DOCSLIB.ORG

Examination of the Shoulder Bruce S

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Examination of the Shoulder Bruce S Examination of the Shoulder Bruce S. Wolock, MD Towson Orthopaedic Associates 3 Joints, 1 Articulation 1. Sternoclavicular 2. Acromioclavicular 3. Glenohumeral 4. Scapulothoracic AC Separation Bony Landmarks 1. Suprasternal notch 2. Sternoclavicular joint 3. Coracoid 4. Acromioclavicular joint 5. Acromion 6. Greater tuberosity of the humerus 7. Bicipital groove 8. Scapular spine 9. Scapular borders-vertebral and lateral Sternoclavicular Dislocation Soft Tissues 1. Rotator Cuff 2. Subacromial bursa 3. Axilla 4. Muscles: a. Sternocleidomastoid b. Pectoralis major c. Biceps d. Deltoid Congenital Absence of Pectoralis Major Pectoralis Major Rupture Soft Tissues (con’t) e. Trapezius f. Rhomboid major and minor g. Latissimus dorsi h. Serratus anterior Range of Motion: Active and Passive 1. Abduction - 90 degrees 2. Adduction - 45 degrees 3. Extension - 45 degrees 4. Flexion - 180 degrees 5. Internal rotation – 90 degrees 6. External rotation – 45 degrees Muscle Testing 1. Flexion a. Primary - Anterior deltoid (axillary nerve, C5) - Coracobrachialis (musculocutaneous nerve, C5/6 b. Secondary - Pectoralis major - Biceps Biceps Rupture- Longhead Muscle Testing 2. Extension a. Primary - Latissimus dorsi (thoracodorsal nerve, C6/8) - Teres major (lower subscapular nerve, C5/6) - Posterior deltoid (axillary nerve, C5/6) b. Secondary - Teres minor - Triceps Abduction Primary a. Middle deltoid (axillary nerve, C5/6) b. Supraspinatus (suprascapular nerve, C5/6) Secondary a. Anterior and posterior deltoid b. Serratus anterior Deltoid Ruputure Axillary Nerve Palsy Adduction Primary a. Pectoralis major (medial and lateral pectoral nerves, C5-T1 b. Latissimus dorsi (thoracodorsal nerve, C6/8) Secondary a. Teres major b. Anterior deltoid External Rotation Primary a. Infraspinatus (suprascapular nerve, C5/6) b. Teres minor (axillary nerve, C5) Secondary a. Posterior deltoid Internal Rotation Primary a. Subscapularis (upper and lower subscapular nerves, C5/6) b. Pectoralis major (medial and lateral pectoral nerves, C5-T1) c. Latissimus dorsi (thorasodorsal nerve, C6/8) d. Teres major (lower subscapular nerve, C5/6) Secondary a. Anterior deltoid Scapular Elevation (Shrug) Primary a. Trapezius (spinal accessory nerve, CN X1) b. Levator scapulae (C3, C4, dorsal scapular nerve) Secondary a. Rhomboid major b. Rhomboid minor Spinal Accessory Nerve Palsy Scapular Retration (Attention) Primary a. Rhomboid major (dorsal scapular nerve, C5) b. Rhomboid minor (dorsal scapular nerve, C5) Secondary a. Trapezius Winged Scapula Scapular Protraction (Reaching) Primary a. Serratus anterior (long thoracic neer, C5/7) Reflex Testing Cervical Spine Sensation Testing C4-Neck C5-Shoulder C6-Lateral forearm , thumb and index fingers C7-Middle finger C8-Medial forearm, small and ring fingers T1-Medial arm T2-Axilla Related Areas 1. Cervical spine 2. Cardiac 3. Thoracic outlet Thoracic Outlet Syndrome Special Tests 1. Impingement sign 2. Drop-arm test 3. Apprehension test 4. Sulcus sign Sulcus Sign Elbow Anatomy Bruce S. Wolock, MD HUMERUS lateral epicondyle capitellum coronoid fossa trochlea olecranon fossa anterior view medial epicondyle posterior view RADIUS head tuberosity neck head ULNA coronoid olecranon process process shaft radial notch Ligaments Medial Annular Lateral Ulnar Collateral Collateral medial collateral (medial epicondyle to ulna) lateral ulnar collateral (lat. epicondyle to ulna) annular (lateral epicondyle, around radius, to ulna) 5 MUSCLES ORIGINATE FROM MEDIAL EPICONDYLE pronator teres fcr pl fds fcu 5 MUSCLES ARISE FROM LATERAL EPICONDYLE 5 Muscles Have More Proximal Humeral Origins 1 5 2 3 4 NAME THE 15 MUSCLES CROSSING THE ELBOW 5 originate on lateral epicondyle 5 originate on medial epicondyle 2 originate on lateral supracondylar ridge 1 originates on scapula & posterior humeral shaft 5 1 originates on scapula & anterior humeral shaft 1 originates on anterior humeral shaft ANOMALOUS MUSCLE CROSSING ELBOW medial epicondyle to ulna: anconeus epitrochlearis (rare) Elbow Cross-Sectional Anatomy Viewing from new perspectives aids understanding Goal: conceptualize the anatomy three-dimensionally For orientation: 27 You are looking at a right upper limb as if standing on tip thumb of right middle finger and looking toward shoulder Yellow line shows level of the section small middle ring finger index finger anterior finger lateral medial finger posterior For orientation: Section through midpalm thumb thenar mc muscles 47 first web muscles small anterior mc lateral medial posterior For orientation: Section through median distal radius and ulna nerve 67 ulnar radial styloid styloid anterior lateral medial posterior extensor tendons For orientation: Section through mid forearm 107 fcr ecrl fcu fdp radius anterior edc ulna lateral medial posterior ecu Section through proximal forearm and radial tuberosity 1. two forearm supinators: supinator, biceps 127 br fds 2. two branches ecrl of same radial 3. two nerve: tuberosity arteries radial nerve supplying anterior lateral medial forearm: posterior radial, ulnar Section through elbow joint 1. Useful for biceps doing pull- ups tendon 2. “small 137 head” in brachialis Latin trochlea annular capi- ligament tellum 3. Joint responsible for ulna forearm anterior lateral medial rotation: posterior radio-ulnar joint Section through condyles of humerus 1. supinates forearm biceps 2. major 147 artery and brachialis nerve: brachial artery humerus median nerve medial epicondyle olecranon anterior 3. the “funny bone” lateral medial triceps posterior tendon ulnar nerve Section through distal humerus 1. injury causes wrist drop biceps after humeral brachialis shaft fx: 157 median radial 3. inserts nerve nerve on radius: brachio- humerus ulnar radialis nerve anterior 2. inserts lateral medial posterior on ulna: triceps The Elbow Physical Examination Bruce S. Wolock, MD History • Age, dominance, occupation, avocations • Severity, when and where • Injury (mechanism of action) • Numbness and tingling • Previous problems DO NOT FORGET NECK, SHOULDER, WRIST Physical Exam • Inspection • Palpation (bony, soft tissue) • Range of motion • Neurologic examination • Special tests Inspection: anterior Carrying angle: normally 10 degrees in men 15 degrees in women varus valgus deformity deformity Inspection: lateral Inspection • Posterior • Medial – subluxation of ulnar nerve Inspection: symmetry Bony Palpation Bony Palpation Bony Palpation Bony Palpation Soft Tissue Palpation Pronator teres FCR PL FDS Flexor carpi ulnaris Soft Tissue Palpation Anconeus ECU EDQ ECRB EDC Soft Tissue Palpation Soft Tissue Palpation TAN = tendon-artery-nerve Soft Tissue Palpation Nerves: Radial Median Ulnar check for subluxation with e/f Range of Motion • Flexion-extension at humeroulnar and humeroradial joints • Supination-pronation at radioulnar at wrist and elbow • Active and passive Range of Motion Flexion >135 Extension 0 or more compare to opposite side Pronation/supination ~80/~80 Compare to opposite side Keep elbows against flanks to block shoulder compensation MUSCLE GRADING as usual 5 Normal Gravity +Full Resistance 4 Good Gravity +Some Resistance 3 Fair Gravity 2 Poor Gravity eliminated 1 Trace Flicker, no joint movement 0 Zero No contractility Neurologic Exam: Motor • Flexion: Brachialis, biceps (musc. n., C5,C6) • Extension: Triceps (radial n., C7) • Supination: Biceps, supinator (radial n., C6) • Pronation: Pronator teres (med. n., C6), pronator quadratus (ain, C8, T1) Neuro Exam: Reflexes • Biceps - C5 • Brachioradialis – C6 • Triceps – C7 Neuro C5 Exam: Sensation C6 T1 C8 C7 Functional Motion • Functional range e/f = 30/130 – loss of flexion more disabling than loss of extension • Functional range p/s = 50/50 Ligament Stability Special Tests • Tinel sign • Tennis elbow stress • Posterolateral rotatory instability .
Load more

Recommended publications
  • Suprascapular Poster NANS
    Novel Lead Placement for Suprascapular Nerve Peripheral Nerve Stimulation Adrian Darryll Sulindro MD, David Spinner DO, Michael Gofeld Department of Rehabilitation Medicine, Affiliate of the Icahn School of Medicine at Mount Sinai, New York, NY Introduction Case Description Discussion Peripheral nerve stimulation is often times used more for chronic An 82 year old male with chronic right shoulder pain, multifactorial in Shoulder pain is very important and prevalent in western society with a one-year prevalence of 4.7 - 46.7% (1). The etiology of chronic shoulder pain is very diverse and can include musculoskeletal and nerve related pains. Peripheral nerve stimulation origin due to osteoarthritis, chronic rotator cuff tendinopathy and orthopedic conditions but also non-orthopedic causes such as cervical radiculopathy, and in of the suprascapular nerve is one of the most common nerves post herpetic neuralgia was evaluated for peripheral nerve our patients case also post herpetic neuralgia. This can limit a patient's ability for his daily targeted for shoulder pain. Here we demonstrate a new novel lead stimulation. His pain is chronic in origin, having been present for over activities and causes burdens on both the patient and society around him. The suprascapular nerve is considered one of the important nerves in the shoulder region. It contains both the placement technique for suprascapular nerve stimulation. 10 years, was described as intense burning sensation, and rating a motor fibers to the supraspinatus and infraspinatus muscles, and is a major part of sensory constant 8/10 on a numeric pain rating scale. Physical therapy, innervation of the shoulder which also includes the axillary nerve.
    [Show full text]
  • Redalyc.Variations in Branching Pattern of the Axillary Artery: a Study
    Jornal Vascular Brasileiro ISSN: 1677-5449 [email protected] Sociedade Brasileira de Angiologia e de Cirurgia Vascular Brasil Astik, Rajesh; Dave, Urvi Variations in branching pattern of the axillary artery: a study in 40 human cadavers Jornal Vascular Brasileiro, vol. 11, núm. 1, marzo, 2012, pp. 12-17 Sociedade Brasileira de Angiologia e de Cirurgia Vascular São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=245023701001 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative ORIGINAL ARTICLE Variations in branching pattern of the axillary artery: a study in 40 human cadavers Variações na ramificação do padrão da artéria axilar: um estudo em 40 cadáveres humanos Rajesh Astik1, Urvi Dave2 Abstract Background: Variations in the branching pattern of the axillary artery are a rule rather than an exception. The knowledge of these variations is of anatomical, radiological, and surgical interest to explain unexpected clinical signs and symptoms. Objective: The large percentage of variations in branching pattern of axillary artery is making it worthwhile to take any anomaly into consideration. The type and frequency of these vascular variations should be well understood and documented, as increasing performance of coronary artery bypass surgery and other cardiovascular surgical procedures. The objective of this study is to observe variations in axillary artery branches in human cadavers. Methods: We dissected 80 limbs of 40 human adult embalmed cadavers of Asian origin and we have studied the branching patterns of the axillary artery.
    [Show full text]
  • Study of Brachial Plexus with Regards to Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 4 Ver. VII (Apr. 2016), PP 23-28 www.iosrjournals.org Study of Brachial Plexus With Regards To Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations. Dr. Shambhu Prasad1, Dr. Pankaj K Patel2 1 (Assistant Professor , Department of Anatomy , NMCH , Sasaram , India ) 2 (Assistant Professor , Department of Pathology , NMCH , Sasaram , India ) Abstract: Aim of the study: to search variations in formation and branching pattern of brachial plexus and correlate them with possible clinical and surgical implications. Materials and Methods: 25human bodies were dissected for this study. Dissection was started in posterior triangle of neck and extended to distal part of upper limb passing through axilla . Photographs were taken and data was tabulated and analyzed . Observations: All 50 plexuses had origin from C5 – T1 . Dorsal scapular nerve was absent in 2 plexuses. Long thoracic nerve was made of C5,C6 fibers in one and of C6,C7 fibers in another . Lower trunk was abnormal in 2 plexuses both of same body, their was no contribution from T1 fibers to posterior cord in one of these plexus. One plexus had double lateral pectoral nerve , communication between lateral and medial pectoral nerves , lateral pectoral and medial root of median nerve also between musculocutaneous and lateral root of median nerve . 2 more plexuses had communication between lateral and medial pectoral nerves. One plexus showed 2 branches coming from posterior division of upper trunk itself before formation of posterior cord.
    [Show full text]
  • Bilateral Presence of a Variant Subscapularis Muscle
    CASE REPORT Bilateral presence of a variant subscapularis muscle Krause DA and Youdas JW Krause DA, Youdas JW. Bilateral presence of a variant subscapularis the lateral subscapularis inserting into the proximal humerus with the tendon of muscle. Int J Anat Var. 2017;10(4):79-80. the subscapularis. The axillary and lower subscapular nerves coursed between the observed muscle and the subscapularis. The presence of the muscle has potential ABSTRACT to entrap the axillary nerve and the lower subscapular nerve. We describe the presence of an accessory subscapularis muscle observed bilaterally Key Words: Accessory subscapularis; Axillary nerve; Lower subscapular nerve; in a human anatomy laboratory. The muscle originated from the mid-region of Entrapment INTRODUCTION everal anatomic variations in axillary musculature have been reported (1- S4). One of the more common variations is the axillary arch muscle, also known as Langer’s muscle, the axillopectoral muscle, and the pectordorsal muscle (3,4). This muscle typically arises from the lateral aspect of the latissimus dorsi inserting deep to the pectoralis major on the humerus. Several variations of the axillary arch muscle are described with a reported incidence of 6-9% (4-6). Less frequent and distinctly different than the axillary arch muscle, is a variant muscle associated with the subscapularis. This has been termed the subscapulo-humeral muscle, subscapularis minor, subscapularis-teres-latissimus muscle, and the accessory subcapularis muscle (1,2,7). Reported incidence ranges from 0.45 to 2.6% (2,7). CASE REPORT A variant muscle associated with the subscapularis bilaterally was observed on a Caucasian female embalmed cadaver during routine dissection in a human anatomy class for first year physical therapy students.
    [Show full text]
  • Risk of Encountering Dorsal Scapular and Long Thoracic Nerves During Ultrasound-Guided Interscalene Brachial Plexus Block with Nerve Stimulator
    Korean J Pain 2016 July; Vol. 29, No. 3: 179-184 pISSN 2005-9159 eISSN 2093-0569 http://dx.doi.org/10.3344/kjp.2016.29.3.179 | Original Article | Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Wonkwang Institute of Science, Iksan, *Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, University of Seonam College of Medicine, Jeonju, Korea Yeon Dong Kim, Jae Yong Yu*, Junho Shim*, Hyun Joo Heo*, and Hyungtae Kim* Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%).
    [Show full text]
  • Systemic Lupus Erythematosus Presenting with Finger Drop
    DOI: 10.7860/JCDR/2018/36196.12107 Case Report Systemic Lupus Erythematosus Section Presenting with Finger Drop Internal Medicine MARJAN RAHIMI FARAHANI1, SAMIRA ALESAEIDI2 ABSTRACT Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multiple organ involvement that can affect joints, skin, heart, lungs, kidneys and nervous system. SLE is a multisystem disorder resulting from abnormal immunological function. SLE affects women more than men. It affects both the central and the peripheral nervous system. Severe acute peripheral neuropathy in SLE is quite rare and it is always accompanied by evidence of active disease in other organs, including the central nervous system. The recognition of neurologic symptoms in SLE remains a clinical problem for physicians. Neurological manifestations are frequently present in SLE patients, although the peripheral nervous system involvement is rarer than the central one. Peripheral neuropathy is a known but uncommon presentation of SLE and the aim of this study is to report various forms of lupus-related neuropathies that may present as finger drop and discusses one of the rare neurological manifestations of lupus which remains a diagnostic challenge. Keywords: Autoimmune diseases, Nervous system, Pathology CASE REPORT A 33-year-old female was referred to the hospital with a chief compliant of symmetric finger drop of second, third and fourth fingers without any wrist drop for nine months before. She was able to use her fists but she had limitation on abduction of all fingers and also full extension of metacarpophalangeal and interphalangeal joints. The evaluation of sensation and reflexes were normal. The patient complained of shoulder, wrist, interphalangeal, knee, and elbow and ankle arthralgia.
    [Show full text]
  • Muscle Attachment Sites in the Upper Limb
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Muscle Attachment Sites in the Upper Limb The Clavicle Pectoralis major Smooth superior surface of the shaft, under the platysma muscle Deltoid tubercle: Right clavicle attachment of the deltoid Deltoid Axillary nerve Acromial facet Trapezius Sternocleidomastoid and Trapezius innervated by the Spinal Accessory nerve Sternocleidomastoid Conoid tubercle, attachment of the conoid ligament which is the medial part of the Sternal facet coracoclavicular ligament Conoid ligament Costoclavicular ligament Acromial facet Impression for the Trapezoid line, attachment of the costoclavicular ligament Subclavian groove: Subclavius trapezoid ligament which binds the clavicle to site of attachment of the Innervated by Nerve to Subclavius which is the lateral part of the the first rib subclavius muscle coracoclavicular ligament Trapezoid ligament This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Scapula Trapezius Right scapula: posterior Levator scapulae Supraspinatus Deltoid Deltoid and Teres Minor are innervated by the Axillary nerve Rhomboid minor Levator Scapulae, Rhomboid minor and Rhomboid Major are innervated by the Dorsal Scapular Nerve Supraspinatus and Infraspinatus innervated by the Suprascapular nerve Infraspinatus Long head of triceps Rhomboid major Teres Minor Teres Major Teres Major
    [Show full text]
  • Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies
    Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies a, b Leo H. Wang, MD, PhD *, Michael D. Weiss, MD KEYWORDS Radial Posterior interosseous Neuropathy Electrodiagnostic study KEY POINTS The radial nerve subserves the extensor compartment of the arm. Radial nerve lesions are common because of the length and winding course of the nerve. The radial nerve is in direct contact with bone at the midpoint and distal third of the humerus, and therefore most vulnerable to compression or contusion from fractures. Electrodiagnostic studies are useful to localize and characterize the injury as axonal or demyelinating. Radial neuropathies at the midhumeral shaft tend to have good prognosis. INTRODUCTION The radial nerve is the principal nerve in the upper extremity that subserves the extensor compartments of the arm. It has a long and winding course rendering it vulnerable to injury. Radial neuropathies are commonly a consequence of acute trau- matic injury and only rarely caused by entrapment in the absence of such an injury. This article reviews the anatomy of the radial nerve, common sites of injury and their presentation, and the electrodiagnostic approach to localizing the lesion. ANATOMY OF THE RADIAL NERVE Course of the Radial Nerve The radial nerve subserves the extensors of the arms and fingers and the sensory nerves of the extensor surface of the arm.1–3 Because it serves the sensory and motor Disclosures: Dr Wang has no relevant disclosures. Dr Weiss is a consultant for CSL-Behring and a speaker for Grifols Inc. and Walgreens. He has research support from the Northeast ALS Consortium and ALS Therapy Alliance.
    [Show full text]
  • Stichting Voor Ooglijders Prof. Dr. HJ
    De publicatie van dit proefschrift werd mede mogelijk gemaakt met fmanciele steun van: Stichting voor Ooglijders Prof. Dr. H.J. Flieringa Stichting Medical Workshop BV Kabi Pharmacia Bournonville-Pharma BV Ter herinnering aan mijn vader Omslag: Henry Cannon I Ebbo Clerlo: CLINICAL ASPECTS AND ETIOLOGY OF FUCHS' HETEROCHROMIC CYCLITIS (KLINISCHE ASPECTEN EN ETIOLOGIE VAN DE HETEROCHROME CYCLITIS VAN FUCHS) proefschrift Ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de Rector Magnificus Prof. dr. P.W.C. Akkermans M. Lit. en volgens besluit van het College van Dekanen. De openbare verdediding zal plaatsvinden op woensdag 3 November 1993 om 15.45 uur. door Ellen Carolien La Heij geboren te Arnstelveen PROMOTIE-COMMISSIE PROMOTORES' Prof. dr. P.T.V.M. de Jong Prof. dr. A. Kijlstra OVERIGE LEDEN, Prof. dr. F.T. Bosman Prof. dr. H.A. Drexhage CONTENTS Chapter 1 1.1 General Introduction ........................ 7 1. 2 Aim of the Thesis_ ................... __ ...... 8 Chapter 2 Fuchs' Heterochromic Cyclitis: Review of the Literature (submitted for publication) 2.1 Historical Background ........................ 9 2.2 Terminology and Classification ............... 9 2. 3 Epidemiology. .11 2. 4 Clinical Features ........................... 11. 2.5 Histopathology of the Iris ................. 22 2. 6 Etiologic Mechanisms ........................ 25 2.7 Therapy and Prognosis .................... ... 37 Chapter 3 Clin~c~l analysis of Fuchs' heterochromic cycl1t1s ........................................ 49 (Doc Ophthalmol. 1991;78:225-235). Chapter 4 Treatment and prognosis of secondary glaucoma in Fuchs' heterochromic cyclitis ............... .... 61 (Am J Ophthalmol. 1993, in press) Chapter 5 Quantitative analysis of iris translucency in Fuchs' heterochromic cyclitis ................. .. 83 (Invest Ophthalmol & Vis Sci.
    [Show full text]
  • Orphanet Report Series Rare Diseases Collection
    Marche des Maladies Rares – Alliance Maladies Rares Orphanet Report Series Rare Diseases collection DecemberOctober 2013 2009 List of rare diseases and synonyms Listed in alphabetical order www.orpha.net 20102206 Rare diseases listed in alphabetical order ORPHA ORPHA ORPHA Disease name Disease name Disease name Number Number Number 289157 1-alpha-hydroxylase deficiency 309127 3-hydroxyacyl-CoA dehydrogenase 228384 5q14.3 microdeletion syndrome deficiency 293948 1p21.3 microdeletion syndrome 314655 5q31.3 microdeletion syndrome 939 3-hydroxyisobutyric aciduria 1606 1p36 deletion syndrome 228415 5q35 microduplication syndrome 2616 3M syndrome 250989 1q21.1 microdeletion syndrome 96125 6p subtelomeric deletion syndrome 2616 3-M syndrome 250994 1q21.1 microduplication syndrome 251046 6p22 microdeletion syndrome 293843 3MC syndrome 250999 1q41q42 microdeletion syndrome 96125 6p25 microdeletion syndrome 6 3-methylcrotonylglycinuria 250999 1q41-q42 microdeletion syndrome 99135 6-phosphogluconate dehydrogenase 67046 3-methylglutaconic aciduria type 1 deficiency 238769 1q44 microdeletion syndrome 111 3-methylglutaconic aciduria type 2 13 6-pyruvoyl-tetrahydropterin synthase 976 2,8 dihydroxyadenine urolithiasis deficiency 67047 3-methylglutaconic aciduria type 3 869 2A syndrome 75857 6q terminal deletion 67048 3-methylglutaconic aciduria type 4 79154 2-aminoadipic 2-oxoadipic aciduria 171829 6q16 deletion syndrome 66634 3-methylglutaconic aciduria type 5 19 2-hydroxyglutaric acidemia 251056 6q25 microdeletion syndrome 352328 3-methylglutaconic
    [Show full text]
  • The SPA Arrangement of the Branches of the Upper Trunk of the Brachial Plexus: a Correction of a Longstanding Misconception and a New Diagram of the Brachial Plexus
    LABORATORY INVESTIGATION J Neurosurg 125:350–354, 2016 The SPA arrangement of the branches of the upper trunk of the brachial plexus: a correction of a longstanding misconception and a new diagram of the brachial plexus Amgad Hanna, MD Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin OBJECTIVE Brachial plexus (BP) diagrams in most textbooks and papers represent the branches and divisions of the upper trunk (UT) in the following sequence from cranial to caudal: suprascapular nerve, anterior division, and then posterior division. This concept contradicts what is seen in the operating room and is noticed by most peripheral nerve surgeons. This cadaveric study was conducted to look specifically at the exact pattern of branching of the upper trunk of the BP. METHODS Ten cadavers (20 BPs) were dissected. Both supra- and infraclavicular exposures were performed. The clavicle was retracted or resected to identify the divisions of the BP. A posterior approach was used in 2 cases. RESULTS In all dissections the origin of the posterior division was in a more cranial and dorsal plane in relation to the anterior division. In most dissections the supra scapular nerve branched off distally from the UT, giving it the appearance of a trifurcation, taking off just cranial and dorsal to the posterior division. The branching pattern of the UT consistently had the following sequential arrangement from cranial and posterior to caudal and anterior: suprascapular nerve (S), posterior division (P), and anterior division (A), hence the acronym SPA. CONCLUSIONS Supraclavicular exposure of the BP exposes only the trunks and divisions. Recognizing the “SPA” arrangement of the branches helps in identifying the correct targets for neurotization, especially given that these 3 branches are the most common targets for BP repair.
    [Show full text]
  • Posterior Approach Technique for Accessory-Suprascapular Nerve Transfer: a Cadaveric Study of the Anatomical Landmarks and Number of Myelinated Axons
    Clinical Anatomy 20:140–143 (2007) ORIGINAL COMMUNICATION Posterior Approach Technique for Accessory-Suprascapular Nerve Transfer: A Cadaveric Study of the Anatomical Landmarks and Number of Myelinated Axons D. PRUKSAKORN,1* K. SANANPANICH,1 S. KHUNAMORNPONG,2 3 1 S. PHUDHICHAREONRAT, AND P. CHALIDAPONG 1Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Thailand 2Department of Pathology, Faculty of Medicine, Chiang Mai University, Thailand 3Department of Pathology, Prasat Neurological Institute, Bangkok, Thailand Accessory-suprascapular nerve transfer by the anterior supraclavicular app- roach technique was suggested to ensure transferrance of the spinal accessory nerve to healthy recipients. However, a double crush lesion of the suprascapu- lar nerve might not be sufficiently demonstrated. In that case, accessory- suprascapular nerve transfer by the posterior approach would probably solve the problem. The aim of this study was to evaluate the anatomical landmarks and histomorphometry of the spinal accessory and suprascapular nerve in the posterior approach. Dissection of fresh cadaveric shoulder in a prone position identified the spinal accessory and suprascapular nerve by the trapezius mus- cle splitting technique. After that, nerves were taken for histomorphometric evaluation. The spinal accessory nerve was located approximately halfway between the spinous process and conoid tubercle. The average distance from the conoid tubercle to the suprascapular nerve (medial edge of the suprascap- ular notch) is 3.3 cm. The mean number of myelinated axons of the spinal accessory and suprascapular nerve was 1,603 and 6,004 axons, respectively. The results of this study supported the brachial plexus reconstructive sur- geons, who carry out accessory-suprascapular nerve transfer by using the posterior approach technique.
    [Show full text]