Chest Wall Injury Society: Defining Sectors Around the Chest Wall

Total Page:16

File Type:pdf, Size:1020Kb

Chest Wall Injury Society: Defining Sectors Around the Chest Wall Chest Wall Injury Society: Rib Fractures Definitions Consensus Survey – Round 3 Defining Sectors Around the Chest wall - Proposals For Sector Boundaries Axillary Lines In Round 2, the use of the anterior and posterior axillary lines was the most popular choice (75% of votes) for the boundaries between of the sectors. We have identified problems with the use of axillary lines as the borders between the sectors. • There is no agreed definition for the axillary lines • It is not easy to identify axillary lines on CT scans • Not all definitions of the axillary lines would give easily reproducible sectors • Not all definitions of the axillary lines would give evenly spaced sectors. A Definition for Axillary Lines • Anterior Axillary Line: Coronal line marked by the anterior axillary fold: it runs down from the point midway between the middle of the clavicle and lateral end of the clavicle • Posterior Axillary Line: Coronal line marked by the posterior axillary fold Anterior Axillary Line Posterior Axillary Line Axillary Lines • BUT: – The muscle markings do not run in vertical lines – The muscle markings may be difficult to see on CT scans, particularly at lower levels of the chest • A reproducible definition is required… Anterior Axillary Line Posterior Axillary Line Angles At Which Anatomical Features Lie • The table above displays how the angles of different anatomical landmarks vary between patients on CT scans. • We have measured angles from the mid-thoracic point to the structure of interest, from the anterior sagittal midline in 96 patients • e.g. the mean angle of the scapula tip was 117o (SD 13.29, range 97-143) Please consider carefully the advantages and disadvantages of the four proposals, given on the following slides Note: the costochondral and paravertebral sectors are the same in each proposal: • Costochondral sector is medial to the costochondral junction of each rib • Paravertebral sector is medial to the costo-transverse joint of each rib Proposals 1. Vertical Lines 2. Muscle Borders 3. Angles from the mid-thoracic point 4. Equal Size Sectors Each will be considered in turn, with explanatory diagrams Proposal 1: Vertical Lines • Anterior / Lateral Sector boundary: – vertical line from the intersection of the posterior border of Pectoralis Major and the 2nd rib • Lateral / Posterior Sector boundary: – Vertical line through the tip of the scapula The following diagrams will provide full explanation Proposal 1: Vertical Lines The Border between the Anterior and Lateral Sectors: Posterior Border of Pectoralis Major • A commonly accepted definition for the anterior axillary line is the posterior border of Pectoralis Major. • However, the border becomes indistinct and absent below the 6th costal cartilage • Therefore we propose a vertical line, displayed as a green arrow at the intersection of the posterior border of Pectoralis Major and the 2nd rib, which is at the same position on each axial slice Proposal 1: Vertical Lines The Border between the Lateral and Posterior Sectors: The Tip of the Scapula • We propose using an vertical line through the tip of the scapula, displayed by a yellow arrow in a fixed location on each axial section, for the border between the lateral and posterior sectors • It is acknowledged that the tip of the scapula is not constant between different cases (see slide 6) Proposal 1: Vertical Lines 1 Mobile white arrow - Costochondral Joint (CCJ) 2 Fixed green arrow - posterior border of Pectoralis Major at 2nd rib 3 Fixed yellow arrow - tip of scapula 4 Mobile orange arrow - costotransverse joint • Imagine “fixing” the position of the yellow and green arrows on the computer screen with Blu- Tack / Power Tack • The fixed arrows (Green and Yellow) are intended to preserve the size of the sectors up and down the chest. • The white arrow (each CCJ) has to be mobile, as the CCJ moves laterally with each successive rib • Orange is mobile (but does not vary much) Proposal 1: Vertical Lines • Anterior / Lateral Sector boundary: – vertical line from the intersection of the posterior border of Pectoralis Major and the 2nd rib • Lateral / Posterior Sector boundary: – Vertical line from the tip of the scapula The following diagrams will provide full explanation Proposal 1 2nd Costochondral Junction Proposal 1 4th Costochondral Junction Proposal 1 6th Costochondral Junction Proposal 1 8th Costochondral Junction At this level and below, the anterior sector is lost Proposal 1 10th Costochondral Junction At this level there is no Anterior Sector Proposal 1: Vertical Lines • Note – the Anterior Sector becomes smaller and disappears at about the 8th Costochondral Joint, because the Costochondral Joints move laterally, further down the chest. – The Lateral Sector becomes smaller below the 8th Costochondral Joint, because the Costochondral Joints move into the Lateral Sector. – The Posterior Sector remains constant Proposal 2: Muscle Border Lines • Anterior / Lateral Sector boundary: – posterior border of Pectoralis Major • Lateral / Posterior Sector boundary: – anterior border of Latissimus Dorsi The following diagrams will provide full explanation Proposal 2 – Muscle Border Lines 1 Mobile white arrow - Costochondral joints 2 Mobile green arrow - posterior border of Pectoralis Major 3 Mobile blue arrow - anterior border of latissimus dorsi 4 Mobile orange arrow - costotransverse joint • Green (posterior border of Pec. major) is mobile – moves medially at each lower level. • White (CCJ) is mobile as the CCJ moves laterally lower down the chest • Blue (anterior border of Lat. dorsi) is mobile – moves posteriorly at each lower level • Orange is mobile (but does not vary much) Proposal 2 2nd Costochondral Junction * * Is a fracture here, in the posterior sector, really posterior? Proposal 2 4th Costochondral Junction Proposal 2 6th Costochondral Junction The border of Pec. Major only extends to the 6th Costal Cartilage At this level and below, there is no anterior sector Proposal 2 th Proposal 1 8 th Costochondral Junction 8 Costochondral Junction The border of Pec. Major only extends to the 6th Costal Cartilage – there is no anterior sector at this level Proposal 2 10th Costochondral Junction Proposal 2 – Muscle Border Lines • Note – The Anterior Sector is very small, due to the origin of Pec. Major from the upper 6 costal cartilages. – The Lateral Sector runs obliquely, moving slightly more posteriorly at lower levels – The Posterior Sector is larger than the Anterior and Lateral Sectors combined, and quite “anterior” at higher levels. It becomes smaller as the anterior border of Lat. Dorsi moves posteriorly down the chest Proposal 3 – Angle from Mid-Thoracic Point • Using angles from the anterior midline, measured from the mid thoracic point • Mid Thoracic point is the mid point from the anterior table of the sternum (or linear alba) and the posterior aspect of the vertebral spinous process The following diagrams will provide full explanation Proposal 3 – Angle from Mid-Thoracic Point • Anterior / Lateral Sector boundary: – 60 degree angle • Lateral / Posterior Sector boundary: – 120 degree angle – The mean angle of the scapula tip in 96 cases was 117o (SD 13.29, range 97-143) CCJ Thoracic Proposal 3 Midline Costo- 2nd Costochondral chondral 60 0 Anterior Junction Lateral Mid Thoracic Pont 120 0 Posterior Paravertebral CTJ 60 o and 120o angles from the midline divides the chest into 3 sectors, but the Costochondral and Paravertebral sectors “take priority” CCJ Thoracic Midline Proposal 3 Costo- th chondral 4 Costochondral 60 0 Anterior Junction Lateral Mid Thoracic Pont 120 0 Posterior CTJ Paravertebral Thoracic CCJ Midline Proposal 3 Costo- chondral 6th Costochondral 0 60 Anterior Junction Lateral Mid Thoracic Pont 120 0 Posterior CTJ Paravertebral Thoracic Midline Proposal 3 Costo- 8th Costochondral chondral 60 0 Junction CCJ Lateral Mid Thoracic Pont 120 0 Posterior CTJ Paravertebral No anterior sector at this level. Thoracic Midline Proposal 3 10th Costochondral 60 0 Costo- Junction chondral CCJ Mid Thoracic Pont Lateral 120 0 Posterior CTJ Paravertebral Proposal 3 – Angle from Mid-Thoracic Point • Note: – The Anterior Sector is small, and it disappears completely at about the 7th or 8th Costochondral Junction – The Lateral Sector remains the same size, until the CCJ moves into it at about the 8th CCJ, then it becomes smaller – The Posterior Sector is constant in size and about the same as most of the Lateral Sector Proposal 4: Equal Size Sectors • Anterior / Lateral Sector boundary: – 1/3rds of the circumference between the costochondral junction and the costotransverse joint • Lateral / Posterior Sector boundary: – 2/3rds of the circumference between the costochondral junction and the costotransverse joint The following diagrams will provide full explanation Costo- Proposal 4 chondral 2nd Costochondral Junction Anterior Lateral Posterior Paravertebral The three sectors remain equal in size, although all become smaller at lower levels All three sectors are present at each level Costo- Proposal 4 chondral 4th Costochondral Junction Anterior Lateral Posterior Paravertebral Proposal 4 Costo- chondral 6th Costochondral Junction Anterior Lateral Posterior Paravertebral Proposal 4 Costo- 8th Costochondral chondral Junction Anterior Lateral Posterior Paravertebral Proposal 4 10th Costochondral Junction Costo- chondral Anterior * Lateral Posterior Paravertebral * Is a fracture here, in the anterior sector, really anterior? Proposal 4 – Equal size sectors • Note: – At each level, the sectors are equal in size
Recommended publications
  • 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.
    [Show full text]
  • 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].
    [Show full text]
  • 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
    [Show full text]
  • MULTIPLE OSSIFIED COSTAL CARTILAGES for 1ST RIB Raghavendra D.R
    International Journal of Anatomy and Research, Int J Anat Res 2014, Vol 2(4):744-47. ISSN 2321- 4287 Case Report DOI: 10.16965/ijar.2014.538 MULTIPLE OSSIFIED COSTAL CARTILAGES FOR 1ST RIB Raghavendra D.R. *1, Nirmala D 2. *1 Post graduate student, Department of anatomy, J J M Medical College, Davangere, Karnataka, India. 2 Associate Professor, Department of anatomy, J J M Medical College, Davangere, Karnataka, India. ABSTRACT Costal cartilages are flattened bars of hyaline cartilages. All ribs except the last two, join with the sternum through their respective costal cartilages directly or indirectly. During dissection for 1st MBBS students in the Department of Anatomy, JJMMC, Davangere, variation was found in a male cadaver aged 45 –50 years. Multiple ossified costal cartilages for 1st rib were present on left side. There were 3 costal cartilages connecting 1st rib to manubrium. There were two small intercostal spaces between them. The lower two small costal cartilages fused together to form a common segment which in turn fused with large upper costal cartilage. The large upper costal cartilage forms costochondral joint with 1st rib. All costal cartilages showed features of calcification. The present variation of multiple ossified costal cartilages are due to bifurcation of costal cartilage. It may cause musculoskeletal pain, intercostal nerve entrapment or vascular compression. Awareness of these anomalies are important for radiologists for diagnostic purpose and for surgeons for performing various clinical and surgical procedures. KEYWORDS: Costal cartilage, bifurcation of Rib, Sternum. Address for Correspondence: Dr. Raghavendra D.R. Post graduate student, Department of anatomy, J J M Medical College, Davangere, 577004, Karnataka, India.
    [Show full text]
  • 1 the Thoracic Wall I
    AAA_C01 12/13/05 10:29 Page 8 1 The thoracic wall I Thoracic outlet (inlet) First rib Clavicle Suprasternal notch Manubrium 5 Third rib 1 2 Body of sternum Intercostal 4 space Xiphisternum Scalenus anterior Brachial Cervical Costal cartilage plexus rib Costal margin 3 Subclavian 1 Costochondral joint Floating ribs artery 2 Sternocostal joint Fig.1.3 3 Interchondral joint Bilateral cervical ribs. 4 Xiphisternal joint 5 Manubriosternal joint On the right side the brachial plexus (angle of Louis) is shown arching over the rib and stretching its lowest trunk Fig.1.1 The thoracic cage. The outlet (inlet) of the thorax is outlined Transverse process with facet for rib tubercle Demifacet for head of rib Head Neck Costovertebral T5 joint T6 Facet for Tubercle vertebral body Costotransverse joint Sternocostal joint Shaft 6th Angle rib Costochondral Subcostal groove joint Fig.1.2 Fig.1.4 A typical rib Joints of the thoracic cage 8 The thorax The thoracic wall I AAA_C01 12/13/05 10:29 Page 9 The thoracic cage Costal cartilages The thoracic cage is formed by the sternum and costal cartilages These are bars of hyaline cartilage which connect the upper in front, the vertebral column behind and the ribs and intercostal seven ribs directly to the sternum and the 8th, 9th and 10th ribs spaces laterally. to the cartilage immediately above. It is separated from the abdominal cavity by the diaphragm and communicates superiorly with the root of the neck through Joints of the thoracic cage (Figs 1.1 and 1.4) the thoracic inlet (Fig.
    [Show full text]
  • Rib Mobilizations Kat Hayes, SPT
    Rib Mobilizations Kat Hayes, SPT A) Anatomy a. 12 Thoracic Vertebrae i. Superior facet facets anteraior/lateral ii. Inferior facet facets posterior/medial iii. Plane of motion alows more lateral flexion but limited due to ribs iv. T2-10 have a superior and inferior demifacet where rib articulates with two vertebrae b. 12 Ribs i. Costovertebral facet 1. T2-10 rib head has an inferior and superior facet to articulates with 2 vertebrae 2. T1, T11-12 articulates with only one costal facet 3. Kinematics: gliding and rotation ii. Costotransverse Joint 1. Tubercle of rib articulates with on transverse processes 2. Kinematics: gliding wih some rotation c. Sternum i. Ribs 1-7 attach at sternum via costochondral joint ii. Ribs 8-10 articulate to costal cartilage iii. Ribs 11, 12 are not attached B) Young et al. mapped referral patterns for costotransverse joint patterns a. 8 asymptomatic male subjects b. Received consecutive, same day injections to either right T2,4,6 or to their left T3,5,7 c. OmnipaqueTM was injected using fluoroscopy into joint d. Subects were asked to desribe the pian using given descriptors and also VAS including description of referred pain C) Indications a. Rib or Thoracic hypomobility b. Pain c. Shallow breathing D) Contraindications a. Rib fracture b. Osteoperosis c. Hypermobility d. Malignancy e. Systemic inflamitory disease f. Ligamentous laxity E) Precautions a. Pulmonary Disease b. Severe Scoliosis c. Spinal fussion d. Pregnancy F) Assessment a. While patients sitting, assess breathing patern and palpate ribs for movement during inhilation/exhalation i. Are they a chest or belly breather ii.
    [Show full text]
  • Spondyloarthropathies and Reactive Arthritis
    RHEUMATOLOGY SPONDYLOARTHRITIS ROBERT L. DIGIOVANNI, DO, FACOI PROGRAM DIRECTOR LMC RHEUMATOLOGY FELLOWSHIP [email protected] DISCLOSURES •NONE SERONEGATIVE SPONDYLOARTHROPATHIES SLIDES PREPARED BY GENE JALBERT, DO SENIOR RHEUMATOLOGY FELLOW THE SPONDYLOARTHROPATHIES: • Ankylosing Spondylitis (A.S.) • Non-radiographic Axial spondyloarthropathies (nr-axSpA) • Psoriatic Arthritis (PsA) • Inflammatory Bowel Disease Associated (Enteropathic) • Crohn and Ulcerative Colitis • +/- Microscopic colitis • Reactive Arthritis (ReA) • Juvenile-Onset SpA • Others: Bechet’s dz, Celiac, Whipples, pouchitis. THE FAMOUS VENN DIAGRAM: SPONDYLOARTHROPATHY: • First case of Axial SpA was reported in 1691 however some believe Ramses II has A.S. • 2.4 million adults in the United States have Seronegative SpA • Compare with RA, which affects about 1.3 million Americans • Prevalence variation for A.S.: Europe (0.12-1%), Asia (0.17%), Latin America (0.1%), Africa (0.07%), USA (0.34%). • Pathophysiology in general: • Responsible Interleukins: IL-12, IL17, IL-22, and IL23. SPONDYLOARTHROPATHY: • Axial SpA: • Radiographic (Sacroiliitis seen on X- ray) • No Radiographic features non- radiographic SpA (nr-SpA) • Nr-SpA was formally known as undifferentiated SpA • Peripheral SpA: • Enthesitis, dactylitis and arthritis • Eventually evolves into a specific diagnosis A.S., PsA, etc. • Can be a/w IBD, HLA-B27 positivity, uveitis SHARED CLINICAL FEATURES: • Axial joint disease (especially SI joints) • Asymmetrical Oligoarthritis (2-4 joints). • Dactylitis (Sausage
    [Show full text]
  • The M. Transversus Thoracis in Man and Monkey
    Okajimas Fol. anat. jap., 48: 103-137, 1971 The M. Transversus Thoracis in Man and Monkey By Jun-ichiro Satoh Department of Anatomy, Faculty of Medicine, Nagasaki University, Nagasaki, Japan Received for publication, December 2, 1970— Of the Mm. thoracis proprii and profundi in man, the muscles that run across the ribs in the most inner layer of the thoracic wall have been termed the Mm. subcostales by Eisler. Of these, the group of muscles located in the mid-anterior chest are the Mm. transversi thoracis while those in the posterior chest are the Mm. subcostales in the narrow sense. The purpose of the present report is to describe the M. transversus thoracis in man and monkey, especially the nerve supply to these muscles which has not yet been documented in detail. The material of study consisted of bodies of adult Japanese (24 cases), Crab-eating monkey (Macaca irus, 15 cases) and Formosan mon- key (Macaca cyclopis, 15 cases). The condition on both sides of the body was examined with magnifying lenses having an illumination attach- ment. Findings I. Mm. transversi thoracis in man In man, the Mm. transversi thoracis were found to be flat, narrow muscles which are multiform being quite variable in shape. In the region of the lateral edge of the sternum, especially at the xiphoid process, they were united each other so that the muscles particularly the lower ones, frequently form so-called muscular digitation, the tip being the attachment to the rib (figures 1 and 2). 1. This muscle arose by tendon from the rib in the area of the costo- chondral joint, that is, from the region extending from the lateral tip of the costal cartilage to the bony rib.
    [Show full text]
  • The Vertebral Column Is 33 Vertebrae Held Together by Ligaments and Muscles, with Intervertebral Discs in Between
    The vertebral column is 33 vertebrae held together by ligaments and muscles, with intervertebral discs in between. The vertebral column provides support and upright posture (attenuates loads) for the body. It is also a site for many muscle attachments. There are natural curves in the spine to help with the support and posture, as well as increasing the flexibility of the spine. The 33 vertebrae are divided into 5 sections, with each group having unique features designed for specific purposes. The groups are: cervical (7), thoracic (12), lumbar (5), sacrum (5), and coccyx (4). All vertebrae have a body, 2 transverse processes, a spinous process, superior/inferior articulating facets, lamina, pedicle, and a vertebral foramen. 1 There are anterior convex curves in the cervical and lumbar spines. Posterior concave curves occur in the thoracic and sacral-coccygeal spines. The curves of the spine may increase/decrease as the body’s center of gravity shifts (ex: pregnancy, weight gain/loss, trauma)—this is a result of trying to maintain in the upright position, the brain over the body’s center of gravity. 2 Scoliosis—excessive lateral curvature; side to side Kyphosis—hunchback; excessive curvature of thoracic Lordosis—swayback ; excessive curvature of lumbar 3 C1 and C2 are shaped differently than the other 5 cervical vertebrae to permit the head to rotate. C1 (atlas) = holds up the world (head) and is missing a body; it articulates with the occipital bone as well as rotating around the odontoid process (dens) of the C2 vertebrae (atlantoaxial joint). The atlantoaxial joint is what type of joint?? C2 (axis) = odontoid process projects up C3-C7 = the body is small and all the processes are short and blunted.
    [Show full text]
  • Student Workbook Answer Pages Italicized Page Numbers After the Answers Indicate Where the Informa- Matching 5) Deep Fascia Tion Can Be Found in Trail Guide
    Student Workbook Answer Pages Italicized page numbers after the answers indicate where the informa- Matching 5) deep fascia tion can be found in Trail Guide. 1) N adipose—p. 17 6) adipose (fatty) tissue 2) F aponeurosis—p. 13 7) superficial fascia 3) D artery—p. 16 8) skin 4) H bone—p. 10 9) deep fascia Introduction 5) E bursa—p. 16 Tour Guide Tips #1, p. 1 6) B fascia—p. 14 1) bony landmarks—p. 2 7) G ligament—p. 13 2) Even though the topography, 8) I lymph node—p. 17 Navigating shape and proportion are unique, 9) A muscle—p. 11 Regions of the Body, p. 6 the body’s composition and struc- 10) J nerve—p. 17 1) pectoral tures are virtually identical on all 11) K retinaculum—p. 15 2) axillary individuals.—p. 2 12) L skin—p. 10 3) brachial 3) To examine or explore by touch- 13) M tendon—p. 13 4) cubital ing (an organ or area of the body), 14) C vein—p. 16 5) abdominal usually as a diagnostic aid—p. 4 6) inguinal 4) locating, aware, assessing—p. 4 Exploring Textures #1, p. 3 7) pubic 5) directs movement, depth.—p. 4 1) epidermis 8) femoral 6) • read the information 2) dermis 9) facial • visualize what you are trying 3) arrector pili muscle 10) mandibular to access 4) sweat gland 11) supraclavicular • verbalize to your partner what 5) hair follicle 12) antecubital you feel 6) blood vessels 13) patellar • locate the structure first 7) muscle fibers 14) crural on yourself 8) endomysium 15) cranial • read the text aloud 9) perimysium 16) cervical • be patient—p.
    [Show full text]
  • Simon Blackburn Bsc (Hons), MBBS, MRCS (Eng) Specialty Registrar in Paediatric Surgery
    6 Anatomy at a Glance 1 Companion website This book is accompanied by a companion website: www.wiley.com/go/anatomyataglance The website includes: • 100 interactive flashcards for self-assessment and revision Some figures in this book have been reproduced from Diagnostic Imaging, by P. Armstrong, M. Wastie and A. Rockall (9781405170390) c Blackwell Publishing Ltd. 2 Anatomy at a Glance Third edition Omar Faiz Bsc (Hons), FRCS (Eng), MS Senior Lecturer & Consultant Surgeon St Mary’s Campus Imperial College, London Simon Blackburn BSc (Hons), MBBS, MRCS (Eng) Specialty Registrar in Paediatric Surgery David Moffat VRD, MD, FRCS Emeritus Professor of Anatomy Cardiff University A John Wiley & Sons, Ltd., Publication 3 This edition first published 2011 © 2011 by Omar Faiz, Simon Blackburn and David Moffat Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell. Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
    [Show full text]
  • Ultrasound Assessment of Entheses and Correlations Between Disease Activity and Ultrasound Scores in Ankylosing Spondylitis: a Cross Sectional Study
    Ultrasound Assessment of Entheses and Correlations Between Disease Activity and Ultrasound Scores in Ankylosing Spondylitis: A Cross Sectional Study HAIQIN XIE Peking University Shenzhen Hospital GENGMIN ZHOU Peking University Shenzhen Hospital BO WEN Peking University Shenzhen Hospital HAIYU LUO Peking University Shenzhen Hospital YUSEN ZHANG Peking University Shenzhen Hospital QIAN DONG U-M: University of Michigan JIANQIU ZHONG Peking University Shenzhen Hospital JIYANG LV Peking University Shenzhen Hospital WEIWEI ZHANG Peking University Shenzhen Hospital HENG LV Peking University Shenzhen Hospital DESHENG SUN Peking University Shenzhen Hospital Qingwen Wang ( [email protected] ) Peking University Shenzhen Hospital https://orcid.org/0000-0003-3723-2414 LIU LI Peking University Shenzhen Hospital Research article Page 1/18 Keywords: Ultrasound, enthesitis, ankylosing spondylitis, disease activity Posted Date: October 27th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-95578/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/18 Abstract Background: An increasing number of studies have applied ultrasound (US) to evaluate enthesitis in spondyloarthritis. However, there is no clear agreement on which sites should be evaluated for enthesitis. Furthermore, there are different opinions on whether US can monitor disease activity. The objectives of this study were to evaluate the common involvement of entheses and correlations between disease activity and US scores in ankylosing spondylitis (AS). Methods: A cross-sectional, monocentric, and controlled study was performed. US was used to scan 34 entheses per person and the Madrid sonography enthesitis index (MASEI) score was used. US scores were used to evaluate the elemental lesions of hypoechogenicity, thickness, erosion, calcication, bursitis, and Doppler signal.
    [Show full text]