DOCSLIB.ORG

Multiple Accessory Structures in the Upper Limb of a Single Cadaver Vollala V R, Nagabhooshana S, Bhat S M, Potu B K, Rakesh V

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Multiple Accessory Structures in the Upper Limb of a Single Cadaver Vollala V R, Nagabhooshana S, Bhat S M, Potu B K, Rakesh V Case Report Singapore Med J 2008; 49(9) : e254 Multiple accessory structures in the upper limb of a single cadaver Vollala V R, Nagabhooshana S, Bhat S M, Potu B K, Rakesh V ABSTRACT terms of the number and morphology of its heads.(1-4) The arterial and muscular variations of the This muscle frequently has more than two heads arising upper limbs are common but important with from the humerus at the insertion of the coracobrachialis regard to surgical approaches. Even though or the neck of the humerus. There are reports describing anomalies of the coracobrachialis muscle supernumerary bicipital heads, ranging from three to are rare, anatomical variations of the biceps seven. Among them, the three-headed variant represents brachii, existence of the accessory muscles in the most common type that has been reported with a the forearm and persistent median artery are prevalence ranging from 7.5%–18.3%.(2,5-8) known and well documented. During routine Normally, the coracobrachialis muscle arises dissection, we observed some important from the tip of the coracoid process of the scapula anatomical variations in a 50-year-old male in common with the short head of the biceps brachii cadaver. The variations were unilateral. The muscle and inserts into the middle of the anteromedial anomalies were: third head for biceps brachii surface of the shaft of the humerus. The reported muscle, an accessory belly for coracobrachialis morphological variations of the coracobrachialis muscle crossing the median nerve and brachial muscle include accessory slips inserting to the medial vessels and continuing with the medial head epicondyle of the humerus, medial supracondylar of triceps brachii muscle to be inserted to the ridge, medial intermuscular septum, the lesser olecranon process (coracoulnaris), a persistent tubercle and a supernumerary head passing over the median artery and an additional muscle in the shoulder joint.(9-11) The presence of accessory muscles in Department of anterior compartment of forearm. Although the forearm was reported back in 1813 by Gantzer, and Anatomy, Melaka Manipal there are individual reports about these from then on, these muscles have been reported with Medical College, variations, the combination of these variations variable attachments.(12-21) The accessory heads of the Manipal University, Manipal 576104, in one cadaver has not previously been described deep flexors of the forearm (Gantzer’s muscles) have Karnataka, in the literature. Awareness of these variations been described as small bellies inserting either into India is necessary to avoid complications during the flexor pollicis longus (FPL) or flexor digitorum Vollala VR, MSc Lecturer radiodiagnostic procedures or surgeries in the profundus (FDP). The median artery is a transitory upper limb. Nagabhooshana S, vessel that represents the arterial axis of the forearm MSc, PhD during early embryonic life. It normally regresses Professor Keywords: anatomical variants, biceps brachii, in the second embryonic month to become the small Bhat SM, MSc coracobrachialis, coracoulnaris, median slender artery, arteria comitans nervi mediani.(22) Associate Professor artery Persistence of the median artery is not uncommon, and Department of Anatomy, Singapore Med J 2008; 49(9): e254-e258 its incidence is reported as ranging between 1.5% and Kasturba Medical 27.1%.(23-25) College, Manipal University, IntrODUctiON Manipal 576104, Case RepOrt Karnataka, The classical description of attachments of the biceps India brachii muscle include: the short head arising from The study involved the upper limb dissections of a 50- Potu BK, MSc the tip of the coracoid process of the scapula and the year-old male cadaver. The dissections of both upper Lecturer long head arising from the supraglenoid tubercle of extremities (right and left) of the body were carried out Rakesh V, MSc the scapula and from the glenoidal labrum. Distally, according to the instructions by Cunningham’s Manual Lecturer (26) the two bellies unite to form a common tendon which of Practical Anatomy. The body was preserved Correspondence to: is inserted into the posterior rough part of the radial by the injection of a formalin-based preservative Dr Venkata Ramana Vollala tuberosity and through the bicipital aponeurosis to (10% formalin) and stored at −4°C. Before taking Tel: (91) 820 292 2642 Fax: (91) 820 257 1905 the subcutaneous posterior border of ulna. It is one photographs, the dissected region was rinsed with water. Email: ramana.anat@ of the most variable muscles in the human body, in The third head of biceps brachii muscle, accessory gmail.com Singapore Med J 2008; 49(9) : e255 1a 1b Fig. 1a Photograph of the anterior compartment of the left Fig. 1b Schematic diagram of the anterior compartment of arm shows the third head of biceps brachii and accessory the left arm. belly of coracobrachialis crossing the median nerve and BB: biceps brachii; CB: coracobrachialis; MHT: medial head brachial vessels. of triceps brachii; NVB: neurovascular bundle (median nerve, BB: biceps brachii; THB: third head of biceps brachii; CB: ulnar nerve and brachial vessels); MCN: musculocutaneous coracobrachialis; MHT: medial head of triceps brachii; NVB: nerve neurovascular bundle (median nerve, ulnar nerve and brachial vessels); MCN: musculocutaneous nerve belly of coracobrachialis muscle crossing the median for the middle finger (Fig. 2). The following are the nerve and brachial vessels, a persistent median artery approximate sizes of the muscle: muscle length 7 cm, and an additional muscle in the anterior compartment tendon length 15 cm, muscle width 0.8 cm, and tendon of forearm were found in the left upper limb. However, width 0.3 cm. The additional muscle belly was anterior the right upper limb showed no abnormality. to both the anterior interosseous nerve and vessels, and The accessory head of the biceps brachii muscle the ulnar artery. The nerve and arterial supply to the arose from the shaft of the humerus between the muscle came from the anterior interosseous nerve and insertion of the coracobrachialis muscle and origin ulnar artery, respectively. There was persistent median of the brachialis muscle. The additional muscle fibres artery taking origin from the anterior interroseous formed a narrow tendon which inserted into the medial artery and accompanied the lateral aspect of the median aspect of the tendon of the biceps brachii muscle to be nerve up to the wrist (Fig 3). The artery gave muscular inserted to the radial tuberosity (Fig. 1a). In the same branches to the nearby muscles. arm, we also found an anomalous coracobrachialis muscle. The origin of coracobrachialis was normal DiscUssiON from the tip of the coracoid process along with the Although the third head of biceps brachii is a common short head of biceps brachii, but the muscle fibres occurrence in mammals,(27-29) previous studies in divided into superficial and deep bellies. The deep human beings show that the third head of biceps fibres inserted to the medial surface of the middle of the brachii is seen in about 8% of Chinese,(3) 10% of shaft of the humerus, deep to the neurovascular bundle white Europeans,(3,30) 12% of black Africans,(3) 18% of the anterior compartment of the arm. The superficial of Japanese,(3) 20.5% of South African blacks, 8.3% fibres crossed the median nerve, ulnar nerve, brachial of South African whites,(5) 20% of Brazilian whites, vessels and continued with the medial head of triceps 9% of Brazilian blacks,(2) 15% of Turks,(6) and merely brachii muscle to be inserted to the olecranon process 2% in the Indian population.(31) Thus, the occurrence (Figs. 1a & b), forming the potential site for entrapment of third head of biceps brachii in the Indian population or compression of the neurovascular bundle. A review is rare. According to Rodriguez-Niedenfuhr et al, of the literature suggests that the occurrence of this the accessory bicipital head in the present case variation is very rare globally. The nerve supply to corresponds to the inferomedial type.(7) Based on its the third head of biceps brachii and coracobrachialis origin, it may be considered as a remnant of the long muscle was from the musculocutaneous nerve. head of coracobrachialis muscle, an ancestral hominoid There was an additional muscle in the anterior muscle.(32,33) The third head of biceps brachii in our compartment of the forearm. It was seen deep to the case originated from the anteromedial surface of the flexor digitorum superficialis (FDS) and took origin humerus distal to the insertion of the coracobrachialis, from the undersurface of the FDS distal to its origin passed inferomedial to the main biceps brachii and from the medial epicondyle of humerus. The muscle anterior to the brachialis muscle, and inserted into the belly ended in a long tendon in the middle part of the medial side of the common biceps tendon. The medial forearm and the tendon merged with the tendon of FDP humeral origin of the third head may provide additional Singapore Med J 2008; 49(9) : e256 Fig. 2 Anterior photograph of the left forearm. The accessory head (Gantzer muscle) of the flexor digitorum profundus arises from under the surface of the flexor digitorum Fig. 3 Photograph shows the persistent median artery. superficialis and inserts into the tendon for the middle finger B: brachial artery; U: ulnar artery; R: radial artery; PMA: of flexor digitorum profundus. persistent median artery; MN: median nerve. FDP: flexor digitorum profundus; Ah of FDP: additional head of flexor digitorum profundus; FDS: flexor digitorum superficialis, *******: tendon of additional head of flexor digitorum profundus. strength to the biceps during supination of the forearm did not find any such reported clinical cases, this kind and elbow flexion irrespective of shoulder position.(34) of neurovascular disorders may be similar to the cases The presence of the third head may cause unusual bone of entrapment by ligament of Struthers.
Load more

Recommended publications
  • Should Joint Presentation File
    6/5/2017 The Shoulder Joint Bones of the shoulder joint • Scapula – Glenoid Fossa Infraspinatus fossa – Supraspinatus fossa Subscapular fossa – Spine Coracoid process – Acromion process • Clavicle • Humerus – Greater tubercle Lesser tubercle – Intertubercular goove Deltoid tuberosity – Head of Humerus Shoulder Joint • Bones: – humerus – scapula Shoulder Girdle – clavicle • Articulation – glenohumeral joint • Glenoid fossa of the scapula (less curved) • head of the humerus • enarthrodial (ball and socket) 1 6/5/2017 Shoulder Joint • Connective tissue – glenoid labrum: cartilaginous ring, surrounds glenoid fossa • increases contact area between head of humerus and glenoid fossa. • increases joint stability – Glenohumeral ligaments: reinforce the glenohumeral joint capsule • superior, middle, inferior (anterior side of joint) – coracohumeral ligament (superior) • Muscles play a crucial role in maintaining glenohumeral joint stability. Movements of the Shoulder Joint • Arm abduction, adduction about the shoulder • Arm flexion, extension • Arm hyperflexion, hyperextension • Arm horizontal adduction (flexion) • Arm horizontal abduction (extension) • Arm external and internal rotation – medial and lateral rotation • Arm circumduction – flexion, abduction, extension, hyperextension, adduction Scapulohumeral rhythm • Shoulder Joint • Shoulder Girdle – abduction – upward rotation – adduction – downward rotation – flexion – elevation/upward rot. – extension – Depression/downward rot. – internal rotation – Abduction (protraction) – external rotation
    [Show full text]
  • Anatomic Variations in Relation to the Origin of the Musculocutaneous Nerve: Absence and Non-Perforation of the Coracobrachialis Muscle
    Int. J. Morphol., 36(2):425-429, 2018. Anatomic Variations in Relation to the Origin of the Musculocutaneous Nerve: Absence and Non-Perforation of the Coracobrachialis Muscle. Anatomical Study and Clinical Significance Variaciones Anatómicas en Relación al Origen del Nervio Musculocutáneo: Ausencia y no Perforación del Músculo Coracobraquial: Estudio Anatómico y Significado Clínico Daniel Raúl Ballesteros Larrotta1; Pedro Luis Forero Porras2 & Luis Ernesto Ballesteros Acuña1 BALLESTEROS, D. R.; FORERO, P. L. & BALLESTEROS, L. E. Anatomic variations in relation to the origin of the musculocutaneous nerve: Absence and non-perforation of the coracobrachialis muscle. Anatomical study and clinical significance. Int. J. Morphol., 36(2):425- 429, 2018. SUMMARY: The most frequent anatomic variations of the musculocutaneous nerve could be divided in two main groups: communicating branches with the median nerve and variations in relation to the origin, which in turn can be subdivided into absence of the nerve and non-perforation of the coracobrachialis muscle. Unusual clinical symptoms and/or unusual physical examination in patients with motor disorders, could be explained by anatomic variations of the musculocutaneous nerve. A total of 106 arms were evaluated, corresponding to 53 fresh male cadavers who were undergoing necropsy. The presence or absence of the musculocutaneous nerve was evaluated and whether it pierced the coracobrachialis muscle or not. The lengths of the motor branches and the distances from its origins to the coracoid process were measured. In 10 cases (9.5 %) an unusual origin pattern was observed, of which six (5.7 %) correspond to non-perforation of the coracobrachialis muscle and four (3.8 %) correspond to absence of the nerve.
    [Show full text]
  • 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.
    [Show full text]
  • Bone Limb Upper
    Shoulder Pectoral girdle (shoulder girdle) Scapula Acromioclavicular joint proximal end of Humerus Clavicle Sternoclavicular joint Bone: Upper limb - 1 Scapula Coracoid proc. 3 angles Superior Inferior Lateral 3 borders Lateral angle Medial Lateral Superior 2 surfaces 3 processes Posterior view: Acromion Right Scapula Spine Coracoid Bone: Upper limb - 2 Scapula 2 surfaces: Costal (Anterior), Posterior Posterior view: Costal (Anterior) view: Right Scapula Right Scapula Bone: Upper limb - 3 Scapula Glenoid cavity: Glenohumeral joint Lateral view: Infraglenoid tubercle Right Scapula Supraglenoid tubercle posterior anterior Bone: Upper limb - 4 Scapula Supraglenoid tubercle: long head of biceps Anterior view: brachii Right Scapula Bone: Upper limb - 5 Scapula Infraglenoid tubercle: long head of triceps brachii Anterior view: Right Scapula (with biceps brachii removed) Bone: Upper limb - 6 Posterior surface of Scapula, Right Acromion; Spine; Spinoglenoid notch Suprspinatous fossa, Infraspinatous fossa Bone: Upper limb - 7 Costal (Anterior) surface of Scapula, Right Subscapular fossa: Shallow concave surface for subscapularis Bone: Upper limb - 8 Superior border Coracoid process Suprascapular notch Suprascapular nerve Posterior view: Right Scapula Bone: Upper limb - 9 Acromial Clavicle end Sternal end S-shaped Acromial end: smaller, oval facet Sternal end: larger,quadrangular facet, with manubrium, 1st rib Conoid tubercle Trapezoid line Right Clavicle Bone: Upper limb - 10 Clavicle Conoid tubercle: inferior
    [Show full text]
  • Analysis on the Acromial Curvature and Its Relationships with The
    r e v b r a s o r t o p . 2 0 1 4;4 9(6):636–641 www.rbo.org.br Original article Analysis on the acromial curvature and its relationships with the subacromial space and ଝ,ଝଝ types of acromion a,b,∗ c José Aderval Aragão , Leonardo Passos Silva , b a Francisco Prado Reis , Camilla Sá dos Santos Menezes a Department of Morphology, Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil b Medical School, Universidade Tiradentes (UNIT), Aracaju, SE, Brazil c Orthopedics and Traumatology Service, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil a r t i c l e i n f o a b s t r a c t Article history: Objective: To correlate the acromial curvature, using the angles proposed, with the subacro- Received 13 September 2013 mial space and types of acromion. Accepted 24 October 2013 Methods: Ninety scapulas were studied. The acromia were classified as types I, II or III. The Available online 31 October 2014 acromial curvature was analyzed by means of the alpha, beta and theta angles. We also measured the distance between the anteroinferior extremity of the acromion and the supra- Keywords: glenoid tubercle (DA). The scapulas were grouped in relation to sex and age. The angles proposed were analyzed in relation to each type of acromion and also in relation to the Acromion/anatomy & histology Shoulder collision syndrome measurements of the distance DA. Rotator cuff Results: Out of the total number of acromia, 39 (43.3%) were type I, 43 (47.7%) type II and eight (9%) type III.
    [Show full text]
  • Kinematics Based Physical Modelling and Experimental Analysis of The
    INGENIERÍA E INVESTIGACIÓN VOL. 37 N.° 3, DECEMBER - 2017 (115-123) DOI: http://dx.doi.org/10.15446/ing.investig.v37n3.63144 Kinematics based physical modelling and experimental analysis of the shoulder joint complex Modelo físico basado en cinemática y análisis experimental del complejo articular del hombro Diego Almeida-Galárraga1, Antonio Ros-Felip2, Virginia Álvarez-Sánchez3, Fernando Marco-Martinez4, and Laura Serrano-Mateo5 ABSTRACT The purpose of this work is to develop an experimental physical model of the shoulder joint complex. The aim of this research is to validate the model built and identify the forces on specified positions of this joint. The shoulder musculoskeletal structures have been replicated to evaluate the forces to which muscle fibres are subjected in different equilibrium positions: 60º flexion, 60º abduction and 30º abduction and flexion. The physical model represents, quite accurately, the shoulder complex. It has 12 real degrees of freedom, which allows motions such as abduction, flexion, adduction and extension and to calculate the resultant forces of the represented muscles. The built physical model is versatile and easily manipulated and represents, above all, a model for teaching applications on anatomy and shoulder joint complex biomechanics. Moreover, it is a valid research tool on muscle actions related to abduction, adduction, flexion, extension, internal and external rotation motions or combination among them. Keywords: Physical model, shoulder joint, experimental technique, tensions analysis, biomechanics, kinetics, cinematic. RESUMEN Este trabajo consiste en desarrollar un modelo físico experimental del complejo articular del hombro. El objetivo en esta investigación es validar el modelo construido e identificar las fuerzas en posiciones específicas de esta articulación.
    [Show full text]
  • Anatomy and Physiology II
    Anatomy and Physiology II Review Bones of the Upper Extremities Muscles of the Upper Extremities Anatomy and Physiology II Review Bones of the Upper Extremities Questions From Shoulder Girdle Lecture • Can you name the following structures? A – F • Acromion F – B B • Spine of the Scapula G – C • Medial (Vertebral) Border H – E C • Lateral (Axillary) Border – A • Superior Angle E I – D • Inferior Angle – G • Head of the Humerus D – H • Greater Tubercle of Humerus – I • Deltoid Tuberosity Questions From Shoulder Girdle Lecture • Would you be able to find the many of the same landmarks on this view (angles, borders, etc)? A • Can you name the following? – D • Coracoid process of scapula C – C D B • Lesser Tubercle – A • Greater Tubercle – B • Bicipital Groove (Intertubercular groove) Questions From Upper Extremities Lecture • Can you name the following structures? – B • Lateral epicondyle – A • Medial epicondyle A B Questions From Upper Extremities Lecture • Can you name the following landmarks? – C • Olecranon process – A • Head of the radius – B D • Medial epicondyle B A – D C • Lateral epicondyle Questions From Upper Extremities Lecture • Can you name the following bones and landmarks? – Which bone is A pointing to? • Ulna – Which bone is B pointing A to? • Radius E – C B • Styloid process of the ulna – D • Styloid process of the radius C – E D • Interosseous membrane of forearm Questions From Upper Extremities Lecture • Can you name the following bony landmarks? – Which landmark is A pointing to? • Lateral epicondyle of humerus – Which
    [Show full text]
  • Morphometric Evaluation of Adult Acromion Process in North Indian Population Anatomy Section
    Original Article DOI: 10.7860/JCDR/2017/21060.9312 Morphometric Evaluation of Adult Acromion Process in North Indian Population Anatomy Section SUSMITA SAHA1, NEELAM VASUDEva2 ABSTRACT distance and acromio-glenoid (Ac-g) distance were measured. Introduction: Dimensions of acromion process are important The measurements were compared with other osteological to show linkage to the shoulder girdle pathologies. Also studies performed on different population group. Data was morphometric analysis of acromion process would be helpful analysed using SPSS version 12.0 and mean values with for surgeons while performing surgical procedures on the standard deviation for each dimension were presented. shoulder joint. Results: The mean values of each measurement were: length: Aim: The purpose of this present study was to observe the 41.007 mm; width: 21.82 mm; thickness: 6.58 mm; C-A distance: detailed morphometric evaluation of adult acromion processes 28.34 mm and Ac-g distance: 26.21 mm. in North Indian population because different morphometric Conclusion: It is expected that various dimensions of adult dimensions play an important role in various disorders of the acromion process will serve as a reference base and will assist shoulder, particularly sub acromial impingement syndrome. the surgeon in the approach to be used and precision of the Materials and Methods: Two hundred adult dry scapulae from operative technique. So, the study will provide a vital support the osteology museum of MAMC, New Delhi, were obtained for for planning and executing acromioplasty in the treatment of evaluation of various measurement of acromion process. The impingement syndrome. length, width, thickness of acromion, coraco-acromial (C-A) Keywords: Acromioplasty, Morphometry, Scapula, Subacromial impingement syndrome INTRODUCTION was only 2.6% along with the three types of acromion process The acromion process projects forward almost at right angles, as described by Bigliani et al.
    [Show full text]
  • Tutorial Article Imaging of the Shoulder W
    EQUINE VETERINARY EDUCATION / AE / april 2010 199 Tutorial Article Imaging of the shoulder W. R. Redding* and A. P. Pease† Department of Clinical Sciences; and †Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough Street, Raleigh, North Carolina 27606, USA.eve_55 199..209 Keywords: horse; lameness; shoulder; ultrasonography; radiology Summary be performed before intra-articular anaesthesia to determine if effusion is present in the joint and to assist with Diagnosis of lameness associated with the shoulder region directing the placement of the needle into the shoulder requires a careful clinical examination, the use of joint. specifically placed intra-articular analgesia and a This paper discusses the normal anatomy as well as the combination of some common imaging techniques to radiographic and ultrasonographic examination of the accurately define the source of pain. Most equine shoulder area. In addition, reference to the use of nuclear practices performing lameness examinations in the horse scintigraphy and the benefits to help localise lesions to the have the radiographic and ultrasonographic equipment shoulder is discussed. necessary to accurately image the shoulder. This article presents a description of the unique anatomy of the Normal anatomy of the shoulder region shoulder and the specific application of radiographic and ultrasonographic techniques to provide a complete set of The most proximal joint in the appendicular skeleton of the diagnostic images of the shoulder region. A brief discussion forelimb is the scapulohumeral joint. It is composed of 2 of nuclear scintigraphy of this region is also included. bones, the distal end of the scapula and the proximal humerus (Sisson 1975).
    [Show full text]
  • A Morphometric Study of the Patterns and Variations of the Acromion and Glenoid Cavity of the Scapulae in Egyptian Population Anatomy Section
    Original Article DOI: 10.7860/JCDR/2015/14362.6386 A Morphometric Study of the Patterns and Variations of the Acromion and Glenoid Cavity of the Scapulae in Egyptian Population Anatomy Section WAEL AMIN NASR EL-DIN1, MONA HASSAN MOHAMMED ALI2 ABSTRACT were analysed using an unpaired t-test. Statistical significance Background: Owing to its many variations, scapula became was set p≤ 0.05. one of the most interesting bones of the human skeleton. Results: The intermediate shape of the acromion presented with Aim: To measure acromial and glenoid morphology in to the highest incidence, while the cobra shaped presented with describe their anatomical patterns and variations in Egyptians the lowest distribution in both sides. The oval shaped glenoid to establish possible morphofunctional correlations related to cavity presented with the highest incidence while the inverted race, geographic region and literature data. coma shaped showed the lowest incidence. Materials and Methods: One hundred and sixty scapulae of These results are in match with other population. However, unknown age and sex were studied. Morphological shapes of the morphometric values of the scapula, acromion process the tip of the acromion; types of acromion; and morphological and glenoid cavity were higher than reported in Turkish and shapes of the glenoid were evaluated. Length and width of Indians. the scapulae, length, breadth and thickness of the acromion Conclusion: Our data are important to compare Egyptian process and distances of the acromio-coracoid and acromio- scapulae to those from various other races that could contribute glenoid in addition to glenoid diameters were measured. to demographic studies of shoulder disease probability and Statistical Analysis: The morphometric values of the two sides management in Egyptian population.
    [Show full text]
  • Coracobrachialis Muscle Pierced by Two Nerves: Case Report
    Case Report www.anatomy.org.tr Received: April 6, 2016; Accepted: June 13, 2016 doi:10.2399/ana.16.008 Coracobrachialis muscle pierced by two nerves: case report Dawit Habte Woldeyes, Belta Asnakew Abegaz Department of Human Anatomy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia Abstract The brachial plexus is formed by the union of the ventral rami of C5–T1. Contributions to the plexus by C4 and T2 differ. The coracobrachialis muscle is an elongated muscle in the superomedial part of the arm. It is a useful landmark for locating other structures in the arm. Variations exist to the coracobrachialis muscle, and to the formation of the brachial plexus, its terminal branches and its relation to surrounding structures. In this report, the coracobrachialis muscle is pierced by two nerves, and one of these nerves joins the median nerve after piercing the coracobrachialis muscle. Awareness of the possible variations of brachial plexus and its surrounding structures is necessary for adequate clinical, surgical and radiological management. Keywords: brachial plexus; coracobrachialis; median nerve; musculocutaneous nerve; unnamed nerve Anatomy 2016;10(2):148–152 ©2016 Turkish Society of Anatomy and Clinical Anatomy (TSACA) Introduction locating other structures in the arm; i.e., the musculocu- taneous nerve pierces it, and the distal part of its attach- The brachial plexus is formed by the union of the ventral ment indicates the location of the nutrient foramen of rami of C5–T1. The most common arrangement of the the humerus.[6,7] brachial plexus is as follows: the fifth and sixth rami unite as the upper trunk, the eighth cervical and first thoracic Variations in the formation of the brachial plexus and its terminal branches in the upper extremity are rami join as the lower trunk, the seventh cervical ramus [1] becomes the middle trunk.
    [Show full text]
  • Angle of Approach to the Superior Rotator Cuff of Arthroscopic Instruments Depends on the Acromial Morphology: an Experimental Study in 3D Printed Human Shoulders
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2019 Angle of approach to the superior rotator cuff of arthroscopic instruments depends on the acromial morphology: an experimental study in 3D printed human shoulders Hoessly, Menduri ; Bouaicha, Samy ; Jentzsch, Thorsten ; Meyer, Dominik C Abstract: BACKGROUND Portal placement is a key factor for the success of arthroscopic procedures, particularly in rotator cuff repair. We hypothesize that the acromial anatomy may strongly determine the position of the shoulder bony landmarks and limit the surgeon’s freedom to position the arthroscopic approaches in direction towards the acromion. The purpose of this study was to analyze the relation between different acromial shapes and the freedom of movement of arthroscopic instruments relative to the rotator cuff from standardized arthroscopic portals in a laboratory study on 3D shoulder models. METHODS 3D models of shoulders with a broad range of different acromial shapes were printed using CT and MRI scans. Angles from the portals to defined points on the rotator cuff and the supraglenoid tubercle were measured. In conventional radiographs, the critical shoulder angle, the scapular body acromial angle, and the glenoid acromial angle were measured and compared with the measured angles to the rotator cuff. RESULTS There was a large variation of angles of approach of instruments tothe rotator cuff between the seven shoulders for each portal. From the joint line portal and the posterior edge portal, the biggest angles were measured to the posterior cuff. From the intermediate portal, the angles were largest to the intermediate rotator cuff and from the anterior portals to the anterior cuff.
    [Show full text]