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A Study on the Absence of Palmaris Longus in a Multi-Racial Population
108472 NV-OA7 pg26-28.qxd 11/05/2007 05:02 PM Page 26 (Black plate) Malaysian Orthopaedic Journal 2007 Vol 1 No 1 SA Roohi, etal A Study on the Absence of Palmaris Longus in a Multi- racial Population SA Roohi, MS (Ortho) (UKM), L Choon-Sian, MD (UKM), A Shalimar, MS (Ortho) (UKM), GH Tan, MS (Ortho) (UKM), AS Naicker, M Med Rehab (UM) Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia ABSTRACT Most standard textbooks of hand surgery quote the prevalence of absence of palmaris longus at around 15%3-5. Palmaris longus is a dispensable muscle with a long tendon However, this figure varies considerably in different ethnic which is very useful in reconstructive surgery. It is absent groups. A study by Thompson et al6 on 300 Caucasian 2.8 to 24% of the population depending on the race/ethnicity subjects found that palmaris longus was absent unilaterally in studied. Four hundred and fifty healthy subjects (equally 16%, and bilaterally in 9% of the study sample for an overall distributed among Malaysia’s 3 major ethnic groups) were prevalence of absence of 24%. Similarly, George7 noted on clinically examined for the presence or absence of palmaris 276 cadavers of European descent that its absence was 13% longus. This tendon was found to be absent unilaterally in unilaterally, 8.7% bilaterally for an overall absence of 15.2%. 6.4% of study subjects, and bilaterally in 2.9% of study Another cadaveric study by Vanderhooft8 in Seattle, USA participants. Malays have a high prevalence of palmaris reported its overall absence to be 12%. -
Diapositiva 1
Thoracic Cage and Thoracic Inlet Professor Dr. Mario Edgar Fernández. Parts of the body The Thorax Is the part of the trunk betwen the neck and abdomen. Commonly the term chest is used as a synonym for thorax, but it is incorrect. Consisting of the thoracic cavity, its contents, and the wall that surrounds it. The thoracic cavity is divided into 3 compartments: The central mediastinus. And the right and left pulmonary cavities. Thoracic Cage The thoracic skeleton forms the osteocartilaginous thoracic cage. Anterior view. Thoracic Cage Posterior view. Summary: 1. Bones of thoracic cage: (thoracic vertebrae, ribs, and sternum). 2. Joints of thoracic cage: (intervertebral joints, costovertebral joints, and sternocostal joints) 3. Movements of thoracic wall. 4. Thoracic cage. Thoracic apertures: (superior thoracic aperture or thoracic inlet, and inferior thoracic aperture). Goals of the classes Identify and describe the bones of the thoracic cage. Identify and describe the joints of thoracic cage. Describe de thoracic cage. Describe the thoracic inlet and identify the structures passing through. Vertebral Column or Spine 7 cervical. 12 thoracic. 5 lumbar. 5 sacral 3-4 coccygeal Vertebrae That bones are irregular, 33 in number, and received the names acording to the position which they occupy. The vertebrae in the upper 3 regions of spine are separate throughout the whole of life, but in sacral anda coccygeal regions are in the adult firmly united in 2 differents bones: sacrum and coccyx. Thoracic vertebrae Each vertebrae consist of 2 essential parts: An anterior solid segment: vertebral body. The arch is posterior an formed of 2 pedicles, 2 laminae supporting 7 processes, and surrounding a vertebral foramen. -
The Structure and Function of Breathing
CHAPTERCONTENTS The structure-function continuum 1 Multiple Influences: biomechanical, biochemical and psychological 1 The structure and Homeostasis and heterostasis 2 OBJECTIVE AND METHODS 4 function of breathing NORMAL BREATHING 5 Respiratory benefits 5 Leon Chaitow The upper airway 5 Dinah Bradley Thenose 5 The oropharynx 13 The larynx 13 Pathological states affecting the airways 13 Normal posture and other structural THE STRUCTURE-FUNCTION considerations 14 Further structural considerations 15 CONTINUUM Kapandji's model 16 Nowhere in the body is the axiom of structure Structural features of breathing 16 governing function more apparent than in its Lung volumes and capacities 19 relation to respiration. This is also a region in Fascla and resplrstory function 20 which prolonged modifications of function - Thoracic spine and ribs 21 Discs 22 such as the inappropriate breathing pattern dis- Structural features of the ribs 22 played during hyperventilation - inevitably intercostal musculature 23 induce structural changes, for example involving Structural features of the sternum 23 Posterior thorax 23 accessory breathing muscles as well as the tho- Palpation landmarks 23 racic articulations. Ultimately, the self-perpetuat- NEURAL REGULATION OF BREATHING 24 ing cycle of functional change creating structural Chemical control of breathing 25 modification leading to reinforced dysfunctional Voluntary control of breathing 25 tendencies can become complete, from The autonomic nervous system 26 whichever direction dysfunction arrives, for Sympathetic division 27 Parasympathetic division 27 example: structural adaptations can prevent NANC system 28 normal breathing function, and abnormal breath- THE MUSCLES OF RESPIRATION 30 ing function ensures continued structural adap- Additional soft tissue influences and tational stresses leading to decompensation. -
Paravertebral Block: Anatomy and Relevant Safety Issues Alberto E Ardon1, Justin Lee2, Carlo D
Paravertebral block: anatomy and relevant safety issues Alberto E Ardon1, Justin Lee2, Carlo D. Franco3, Kevin T. Riutort1, Roy A. Greengrass1 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, 2Department of Anesthesiology, Olympia Anesthesia Associates, Providence St. Peter Hospital, Olympia, WA, 3Department of Anesthesiology and Pain Management, John H. Review Article Stroger Jr. Hospital of Cook County, Chicago, IL, USA Korean J Anesthesiol 2020;73(5):394-400 Paravertebral block, especially thoracic paravertebral block, is an effective regional anes- https://doi.org/10.4097/kja.20065 thetic technique that can provide significant analgesia for numerous surgical procedures, pISSN 2005–6419 • eISSN 2005–7563 including breast surgery, pulmonary surgery, and herniorrhaphy. The technique, although straightforward, is not devoid of potential adverse effects. Proper anatomic knowledge and adequate technique may help decrease the risk of these effects. In this brief discourse, we discuss the anatomy and technical aspects of paravertebral blocks and emphasize the im- Received: February 10, 2020 portance of appropriate needle manipulation in order to minimize the risk of complica- Revised: March 5, 2020 tions. We propose that, when using a landmark-based approach, limiting medial and later- Accepted: March 15, 2020 al needle orientation and implementing caudal (rather than cephalad) needle redirection may provide an extra margin of safety when performing this technique. Likewise, recog- Corresponding author: nizing a target that is not in close proximity to the neurovascular bundle when using ultra- Alberto E Ardon, M.D., M.P.H. sound guidance may be beneficial. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 Keywords: Anatomy; Paravertebral; Postoperative pain; Regional anesthesia; Safety; Trun- San Pablo Rd, Jacksonville, FL 32224, USA cal nerve block. -
Ligaments of the Costovertebral Joints Including Biomechanics, Innervations, and Clinical Applications: a Comprehensive Review W
Open Access Review Article DOI: 10.7759/cureus.874 Ligaments of the Costovertebral Joints including Biomechanics, Innervations, and Clinical Applications: A Comprehensive Review with Application to Approaches to the Thoracic Spine Erfanul Saker 1 , Rachel A. Graham 2 , Renee Nicholas 3 , Anthony V. D’Antoni 2 , Marios Loukas 1 , Rod J. Oskouian 4 , R. Shane Tubbs 5 1. Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies 2. Department of Anatomy, The Sophie Davis School of Biomedical Education 3. Department of Physical Therapy, Samford University 4. Neurosurgery, Complex Spine, Swedish Neuroscience Institute 5. Neurosurgery, Seattle Science Foundation Corresponding author: Erfanul Saker, [email protected] Abstract Few studies have examined the costovertebral joint and its ligaments in detail. Therefore, the following review was performed to better elucidate their anatomy, function and involvement in pathology. Standard search engines were used to find studies concerning the costovertebral joints and ligaments. These often- overlooked ligaments of the body serve important functions in maintaining appropriate alignment between the ribs and spine. With an increasing interest in minimally invasive approaches to the thoracic spine and an improved understanding of the function and innervation of these ligaments, surgeons and clinicians should have a good working knowledge of these structures. Categories: Neurosurgery, Orthopedics, Rheumatology Keywords: costovertebral joint, spine, anatomy, thoracic Introduction And Background The costovertebral joint ligaments are relatively unknown and frequently overlooked anatomical structures [1]. Although small and short in size, they are abundant, comprising 108 costovertebral ligaments in the normal human thoracic spine, and they are essential to its stability and function [2-3]. -
Netter's Musculoskeletal Flash Cards, 1E
Netter’s Musculoskeletal Flash Cards Jennifer Hart, PA-C, ATC Mark D. Miller, MD University of Virginia This page intentionally left blank Preface In a world dominated by electronics and gadgetry, learning from fl ash cards remains a reassuringly “tried and true” method of building knowledge. They taught us subtraction and multiplication tables when we were young, and here we use them to navigate the basics of musculoskeletal medicine. Netter illustrations are supplemented with clinical, radiographic, and arthroscopic images to review the most common musculoskeletal diseases. These cards provide the user with a steadfast tool for the very best kind of learning—that which is self directed. “Learning is not attained by chance, it must be sought for with ardor and attended to with diligence.” —Abigail Adams (1744–1818) “It’s that moment of dawning comprehension I live for!” —Calvin (Calvin and Hobbes) Jennifer Hart, PA-C, ATC Mark D. Miller, MD Netter’s Musculoskeletal Flash Cards 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 NETTER’S MUSCULOSKELETAL FLASH CARDS ISBN: 978-1-4160-4630-1 Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia PA, USA: phone 1-800-523-1649, ext. 3276 or (215) 239-3276; or e-mail [email protected]. -
Peripartum Pubic Symphysis Diastasis—Practical Guidelines
Journal of Clinical Medicine Review Peripartum Pubic Symphysis Diastasis—Practical Guidelines Artur Stolarczyk , Piotr St˛epi´nski* , Łukasz Sasinowski, Tomasz Czarnocki, Michał D˛ebi´nski and Bartosz Maci ˛ag Department of Orthopedics and Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland; [email protected] (A.S.); [email protected] (Ł.S.); [email protected] (T.C.); [email protected] (M.D.); [email protected] (B.M.) * Correspondence: [email protected] Abstract: Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications. Keywords: pubic symphysis separation; pubic symphysis diastasis; pubic symphysis; pregnancy; PSD 1. Introduction The proper development of a fetus is made possible due to numerous adaptive Citation: Stolarczyk, A.; St˛epi´nski,P.; changes in women’s bodies, including such complicated systems as: endocrine, nervous Sasinowski, Ł.; Czarnocki, T.; and musculoskeletal. With regard to the latter, those changes can be observed particularly D˛ebi´nski,M.; Maci ˛ag,B. Peripartum Pubic Symphysis Diastasis—Practical in osteoarticular and musculo-ligamento-fascial structures. Almost all of those changes Guidelines. J. Clin. Med. -
Pelvic Anatomyanatomy
PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx) -
Thoracic and Lumbar Spine Anatomy
ThoracicThoracic andand LumbarLumbar SpineSpine AnatomyAnatomy www.fisiokinesiterapia.biz ThoracicThoracic VertebraeVertebrae Bodies Pedicles Laminae Spinous Processes Transverse Processes Inferior & Superior Facets Distinguishing Feature – Costal Fovea T1 T2-T8 T9-12 ThoracicThoracic VertebraeVertebrae andand RibRib JunctionJunction FunctionsFunctions ofof ThoracicThoracic SpineSpine – Costovertebral Joint – Costotransverse Joint MotionsMotions – All available – Flexion and extension limited – T7-T12 LumbarLumbar SpineSpine BodiesBodies PediclesPedicles LaminaeLaminae TransverseTransverse ProcessProcess SpinousSpinous ProcessProcess ArticularArticular FacetsFacets LumbarLumbar SpineSpine ThoracolumbarThoracolumbar FasciaFascia LumbarLumbar SpineSpine IliolumbarIliolumbar LigamentsLigaments FunctionsFunctions ofof LumbarLumbar SpineSpine – Resistance of anterior translation – Resisting Rotation – Weight Support – Motion IntervertebralIntervertebral DisksDisks RatioRatio betweenbetween diskdisk thicknessthickness andand vertebralvertebral bodybody heightheight DiskDisk CompositionComposition – Nucleus pulposis – Annulus Fibrosis SpinalSpinal LigamentsLigaments AnteriorAnterior LongitudinalLongitudinal PosteriorPosterior LongitudinalLongitudinal LigamentumLigamentum FlavumFlavum InterspinousInterspinous LigamentsLigaments SupraspinousSupraspinous LigamentsLigaments IntertransverseIntertransverse LigamentsLigaments SpinalSpinal CurvesCurves PosteriorPosterior ViewView SagittalSagittal ViewView – Primary – Secondary -
Part 1 the Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3
ECA1 7/18/06 6:30 PM Page 1 Part 1 The Thorax ECA1 7/18/06 6:30 PM Page 2 ECA1 7/18/06 6:30 PM Page 3 Surface anatomy and surface markings The experienced clinician spends much of his working life relating the surface anatomy of his patients to their deep structures (Fig. 1; see also Figs. 11 and 22). The following bony prominences can usually be palpated in the living subject (corresponding vertebral levels are given in brackets): •◊◊superior angle of the scapula (T2); •◊◊upper border of the manubrium sterni, the suprasternal notch (T2/3); •◊◊spine of the scapula (T3); •◊◊sternal angle (of Louis) — the transverse ridge at the manubrio-sternal junction (T4/5); •◊◊inferior angle of scapula (T8); •◊◊xiphisternal joint (T9); •◊◊lowest part of costal margin—10th rib (the subcostal line passes through L3). Note from Fig. 1 that the manubrium corresponds to the 3rd and 4th thoracic vertebrae and overlies the aortic arch, and that the sternum corre- sponds to the 5th to 8th vertebrae and neatly overlies the heart. Since the 1st and 12th ribs are difficult to feel, the ribs should be enu- merated from the 2nd costal cartilage, which articulates with the sternum at the angle of Louis. The spinous processes of all the thoracic vertebrae can be palpated in the midline posteriorly, but it should be remembered that the first spinous process that can be felt is that of C7 (the vertebra prominens). The position of the nipple varies considerably in the female, but in the male it usually lies in the 4th intercostal space about 4in (10cm) from the midline. -
Basic Biomechanics
Posture analysis • A quick evaluation of structure and function • Doctor views patient from behind (P-A) and from the side (lateral) • References points of patient’s anatomy relative to plumb (a position of balance) 9/3/2013 1 Posture analysis • Lateral View – Knees (anterior, posterior, plumb, genu recurvatum) – Trochanter (anterior, posterior, plumb) – Pelvis (anterior, posterior, neutral pelvic tilt) – Lumbar lordosis (hypo-, hyper-, normal) – Mid-axillary line (anterior, posterior, plumb) – Thoracic kyphosis (hyp-, hyper- normal) – Acromion (anterior, posterior, plumb) – Scapulae (protracted, retracted, normal) – Cervical lordosis (hypo-, hyper-, normal) – External auditory meatus (anterior, posterior, plumb) – Occiput (extended, neutral, flexed) 9/3/2013 2 Posture analysis • Posterior – Anterior View – Feet (pronation, supination, normal) – Achilles tendon (bowed in/out, normal) – Knees (genu valga/vera, normal - internal/external rotation) – Popliteal crease heights (low, high, level) – Trochanter heights (low, high, level) – Iliac crest heights (low on the right/left, normal) – Lumbar scoliosis (right/left, or no signs of) – Thoracic scoliosis (right/left, or no signs of) – Shoulder level (low on the right/left, or normal) – Cervical scoliosis (right/left, or no signs of) – Cervical position (rotation, tilt, neutral) – Mastoid (low on the right/left, or normal) 9/3/2013 3 …..poor postures 9/3/2013 4 Functional Anatomy of the Spine • The vertebral curvatures – Cervical Curve • Anterior convex curve (lordosis) develop in infancy -
Diagnosis of Atlantoaxial Instability Requires Clinical Suspicion To
al of S rn pi ou n Henderson Sr and Henderson Jr, J Spine 2017, 6:2 J e Journal of Spine DOI: 10.4172/2165-7939.1000364 ISSN: 2165-7939 Mini Review OMICS International Diagnosis of Atlantoaxial Instability Requires Clinical Suspicion to Drive the Radiological Investigation Fraser C Henderson Sr.1,2* and Fraser C Henderson Jr.3 1Doctors Community Hospital, Lanham, MD, USA 2The Metropolitan Neurosurgery Group, LLC, Chevy Chase, MD, USA 3Medical University of South Carolina, Charleston, SC, USA Introduction bending to the contralateral side, are often injured in motor vehicle collisions, and could be implicated in whiplash-associated disorders Atlantoaxial instability (AAI) occurs as a result of trauma, [15]. Failure of the alar ligament allows a 30% increased rotation to congenital conditions such as os odontoideum, neoplasm, infection the opposite side [16]. The atlantoaxial joint is ill-equipped to handle and degenerative connective tissue disorders such as rheumatoid the required multi-axial movements in the presence of ligamentous arthritis, genetic conditions such as HOX-D3 and Down syndrome, laxity or disruption [17]. Weakness of the muscles and ligaments, and heritable connective tissue disorders, emblematic of which are hormonal changes, infection, immunological problems, and congenital the Ehlers Danlos syndromes (EDS). Prototypical of disorders in dysmorphism may contribute to the overall mechanical dysfunction at which AAI is diagnosed, is rheumatoid arthritis (RA). Prior to the the C1-C2 motion segment. development of effective disease-modifying pharmacotherapies, 88% of RA patients exhibited radiographic evidence of C1-C2 involvement, Hypermobility of the AAJ is common in children, and up to 45° of in whom 49% were symptomatic and 20% myelopathic; ultimately, rotation may be observed in each direction.