Accessory Subscapularis Muscle – a Forgotten Variation?
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Anatomical Variations of Brachial Plexus in Fetal Cadavers
DOI: 10.5137/1019-5149.JTN.21339-17.2 Received: 27.07.2017 / Accepted: 18.10.2017 Published Online: 13.11.2017 Original Investigation Anatomical Variations of Brachial Plexus in Fetal Cadavers Alparslan KIRIK1, Senem Ertugrul MUT2, Mehmet Kadri DANEYEMEZ3, Halil Ibrahim SECER4 1Etimesgut Sehit Sait Erturk State Hospital, Neurosurgery Clinic, Ankara, Turkey 2University of Kyrenia, Faculty of Medicine, Visiting Professor, Near East University, Faculty of Medicine, Department of Neurology, Girne, Turkish Republic of Northern Cyprus 3University of Health Sciences, Gulhane Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey 4University of Kyrenia, Faculty of Medicine, Visiting Professor, Near East University, Faculty of Medicine, Department of Neurosurgery, Girne, Turkish Republic of Northern Cyprus This study has been presented as an oral presentation at the 25th Scientific Congress of the Turkish Neurosurgical Society between 22 and 26 April 2011 at Antalya, Turkey. ABSTRACT AIM: The plexus brachialis is a complex structure with anatomical variations and connections with neighboring tissues. These variations may cause disparity in the motor and sensorial innervations of the upper extremity. The knowledge of anatomy and possible variations are important for performing surgical procedures in the neck, shoulder and axilla. This study was planned to demonstrate the anatomical variations of the infantile brachial plexus. MaterIAL and METHODS: A total of 20 plexus brachialis from 11 fetal cadavers were dissected and examined microscopically. The branching patterns and variations were evaluated. The width of the nerves was assessed at the level of the nerve root, trunk and cord on the basis of all brachial plexuses and they were arranged in terms of thickness. -
Thoracic Outlet and Pectoralis Minor Syndromes
S EMINARS IN V ASCULAR S URGERY 27 (2014) 86– 117 Available online at www.sciencedirect.com www.elsevier.com/locate/semvascsurg Thoracic outlet and pectoralis minor syndromes n Richard J. Sanders, MD , and Stephen J. Annest, MD Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218 article info abstract Compression of the neurovascular bundle to the upper extremity can occur above or below the clavicle; thoracic outlet syndrome (TOS) is above the clavicle and pectoralis minor syndrome is below. More than 90% of cases involve the brachial plexus, 5% involve venous obstruction, and 1% are associate with arterial obstruction. The clinical presentation, including symptoms, physical examination, pathology, etiology, and treatment differences among neurogenic, venous, and arterial TOS syndromes. This review details the diagnostic testing required to differentiate among the associated conditions and recommends appropriate medical or surgical treatment for each compression syndrome. The long- term outcomes of patients with TOS and pectoralis minor syndrome also vary and depend on duration of symptoms before initiation of physical therapy and surgical intervention. Overall, it can be expected that 480% of patients with these compression syndromes can experience functional improvement of their upper extremity; higher for arterial and venous TOS than for neurogenic compression. & 2015 Published by Elsevier Inc. 1. Introduction compression giving rise to neurogenic TOS (NTOS) and/or neurogenic PMS (NPMS). Much less common is subclavian Compression of the neurovascular bundle of the upper and axillary vein obstruction giving rise to venous TOS (VTOS) extremity can occur above or below the clavicle. Above the or venous PMS (VPMS). -
Subscapularis Rotator Cuff Repair
Arthroscopic Subscapularis Repair Indications for Surgery The rotator cuff is a group of four muscles that run from the scapula (shoulder blade) and attach to the humeral head (top of upper arm bone) by their tendons. One of the muscles of the rotator cuff is the subscapularis. The subscapularis muscle runs from the underside of the scapula (shoulder blade) to the front of the humerus (arm bone) and is responsible for internal rotation of the arm. When the rotator cuff is injured, the tendon is typically torn off the humerus (upper arm bone), retracts and cannot heal back on its own. The subscapularis tendon also plays a role in stabilizing the biceps tendon. When the subscapularis tendon is torn, it allows the biceps tendon to dislocate, become unstable, shift, fret like a rope and cause pain. If left untreated, the biceps may rupture and result in a “Popeye-like” deformity. Orthopaedic Surgery & Sports Medicine 630-324-0402 ⚫ [email protected] Teaching & Research Foundation stevenchudikmd.com otrfund.org Schedule online now © 2019 Steven Chudik MD Shoulder, Knee & Sports Medicine. All rights reserved. MRI of torn subscapularis tendon with retraction. Small arrow indicates where the subscapularis muscle should be attached to the humerus. Rotator cuff tears tend to progress and become larger and more symptomatic. Additionally, as time goes by the rotator cuff tendon retracts further and the rotator cuff muscle atrophies (shrinks and weakens) and degenerates (irreversibly turns to useless fat and scar tissue). This makes the repair technically more difficult (potentially not possible) and the rotator cuff becomes less likely to heal and function normally. -
Multi-Modal Imaging of the Subscapularis Muscle
Insights Imaging (2016) 7:779–791 DOI 10.1007/s13244-016-0526-1 REVIEW Multi-modal imaging of the subscapularis muscle Mona Alilet1 & Julien Behr2 & Jean-Philippe Nueffer1 & Benoit Barbier-Brion 3 & Sébastien Aubry 1,4 Received: 31 May 2016 /Revised: 6 September 2016 /Accepted: 28 September 2016 /Published online: 17 October 2016 # The Author(s) 2016. This article is published with open access at Springerlink.com Abstract • Long head of biceps tendon medial dislocation can indirect- The subscapularis (SSC) muscle is the most powerful of the ly signify SSC tendon tears. rotator cuff muscles, and plays an important role in shoulder • SSC tendon injury is associated with anterior shoulder motion and stabilization. SSC tendon tear is quite uncom- instability. mon, compared to the supraspinatus (SSP) tendon, and, most • Dynamic ultrasound study of the SSC helps to diagnose of the time, part of a large rupture of the rotator cuff. coracoid impingement. Various complementary imaging techniques can be used to obtain an accurate diagnosis of SSC tendon lesions, as well Keywords Subscapularis . Tendon injury . Rotator cuff . as their extension and muscular impact. Pre-operative diag- Magnetic resonance imaging . Coracoid impingement nosis by imaging is a key issue, since a lesion of the SSC tendon impacts on treatment, surgical approach, and post- operative functional prognosis of rotator cuff injuries. Introduction Radiologists should be aware of the SSC anatomy, variabil- ity in radiological presentation of muscle or tendon injury, The subscapularis (SSC) muscle is one of the four compo- and particular mechanisms that may lead to a SSC injury, nents of the rotator cuff along with the supraspinatus (SSP), such as coracoid impingement. -
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Folia Morphol. Vol. 79, No. 1, pp. 1–14 DOI: 10.5603/FM.a2019.0047 R E V I E W A R T I C L E Copyright © 2020 Via Medica ISSN 0015–5659 journals.viamedica.pl Should Terminologia Anatomica be revised and extended? A critical literature review P.P. Chmielewski1, B. Strzelec2, 3 1Division of Anatomy, Department of Human Morphology and Embryology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland 2Department and Clinic of Vascular, General and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland 3Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland [Received: 14 November 2018; Accepted: 31 December 2018] The first edition of the Terminologia Anatomica was published in 1998 by the Federative Committee for Anatomical Terminology, whereas the second edition was issued in 2011 by the Federative International Programme for Anatomical Terminologies. Since then many attempts have been made to revise and extend the official terminology as several inconsistencies have been noted. Moreover, numerous crucial terms were either omitted or deliberately excluded from the official terminology, like sulcus popliteus and diaphragma urogenitale, respec- tively. Furthermore, several synonyms are to be discarded. Notwithstanding the criticism, the use of the current version of terminology is strongly recommended. Although the Terminologia Anatomica is open to future expansion and revision, every change should be made after a thorough discussion of the historical context and scientific legitimacy of a given term. The anatomical nomenclature must be as simple as possible but also precise and coherent. It is generally accepted that hasty innovation ought not to be endorsed. -
A Very Rare Case of an Accessory Subscapularis Muscle and Its Potential Clinical Significance
Surgical and Radiologic Anatomy (2021) 43:19–25 https://doi.org/10.1007/s00276-020-02531-6 ANATOMIC VARIATIONS A very rare case of an accessory subscapularis muscle and its potential clinical signifcance Nicol Zielinska1 · Łukasz Olewnik1 · Piotr Karauda1 · R. Shane Tubbs3,4,5 · Michał Polguj2 Received: 27 May 2020 / Accepted: 7 July 2020 / Published online: 12 July 2020 © The Author(s) 2020 Abstract The subscapularis muscle is the largest muscle of the rotator cuf and its main function is internal rotation. It is morphologi- cally variable in both point of origin and insertion. The presence of an accessory subscapularis muscle can lead to brachial plexus neuropathy. This report presents a very rare accessory subscapularis muscle originating from two distinct bands on the subscapularis and teres major muscles. The insertion was divided among four tendons. The fourth tendon is bifurcated. One of these was connected to the tendon of the subscapularis muscle and the other three inserted into the base of the cora- coid process of the scapula. This anomalous muscle has the potential to entrap the nerves of the posterior cord such as the axillary, lower subscapular, and thoracodorsal nerves. Keywords Subscapularis muscle · Subscapularis tendon · Accessory subscapularis muscle · Lower subscapular nerve · Rotator cuf · Quadrangular space syndrome · Compression syndrome Introduction the subscapularis fossa. Its insertion is situated on the supe- rior part of the humerus (in most cases, the lesser tuberosity) The subscapularis muscle (SM) is the largest and the most [11, 14, 23]. The SM limits the axillary fossa from behind. It powerful muscle of the rotator cuf [10, 11]. -
Anatomy, Shoulder and Upper Limb, Shoulder Muscles
Eovaldi BJ, Varacallo M. Anatomy, Shoulder and Upper Limb, Shoulder Muscles. [Updated 2018 Dec 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534836/ Anatomy, Shoulder and Upper Limb, Shoulder Muscles Authors Benjamin J. Eovaldi1; Matthew Varacallo2. Affilations 1 University of Tennessee HSC 2 Department of Orthopaedic Surgery, University of Kentucky School of Medicine Last Update: December 3, 2018. Introduction The shoulder joint (glenohumeral joint) is a ball and socket joint with the most extensive range of motion in the human body. The muscles of the shoulder dynamically function in performing a wide range of motion, specifically the rotator cuff muscles which function to move the shoulder and arm as well as provide structural integrity to the shoulder joint. The different movements of the shoulder are: abduction, adduction, flexion, extension, internal rotation, and external rotation.[1] The central bony structure of the shoulder is the scapula. All the muscles of the shoulder joint interact with the scapula. At the lateral aspect of the scapula is the articular surface of the glenohumeral joint, the glenoid cavity. The glenoid cavity is peripherally surrounded and reinforced by the glenoid labrum, shoulder joint capsule, supporting ligaments, and the myotendinous attachments of the rotator cuff muscles. The muscles of the shoulder play a critical role in providing stability to the shoulder joint. The primary muscle group that supports the shoulder joint is the rotator cuff muscles. The four rotator cuff muscles include:[2] • Supraspinatus • Infraspinatus • Teres minor • Subscapularis. Structure and Function The upper extremity is attached to the appendicular skeleton by way of the sternoclavicular joint. -
Subscapularis: the Hidden Culprit Judith Delany, LMT
Subscapularis: The Hidden Culprit Judith DeLany, LMT The shoulder is a vastly complex structure. © Mediclip Manual Medicine collection 1, 1997 Seven joints are involved in functional movement Williams & Wilkins. A Waverly Company of the shoulder girdle. Each of these joints is interdependent on the integrity and function of the others. They include the glenohumeral (scapulohumeral), suprahumeral (subdeltoid), scapulothoracic (scapulocostal), acromioclavicular, sternoclavicular, first contralateral sternocostal, and first contralateral costovertebral joints. With the gathering of an inordinate amount of data from each of these joints and their associated muscles, bursae, and ligaments, it is easy to see how ‘information overload’ might readily occur, with no clear indication of where therapy should begin. The glenohumeral joint is considered by many to be the most important joint of the shoulder girdle. When all tissues associated with this joint are functioning normally, it has a greater degree of Fig. 1: Only a small portion of subscapularis is palpable. movement than any other joint in the body. Even when other joints of the girdle are restricted, if movements of the glenohumeral joint are healthy, are commonly called the rotator cuff or SITS the arm may be functional (at least to some degree) muscles. The fibers of the SITS tendons blend with and allow some use of the limb. However, when the the joint capsule, which makes them especially glenohumeral joint is restricted, there will be little vulnerable to injury since they are so closely or no use of the arm. approximated to the joint. Since the convex ovoid humeral head Subscapularis, a particularly important significantly exceeds the surface area of the glenoid muscle when considering shoulder dysfunctions, is fossa, with which it articulates, only a small part of almost hidden from palpation. -
Arterial Supply to the Rotator Cuff Muscles
Int. J. Morphol., 32(1):136-140, 2014. Arterial Supply to the Rotator Cuff Muscles Suministro Arterial de los Músculos del Manguito Rotador N. Naidoo*; L. Lazarus*; B. Z. De Gama*; N. O. Ajayi* & K. S. Satyapal* NAIDOO, N.; LAZARUS, L.; DE GAMA, B. Z.; AJAYI, N. O. & SATYAPAL, K. S. Arterial supply to the rotator cuff muscles.Int. J. Morphol., 32(1):136-140, 2014. SUMMARY: The arterial supply to the rotator cuff muscles is generally provided by the subscapular, circumflex scapular, posterior circumflex humeral and suprascapular arteries. This study involved the bilateral dissection of the scapulohumeral region of 31 adult and 19 fetal cadaveric specimens. The subscapularis muscle was supplied by the subscapular, suprascapular and circumflex scapular arteries. The supraspinatus and infraspinatus muscles were supplied by the suprascapular artery. The infraspinatus and teres minor muscles were found to be supplied by the circumflex scapular artery. In addition to the branches of these parent arteries, the rotator cuff muscles were found to be supplied by the dorsal scapular, lateral thoracic, thoracodorsal and posterior circumflex humeral arteries. The variations in the arterial supply to the rotator cuff muscles recorded in this study are unique and were not described in the literature reviewed. Due to the increased frequency of operative procedures in the scapulohumeral region, the knowledge of variations in the arterial supply to the rotator cuff muscles may be of practical importance to surgeons and radiologists. KEY WORDS: Arterial supply; Variations; Rotator cuff muscles; Parent arteries. INTRODUCTION (Abrassart et al.). In addition, the muscular parts of infraspinatus and teres minor muscles were supplied by the circumflex scapular artery while the tendinous parts of these The rotator cuff is a musculotendionous cuff formed muscles received branches from the posterior circumflex by the fusion of the tendons of four muscles – viz. -
…Going One Step Further
…going one step further M11 (1000347) 11 10 2 9 8 1 3 7 12 4 5 6 13 } 19 20 14 21 18 22 23 17 32 31 30 24 15 33 29 25 16 28 27 26 35 36 20 21 3 18 34 10 15 8 9 12 32 30 28 24 29 13 } 37 19 38 23 17 9 39 5 31 14 27 26 23 40 16 31 4 41 30 5 42 67 61 43 2 32 44 6 45 66 46 47 48 65 49 1 50 51 62 60 63 59 64 58 52 57 30 56 55 53 54 3 Latin 1 Conexus intertendinei 53 M. flexor digitorum profundus, tendo 2 Mm. interossei dorsales manus 54 Vaginae fibrosae, pars anularis 3 N. radialis 55 N. ulnaris, nn. digitales palmares proprii 4 A. radialis 56 Vaginae fibrosae, pars cruciforme 5 Retinaculum extensorum 57 Arcus palmaris superficialis 6 M. abductor pollicis brevis 58 M. abductor digiti minimi manus 7 M. extensor carpi radialis brevis 59 M. opponens digiti minimi manus 8 M. extensor carpi radialis longus 60 N. ulnaris, ramus superficialis 9 M. brachioradialis 61 Aa. metatarsales dorsales 10 M. brachialis 62 Os metacarpale, caput 11 M. deltoideus 63 Aa. digitales dorsales manus 12 M. supraspinatus 64 Nn. digitales dorsales (manus) 13 Scapula, spina 65 M. extensor indicis, tendo 14 M. trapezius 66 Os metacarpale, corpus 15 M. infraspinatus 67 M. extensor pollicis, tendo 16 M. latissimus dorsi 17 M. teres major 18 M. teres minor 19 Spatium axillare mediale 20 M. triceps brachii, caput longum 21 M. -
Study of Axillary Arch: Embryological Basis and Its Clinical Implications
Original Article Indian Journal of Anatomy291 Volume 7 Number 3, May - June 2018 DOI: http://dx.doi.org/10.21088/ija.2320.0022.7318.12 Study of Axillary Arch: Embryological Basis and Its Clinical Implications Divya Shanthi D’Sa1, Vasudha T.K.2 Abstract Aim: To study the incidence, embryological basis and clinical implications of unusual but most common anatomical variant, axillary arch. Materials & Methods: The study was conducted in the department of Anatomy, Subbaiah Institute of Medical Sciences, Shimoga during routine cadaveric dissection on 60 upper limbs. Results: Of the 60 upper limbs dissected, Axillary arch was seen in one right upper limb. It was extending between latissimus dorsi and fascia covering the subscapularis muscle after crossing the posterior cord of brachial plexus and circumflex scapular vessels. It was supplied by a branch from the thoracodorsal nerve. Conclusion: The presence of an axillary arch needs to be considered in differential diagnosis of axillary swellings and also in surgeries of shoulder region. Therefore it is mandatory to know the variant slips of the musculotendinous arch. Keywords: Axillary Arch; Latissimus Dorsi; Neurovascular Bundle; Clinical Implications. Introduction other variants of this anomaly have also been observed like the muscle adhering to the coracoid process of the scapula, medial epicondyle of the Humerus or The axillary arch muscle is an accessory muscle blending with the fibers of teres major, long head of that extends between the pectoralis major and triceps brachii, coracobrachialis -
Evolution of the Muscular System in Tetrapod Limbs Tatsuya Hirasawa1* and Shigeru Kuratani1,2
Hirasawa and Kuratani Zoological Letters (2018) 4:27 https://doi.org/10.1186/s40851-018-0110-2 REVIEW Open Access Evolution of the muscular system in tetrapod limbs Tatsuya Hirasawa1* and Shigeru Kuratani1,2 Abstract While skeletal evolution has been extensively studied, the evolution of limb muscles and brachial plexus has received less attention. In this review, we focus on the tempo and mode of evolution of forelimb muscles in the vertebrate history, and on the developmental mechanisms that have affected the evolution of their morphology. Tetrapod limb muscles develop from diffuse migrating cells derived from dermomyotomes, and the limb-innervating nerves lose their segmental patterns to form the brachial plexus distally. Despite such seemingly disorganized developmental processes, limb muscle homology has been highly conserved in tetrapod evolution, with the apparent exception of the mammalian diaphragm. The limb mesenchyme of lateral plate mesoderm likely plays a pivotal role in the subdivision of the myogenic cell population into individual muscles through the formation of interstitial muscle connective tissues. Interactions with tendons and motoneuron axons are involved in the early and late phases of limb muscle morphogenesis, respectively. The mechanism underlying the recurrent generation of limb muscle homology likely resides in these developmental processes, which should be studied from an evolutionary perspective in the future. Keywords: Development, Evolution, Homology, Fossils, Regeneration, Tetrapods Background other morphological characters that may change during The fossil record reveals that the evolutionary rate of growth. Skeletal muscles thus exhibit clear advantages vertebrate morphology has been variable, and morpho- for the integration of paleontology and evolutionary logical deviations and alterations have taken place unevenly developmental biology.