpatient follow-up for one to three years has shown no unknown, though several theories have been proposed. The recurrence of pneumothorax. formation and rupture of "blebs" in the lung are frequently associated with primary pneumothorax, 1-3 but the manage- Discussion ment of the condition remains controversial and depends on its severity and the patient's previous medical history. For For most cases of primary spontaneous pneumothorax, definitive treatment pleurectomy still remains the treatment observation, bed rest, or intercostal tube drainage are of choice.4 5 We have treated 25 young patients with primary adequate; but for patients with persistent air leak, and for spontaneous pneumothorax with apical pleurectomy those with a history of recurrent attacks, some form of through the auscultation triangle, without incision of the definitive treatment is necessary. Various methods have muscles of the chest wall. We have found that this approach been recommended, from artificial obliteration of the has several advantages over a full thoracotomy. pleural space with various chemicals or oils to the stripping of the parietal pleura and closure of the air leak through a Operative technique and results formal thoracotomy. In our experience, these forms of treatment are often Twenty-five young patients with primary spontaneous associated with unnecessary pain and discomfort for the pneumothorax have been treated, of whom 15 were men. -
DEPARTMENT of ANATOMY IGMC SHIMLA Competency Based Under
DEPARTMENT OF ANATOMY IGMC SHIMLA Competency Based Under Graduate Curriculum - 2019 Number COMPETENCY Objective The student should be able to At the end of the session student should know AN1.1 Demonstrate normal anatomical position, various a) Define and demonstrate various positions and planes planes, relation, comparison, laterality & b) Anatomical terms used for lower trunk, limbs, joint movement in our body movements, bony features, blood vessels, nerves, fascia, muscles and clinical anatomy AN1.2 Describe composition of bone and bone marrow a) Various classifications of bones b) Structure of bone AN2.1 Describe parts, blood and nerve supply of a long bone a) Parts of young bone b) Types of epiphysis c) Blood supply of bone d) Nerve supply of bone AN2.2 Enumerate laws of ossification a) Development and ossification of bones with laws of ossification b) Medico legal and anthropological aspects of bones AN2.3 Enumerate special features of a sesamoid bone a) Enumerate various sesamoid bones with their features and functions AN2.4 Describe various types of cartilage with its structure & a) Differences between bones and cartilage distribution in body b) Characteristics features of cartilage c) Types of cartilage and their distribution in body AN2.5 Describe various joints with subtypes and examples a) Various classification of joints b) Features and different types of fibrous joints with examples c) Features of primary and secondary cartilaginous joints d) Different types of synovial joints e) Structure and function of typical synovial -
Parts of the Body 1) Head – Caput, Capitus 2) Skull- Cranium Cephalic- Toward the Skull Caudal- Toward the Tail Rostral- Toward the Nose 3) Collum (Pl
BIO 3330 Advanced Human Cadaver Anatomy Instructor: Dr. Jeff Simpson Department of Biology Metropolitan State College of Denver 1 PARTS OF THE BODY 1) HEAD – CAPUT, CAPITUS 2) SKULL- CRANIUM CEPHALIC- TOWARD THE SKULL CAUDAL- TOWARD THE TAIL ROSTRAL- TOWARD THE NOSE 3) COLLUM (PL. COLLI), CERVIX 4) TRUNK- THORAX, CHEST 5) ABDOMEN- AREA BETWEEN THE DIAPHRAGM AND THE HIP BONES 6) PELVIS- AREA BETWEEN OS COXAS EXTREMITIES -UPPER 1) SHOULDER GIRDLE - SCAPULA, CLAVICLE 2) BRACHIUM - ARM 3) ANTEBRACHIUM -FOREARM 4) CUBITAL FOSSA 6) METACARPALS 7) PHALANGES 2 Lower Extremities Pelvis Os Coxae (2) Inominant Bones Sacrum Coccyx Terms of Position and Direction Anatomical Position Body Erect, head, eyes and toes facing forward. Limbs at side, palms facing forward Anterior-ventral Posterior-dorsal Superficial Deep Internal/external Vertical & horizontal- refer to the body in the standing position Lateral/ medial Superior/inferior Ipsilateral Contralateral Planes of the Body Median-cuts the body into left and right halves Sagittal- parallel to median Frontal (Coronal)- divides the body into front and back halves 3 Horizontal(transverse)- cuts the body into upper and lower portions Positions of the Body Proximal Distal Limbs Radial Ulnar Tibial Fibular Foot Dorsum Plantar Hallicus HAND Dorsum- back of hand Palmar (volar)- palm side Pollicus Index finger Middle finger Ring finger Pinky finger TERMS OF MOVEMENT 1) FLEXION: DECREASE ANGLE BETWEEN TWO BONES OF A JOINT 2) EXTENSION: INCREASE ANGLE BETWEEN TWO BONES OF A JOINT 3) ADDUCTION: TOWARDS MIDLINE -
Comprehensive Review of the Superficial Veins of the Forearm from a Historical, Anatomical and Clinical Point of View
IJAE Vol. 124, n. 2: 142-152, 2019 ITALIAN JOURNAL OF ANATOMY AND EMBRYOLOGY Circulatory system Comprehensive review of the superficial veins of the forearm from a historical, anatomical and clinical point of view Lucas Alves Sarmento Pires1,2,*, Albino Fonseca Junior1,2, Jorge Henrique Martins Manaia1,2, Tulio Fabiano Oliveira Leite3, Marcio Antonio Babinski1,2, Carlos Alberto Araujo Chagas2 1 Medical Sciences Post Graduation Program, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil 2 Morphology Department, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil 3 Interventional Radiology Unit, Radiology Institute, University of São Paulo Medical School, São Paulo, Brazil Abstract The superficial veins of the forearm are prone to possess different patterns of anastomosis. This is highly significant, as venipunctures in the upper limb are among the most performed procedures in the world and they often rely on the veins of the cubital fossa. In addition, the relationship of these veins to the cutaneous nerves are also prone to vary and are often uncer- tain. These veins are also manipulated in the creation of arteriovenous fistula for dialisis, which remains as the best choice of treatment for renal failure patients. Such fistulas are often per- formed on the wrist or the cubital fossa, with the cephalic vein or basilic vein. It is known that anatomical variations of the vessels and nerves on the cubital fossa may induce the profession- als to error, and one of the most common complications of venipuncture are accidental nerve puncture, which can lead to paresthesia and pain. We aim to perform a comprehensive review of the venous arrangements of the cubital fossa and their clinical aspects, as well as of veni- puncture from a historical perspective and of the complications of venipuncture and arterio- venous fistula from an anatomical point of view, with the purpose of compiling available data and help healthcare professionals to reduce puncture errors or arteriovenous fistula complica- tions and improve patient care. -
Minimising Iatrogenic Nerve Injury in Primary Care
Clinical Intelligence Katharine A Wallis, Thomas Hills and S Ali Mirjalili Minimising iatrogenic nerve injury in primary care Nerve injuries usually present as pain, NERVE ANATOMICAL COURSE numbness, or weakness, and can have Sciatic nerve in the gluteal region devastating consequences for patients. Sciatic nerve injury in the buttock may Procedures that are common in primary result in numbness, and weakness of the care can cause nerve injury. Iatrogenic hamstrings and all muscles below the nerve injuries are largely preventable by knee. The upper outer quadrant of the understanding nerve anatomical course buttock (dorsogluteal region) remains and surface anatomy, and the risky one of the most common sites for interventions and regions. Most knowledge intramuscular injection worldwide.2 Recent of nerve anatomical course is derived cross-sectional imaging studies in living from early work on cadaver dissection, adults and children have led to a revision of but modern imaging techniques more the surface anatomy of the sciatic nerve.3 accurately map nerve anatomical course This evidence suggests that the safe zone in living bodies. for injection is not the upper outer buttock We provide an overview of nerve injuries but the gluteal triangle (ventrogluteal in primary care, discuss updated nerve region). The gluteal triangle is located by anatomical course and surface anatomy placing the palm of the opposing hand on based on modern radiological evidence, the greater trochanter and the index finger and make recommendations to guide safer on the anterior superior iliac spine, forming interventions in primary care. a triangle with the middle finger pointing towards the iliac crest, as demonstrated NERVE INJURIES IN PRIMARY CARE in Figure 1.3 The recommended injection In New Zealand’s primary care treatment site is the centre of the triangle with the injury claims dataset there were 69 nerve needle inserted at 90° to the skin surface. -
Surface and Regional Anatomy 297
Van De Graaff: Human IV. Support and Movement 10. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Surface and Regional 10 Anatomy Introduction to Surface Anatomy 297 Surface Anatomy of the Newborn 298 Head 300 Neck 306 Trunk 309 Pelvis and Perineum 318 Shoulder and Upper Extremity 319 Buttock and Lower Extremity 326 CLINICAL CONSIDERATIONS 330 Clinical Case Study Answer 339 Chapter Summary 340 Review Activities 341 Clinical Case Study A 27-year-old female is brought to the emergency room following a motor vehicle accident. You examine the patient and find her to be alert but pale and sweaty, with breathing that is rapid and shallow. You see that she has distension of her right internal jugular vein visible to the jaw and neck. Her trachea is deviated 3 cm to the right of midline. She has tender contu- sions on her left anterior chest wall with minimal active bleeding over one of the ribs. During the brief period of your examination, the patient exhibits more respiratory distress, and her blood pressure begins to drop. You urgently insert a large-gauge needle into her left hemitho- rax and withdraw 20 cc of air. This results in immediate improvement in the patient’s breath- ing and blood pressure. Why does the patient have a distended internal jugular vein on the right side of her neck? Could this be related to a rapid drop in blood pressure? What is the clinical situation of this patient? Hint: As you read this chapter, note that knowledge of normal surface anatomy is vital to the FIGURE: In order to effectively administer medical treatment, it is imperative for a recognition of abnormal surface anatomy, and that the latter may be an easy clue to the pathol- physician to know the surface anatomy of each ogy lying deep within the body. -
Anatomy and Physiology in Relation to Compression of the Upper Limb and Thorax
Clinical REVIEW anatomy and physiology in relation to compression of the upper limb and thorax Colin Carati, Bren Gannon, Neil Piller An understanding of arterial, venous and lymphatic flow in the upper body in normal limbs and those at risk of, or with lymphoedema will greatly improve patient outcomes. However, there is much we do not know in this area, including the effects of compression upon lymphatic flow and drainage. Imaging and measuring capabilities are improving in this respect, but are often expensive and time-consuming. This, coupled with the unknown effects of individual, diurnal and seasonal variances on compression efficacy, means that future research should focus upon ways to monitor the pressure delivered by a garment, and its effects upon the fluids we are trying to control. More is known about the possible This paper will describe the vascular Key words effects of compression on the anatomy of the upper limb and axilla, pathophysiology of lymphoedema when and will outline current understanding of Anatomy used on the lower limbs (Partsch and normal and abnormal lymph drainage. It Physiology Junger, 2006). While some of these will also explain the mechanism of action Lymphatics principles can be applied to guide the use of compression garments and will detail Compression of compression on the upper body, it is the effects of compression on fluid important that the practitioner is movement. knowledgeable about the anatomy and physiology of the upper limb, axilla and Vascular drainage of the upper limb thorax, and of the anatomical and vascular It is helpful to have an understanding of Little evidence exists to support the differences that exist between the upper the vascular drainage of the upper limb, use of compression garments in the and lower limb, so that the effects of these since the lymphatic drainage follows a treatment of lymphoedema, particularly differences can be considered when using similar course (Figure 1). -
Ana Tomical Triangles J
43 ANA TOMICAL TRIANGLES J. LESLIE PACE, M.D. Department of Anatomy, Royal University of Malta Anatomical description is given of certain areas in the human hody which have :.l triangular sha!)e and which are of anatomical or surgical importance. There are at lea;,t 30 describe,d ,anatomical triangles, many of which receive eponymous names. Some are of nUlrked importance and well known e.g. Scarpa's femoral triangle, Hesselbach's inguinal triangle, H!ld Petit '5 lumbar triangle; others arc of relative1y minor importance and n.ot so well-known e.g. Elau's, Friteau's and Assezat's triangles. Anatomical trianlfles are described in various regions .of the body e.g. Macewen's ana Trautmann's in the head regiml, Beclaud's and PirDgoff's in the neck region, He'lSelbach '5, Henke '5, Petit's amI Grynfeltt's in the ,abdominal wall region and Searpa's Hnd Weber's in the lower limb Tf~gion. Their size varies, some being large e.g. Scarpa's triangle, others being very small e.g. Macewen's triangle. The bDundaries of these triangular areas may cDnsist of muscle borders e.g. the triangle .of Lannier and the variDUS tria,ngles of the neck; of n111sc1e borders and· bony cn1"fac(1,~ e.g. P(~lit'.~l tri,f)ng]c, t]1(' tria11['1]" ,C)f M'll"('ille J;lIlfl t1H~ tl"i[J11~le of Auscultation; of muscle borders and blood ves,ds e.g. Uesselbach's; of imaginary line, clrawn hetween fixed bony points e.g.