Prevalence and variance of the sternalis muscle: a study in the Chinese population using multi-detector CT

Objective

To analyze the prevalence, anatomical features, as well as variance of the sternalis muscle in the Chinese population using multi-detector computed tomography (MDCT).

Methods

We retrospectively reviewed 6,000 adult axial MDCT images to determine the overall and gender prevalence of the sternalis muscles. We also analyzed the side prevalence and anatomical features, including shape, size, location and course.

Results

The sternalis muscle was present in 347 (5.8 %) of 6,000 adults. This muscle was more common in males (6.0 %, 187/3091) than in females (5.5 %, 160/2909). Among the 347 adults, 118 (34.0 %) had bilateral sternalis muscles; 148 (42.7 %) had right sternalis muscles; and 81 (23.3 %) had left sternalis muscles. The sternalis muscle was either flat or nodular and located superficial to the major pectoral muscles on CT axial transverse images. According to the muscle morphology and course, we classified sternalis muscles as three different types and nine subtypes. The muscles appeared with a single head and single belly in 58.5 %, double or multiple heads in 18.1 %, and double or multiple bellies in 23.4 %. The mean length, width and thickness were 111.1 ± 33.0, 17.7 ± 9.9 and 4.1 ± 1.7 mm measured on MDCT.

Conclusion

The sternalis muscle was highly prevalent in normal Chinese adults. MDCT is an effective method to demonstrate this muscle in vivo.     

Bilateral sternalis with unusual left-sided presentation: a clinical perspective

An unusual variation creates interest among anatomists, but is a cause of concern among clinicians when it mimics a pathology. The sternalis muscle is one such variant of the anterior chest wall located subcutaneously over the pectoralis major, ranging from a few short fibers to a well-formed muscle. We observed a bilateral case, which was accompanied by an atypical presentation on the left side where a huge, bulky sternalis muscle was associated with the absence of the sternal fibers of the pectoralis major. The fibers arose as a lateral strip from the upper two-thirds of the body of the sternum and costal cartilages 2 through 6 with the intervening fascia and aponeurosis of the external oblique. The right sternalis was strap-like and was placed vertically over the sternal fibers of the pectoralis major, arising from the underlying fascia and aponeurosis of the external oblique. The sternalis muscles, on each side, converged into an aponeurosis over the manubrium that was continuous with the sternal heads of the right and left sternocleidomastoid muscle, respectively. This rare anomaly has puzzled radiologists and surgeons in confirming diagnosis, missing it all together or mistaking it for a tumor on mammography or CT scan. These findings prompted us to review its topography, development, and application in relation to the anterior chest wall.     

Surgical anatomy of the pectoral nerves and the pectoral musculature

The pectoral nerves (PNs) may be selectively injured through various traumatic mechanisms such as direct trauma, hypertrophic muscle compression, and iatrogenic injuries (breast surgery and axillary node dissection, pectoralis major muscle transfers). The PN may be surgically recovered through nerve transfers. They may also be used as donors to the musculocutaneous, axillary, long thoracic, and spinal accessory nerves and for reinnervation of myocutaneous free flaps. Thus, in this article, we reviewed the surgical anatomy of PN. A meta-analysis of the available literature showed that the lateral pectoral nerve (LPN) arises most frequently with two branches from the anterior divisions of the upper and middle trunks (33.8%) or as a single root from the lateral cord (23.4%). The medial pectoral nerve (MPN) usually arises from the medial cord (49.3%), anterior division of the lower trunk (43.8%), or lower trunk (4.7%). The two PN are usually connected immediately distal to the thoracoacromial artery by the so-called ansa pectoralis. The MPN may also show communications with the intercostobrachial nerve. In 50%-100% of cases, it may pass, at least with some branches, through the pectoralis minor muscle. The LPN supplies the upper portions of the pectoralis major muscle; the MPN innervates the lower parts of the pectoralis major and the pectoralis minor muscle. Among the accessory muscles of the pectoral girdle, the LPN may also innervate the tensor semivaginae articulationis humero-scapularis, pectoralis minimus, sternoclavicularis, axillary arch, sternalis, and infraclavicularis muscles; the MPN may innervate the pectoralis quartus, chondrofascialis, axillary arch, chondroepitrochlearis, and sternalis muscles.     

Innervation of the sternalis muscle accompanied by congenital partial absence of the pectoralis major muscle

In one case accompanied by congenital partial absence of the pectoralis major muscle the sternalis muscle was examined to confirm its innervation by means of analysis of intramuscular nerve distribution. It was proved that the sternalis muscle was supplied only by the pectoral nerves even in the case of sternalis in direct contact with the proper thoracic wall. These findings as well as the results of Ura (1937) and Morita (1944) favor the interpretation presented by Eisler (1901), in which the sternalis muscle was described as being supplied only by the pectoral nerves. However, the problem of double innervation of the sternalis requires continued discussion because the relationships between the pectoral nerves and the branches of the intercostal nerves or extramural nerves (Yamada & Mannen, 1985; Kodama et al., 1986) have not yet been resolved. The precise genesis of the sternalis muscle should be also examined though it has already been proved to be derived from the pectoralis muscle group including the subcutaneous trunci muscle.     

The sternalis muscle in the Bulgarian population: classification of sternales

The sternalis muscle (musculus sternalis) is the name usually given to this common anatomical variant, but the terms 'episternalis', 'presternalis', 'sternalis brutorum', 'rectus thoracis', 'rectus sterni', 'superficial rectus abdominis' and 'japonicus' have also been used in the literature (for reviews see Le Double, 1879; Calori, 1888; Pichler, 1911; Blees, 1968). According to Turner (1867), Cabrolius was the first, in 1604, to describe sternalis. Nevertheless this muscle is often unknown even in clinical practice (Bailey & Tzarnas, 1999; Vandeweyer, 1999).
Thus far, investigations on the incidence of sternalis have been made both in large populations such as the American (Barlow, 1935) and small populations, for example in Taiwan (Shen et al. 1992; Jeng & Su, 1998). In Europe, all studies on the frequency of this muscle have been made amongst subpopulations in Western (e.g. Cunningham, 1888; Le Double, 1890, 1897) and Northern Europe (Gruber, 1860) although the reported frequencies have been quite different. There is a lack of information about sternalis in Eastern European populations. We therefore present data from a study on the incidence of sternalis muscle in Bulgaria.     

The sternalis muscle: an uncommon anatomical variant among Taiwanese

The sternalis muscle is an uncommon anatomical variant. It is located on the human anterior pectoral wall, superficial to pectoralis major. This muscle has been reported both in males and females, and in whites, blacks and Asians (Barlow, 1934; Kida & Kudoh, 1991; Shen et al. 1992; Bradley et al. 1996).
Although the importance of this muscle is still a mystery, various different interpretations have been made. Clemente (1985) considered sternalis to be a misplaced pectoralis major, although some embryologists have viewed it as part of a ventral longitudinal column muscle layer arising at the ventral tip of the hypomeres (Sadler, 1995). Sadler claimed that this muscle is represented by rectus abdominis in the abdominal region and by the infrahyoid musculature in the cervical region; in the thorax, this layer usually disappears but occasionally remains as a sternalis muscle. Kitamura et al. (1985) reported a case of congenital partial deficiency of pectoralis major accompanied by an enormous sternalis. Barlow (1934), on the other hand, claimed that sternalis represents the remains of a panniculus carnosus.     

Sternalis muscle,what every anatomist and clinician should know

The sternalis muscle is a well documented but rare muscular variation of the anterior thoracic wall. It lies between the superficial fascia and the pectoral fascia and is found in about 8% of the population. It presents in several morphological variants both unilaterally and bilaterally and has no apparent physiological function. There is still much disagreement about its nerve supply and embryological origin. With the advent of medical imaging and thoracic surgery the clinical importance of this muscle has been re‐emphasized. It has been implicated in misdiagnosis of breast masses on routine mammograms owing to its parasternal location and relative unfamiliarity among radiologists. When undetected before any thoracic surgery, it has the potential to interfere with and prolong such procedures. When present and detected preoperatively it can be used as a muscular flap in reconstructive surgeries of the breast and neck. This article will present the sternalis muscle with special emphasis on its morphology, homology, and clinical significance. Clin. Anat. 27:866–884, 2014. © 2014 Wiley Periodicals, Inc.     

Case report: bilateral sternalis muscles with a bilateral pectoralis major anomaly

The importance of continuing to record and discuss anatomical anomalies was addressed recently by Hicks & Newell (1997) in the light of technical advances and interventional methods of diagnosis and treatment. Two recent radiological reports (Bradley et al. 1996; Murphy & Nokes, 1996) highlighted the diagnostic dilemma posed by a sternalis muscle in the detection of breast cancer.     

Left musculus sternalis

During routine dissection in the Morphological Sciences Department II of the Universidad Complutense de Madrid, the presence of a sternalis muscle was observed in the left hemithorax of a 70-year-old male cadaver. We report on its position, relationships, and innervation, as well as its clinical relevance, indicating some guidelines for its physical examination. We also present a brief overview of the existing literature regarding the nomenclature, historical reports, and incidence of this muscle.     

The muscular arch of the axilla and its nerve supply in Japanese adults]

We examined 94 axillary regions of 47 Japanese adults and found the muscular arch of the axilla (Maa) in five sides of three cadavers as well as the tendinous arch of the axilla (Taa) in two sides of two cadavers. The results are summarized as follows: 1) The frequency of Maa was 6.4% of the total bodies and 5.3% of the sides in this series. 2) In the left side of a 57-year-old male (No. 427), Maa was attached to the surface of the coracobrachialis muscle after fusing with the dorsal surface of the inserting tendon of the pectoralis quartus muscle. Both muscles were supplied by the caudal pectoral nerve (Npc) from the medial pectoral nerve. Moreover, in this same specimen, the sternalis muscle was recognized on the ventral surface of the pectoralis major muscle. In the left side of a 93-year-old female (No. 386), the cranial part of the muscular arch of the axilla (Cpa) was extended to the coracoid process by a tendon and attached to the abdominal part of the pectoralis major by two muscle bundles supplied by independent branches from Npc. One muscle bundle was attached to the lower margin of the abdominal part of the pectoralis major on the same plane, and the other bundle was located on the dorsal surface of the abdominal part. In a 74-year-old female (No. 411), the well-developed lateral part of the muscular arch of the axilla (Lpa) was attached to the inferior side of the tendinous arch. According to Ruge (1914) and Kasai et al. (1977), this arch was in the transition of the muscle bundle of Cpa to the arch. In the right side of the same specimen, only the thoracodorsal nerve (Ntd) was distributed into Lpa, whereas in the left side, only Npc supplied branches to Lpa. 3) The axillary arch was classified into 8 types based on the form and the supplying nerve of Cpa and Lpa. Cpa consisting of the muscle bundle is Type I, and Cpa consisting of the tendinous arch is Type II. We proposed that only Type II-A, with Cpa as tendinous arch and no Lpa, be designated as Taa (found in two cases), and the others as Maa. The following types were found in this study: Type I-A, consisting of only Cpa supplied by Npc (two cases); Type I-D, consisting of Cpa supplied by Npc and Lpa supplied by Ntd (one case); Type II-B, consisting of the tendinous arch and Lpa supplied by Npc (one case); Type II-D, consisting of the tendinous arch and Lpa supplied by Ntd (one case). 4) From the above findings, it can be suggested that Maa of varying shapes have been formed by a portion of the latissimus dorsi muscle supplied by Ntd, together with the pectoralis subcutaneous muscle, consisting of the pectoralis abdominalis, humeroabdominalis, humerodorsalis and ventrolateralis muscles supplied by Npc. The latter three muscles were proposed by Ura (1937) as the panniculus carnosus muscle, which was well developed in some lower mammalian orders. However, early investigators suggested that Maa was derived from the panniculus. Maa might have occurred as a rudimentary phylogenetic remainder in an early human embryonic stage.     

Functional morphology of the maxillo-mandibular apparatus in the miniature swine MINI-LEWE. 8. The development of the intramuscular nerve ramification pattern in the masticatory muscles

Postnatal changes in the intramuscular innervation pattern of the masticatory muscles of the miniature pig MINI-LEWE are only gradual. There are no definite relationships between the paths of nerves and the positions of the fasciae. The few anastomoses found were in the masseter muscle. The only other nerve found to be implicated in the motor innervation of the masticatory muscles was the motor root of the trigeminal nerve. Innervation studies are a good way of identifying the bounds of muscles: the masseter and zygomaticomandibularis muscles, for instance, are innervated jointly by the massetericus nerve, so that the zygomaticomandibularis muscle can be regarded as belonging to the masseter muscle.     

VAMP2 is expressed in myogenic cells during rat development

Vesicle-associated membrane protein 2 (VAMP2) is a member of the SNARE family of proteins that regulate the intracellular vesicle fusion process. This study investigated the developmental expression of VAMP2 in the rat embryo. In the trunk, VAMP2 was primarily found in the heart on embryonic day (E) 10. On E12.5, VAMP2 expression was found in nerve fibers, somites, and heart. In somites, epithelial cells in the dorsomedial lip, and elongated myoblasts in myotome were positive for VAMP2. On E16.5, VAMP2 was expressed in the heart, nerve fibers, and skeletal muscles. In skeletal muscles, multinuclear myotubes were positive for VAMP2. In the head, where muscles are derived both from somitic and non-somitic origin, VAMP2 was found in myotubes of the extrinsic ocular muscles and masseter muscle on E16.5. These findings suggest the involvement of VAMP2 in the development of skeletal muscles of somitic and non-somitic origins.     

Oscillatory activity in forelimb muscles of behaving monkeys evoked by microstimulation in the cerebellar nuclei

Coherent 20-35 Hz (beta) oscillations are a prominent feature of activity in primary motor cortex and muscles of monkeys and humans performing voluntary movements. We found that coherent beta oscillations are also present in the cerebellar nuclei (CN). Two monkeys were operantly conditioned to perform a wrist flexion/extension step-tracking task while we recorded neuronal activity or microstimulated in CN and recorded EMG activity from forelimb muscles. Coherent beta oscillations were found between discharges of some CN neurons and tonically active shoulder, elbow and wrist/finger flexion and extension muscles. Similarly, localized microstimulation pulses in CN evoked transient beta oscillations in widespread forelimb muscles. We conclude that coherent motor system beta oscillations are present in CN and that CN may be an important nodal point for the generation and/or propagation of beta oscillations throughout the motor system.     

Neuromuscular irritability and serum creatine phosphate kinase in athletes in training

Athletes in training were examined at rest for serum creatine phosphate kinase (CPK) and irritability of the quadriceps muscles vastus medialis and rectus femoris. The irritability of the former shows a significant correlation with that of various other phasic muscles of the extremities. A significantly higher serum CPK-activity was found in athletes with hyperexcitability of the phasic muscles for rheobasic stimuli. The possible origin of the high resting level of CPK in athletes, as well as the characteristics of the investigated muscles, are discussed.     

High energy phosphates and related compounds,glycogen levels and histology in the rat tibialis anterior muscle after forced lengthening and isometric exercise

Eccentric exercise may elicit damage to the contractile elements. This primary damage is followed by secondary changes, consisting of histological changes and changes in glycogen and energy metabolism. The mechanism underlying changes in glycogen homeostasis and energy metabolism is not well established. The aim of this study was to investigate the possible relationship between changes in adenine and guanine nucleotides, inosine monophosphate (IMP), creatine phosphate, glycogen content and histology in the rat tibialis anterior (TA) muscle after forced lengthening or isometric exercise. The right muscles were either forcibly lenghtened or isometrically exercised, while the contralateral muscles served as non-exercised controls. The exercised muscles were dissected 0, 6 and 24 h post-exercise and the contents of adenine and guanine nucleotides, IMP, creatine phosphate, and glycogen determined. In addition, histological changes were assessed. Immediately after both types of exercise increases in tissue IMP levels were found. Irrespective of the type of exercise, glycogen content was decreased immediately post-exercise, but restored 6 h postexercise. Twenty-four hours later a second decline in glycogen content was found after both types of exercise. In forcibly lengthened muscles ATP content was decreased 24 h post-exercise. In isometrically exercised muscles ATP was not decreased at any time. Gross structural changes were found in all forcibly lengthened muscles (9–12% of TA muscle volume). In isometrically exercised muscles structural changes were minor (up to 0.1 % of muscle volume), were found only immediately post-exercise and in only 4 out of 18 muscles. It is concluded that forced lengthening results in decreased ATP levels. Changes in glycogen homeostasis were found after both isometric exercise and forced lengthening, demonstrating that these changes are not strictly related to degenerative changes.     

Bilateral innervation of syringeal muscles by the hypoglossal nucleus in the jungle crow (Corvus macrorhynchos)

Bird vocalizations are produced by contractions of syringeal muscles, which are controlled by the hypoglossal nucleus. In oscines, syringeal muscles are controlled by the hypoglossal nucleus ipsilaterally, whereas syringeal innervation is bilateral in non-oscines. We have determined the course of hypoglossal nerves in the jungle crow Corvus macrorhynchos . Our results indicate a cross-over of the hypoglossal nerve from the left side to the right side on the trachea 7 mm rostral to the Musculus sternotrachealis . We also investigated the innervation of the syringeal muscles of jungle crows from the hypoglossal nucleus using the horseradish peroxidase (HRP) method. After HRP was injected into the syringeal muscles on each side, HRP-labeled cells were found bilaterally in the hypoglossal nerve. These results suggest that the syringeal muscles of jungle crows are innervated bilaterally from the hypoglossal nucleus, although these birds are categorized as oscines.     

Multijoint muscle regulation mechanisms examined by measured human arm stiffness and EMG signals

Stiffness properties of the musculo-skeletal system can be controlled by regulating muscle activation and neural feedback gain. To understand the regulation of multijoint stiffness, we examined the relationship between human arm joint stiffness and muscle activation during static force control in the horizontal plane by means of surface electromyographic (EMG) studies. Subjects were asked to produce a specified force in a specified direction without cocontraction or they were asked to keep different cocontractions while producing or not producing an external force. The stiffness components of shoulder, elbow, and their cross-term and the EMG of six related muscles were measured during the tasks. Assuming that the EMG reflects the corresponding muscle stiffness, the joint stiffness was predicted from the EMG by using a two-link six-muscle arm model and a constrained least-square-error regression method. Using the parameters estimated in this regression, single-joint stiffness (diagonal terms of the joint-stiffness matrix) was decomposed successfully into biarticular and monoarticular muscle components. Although biarticular muscles act on both shoulder and elbow, they were found to covary strongly with elbow monoarticular muscles. The preferred force directions of biarticular muscles were biased to the directions of elbow monoarticular muscles. Namely, the elbow joint is regulated by the simultaneous activation of monoarticular and biarticular muscles, whereas the shoulder joint is regulated dominantly by monoarticular muscles. These results suggest that biarticular muscles are innervated mainly to control the elbow joint during static force-regulation tasks. In addition, muscle regulation mechanisms for static force control tasks were found to be quite different from those during movements previously reported. The elbow single-joint stiffness was always higher than cross-joint stiffness (off-diagonal terms of the matrix) in static tasks while elbow single-joint stiffness is reported to be sometimes as small as cross-joint stiffness during movement. That is, during movements, the elbow monoarticular muscles were occasionally not activated when biarticular muscles were activated. In static tasks, however, monoarticular muscle components in single-joint stiffness were increased considerably whenever biarticular muscle components in single- and cross-joint stiffness increased. These observations suggest that biarticular muscles are not simply coupled with the innervation of elbow monoarticular muscles but also are regulated independently according to the required task. During static force-regulation tasks, covariation between biarticular and elbow monoarticular muscles may be required to increase stability and/or controllability or to distribute effort among the appropriate muscles.     

桡骨环状韧带副张肌的某些资料

本文在100例成人上肢肘区标本上,观测了桡骨环状韧带内,外侧副张肌的位置和形态。内侧副张肌的出现率为26％,外侧副张肌的出现率为61％,该二肌均受桡神经深支支配。本文还根据内,外侧副张肌的起止对其功能意义进行讨论。未见副旋后肌。     

Parallel spindle systems in the small muscles of the rat tail

1. The examination consisted of a histological analysis using paraffin sections, gold chloride staining and osmic acid techniques.2. The parallel spindle system found in the rat tail muscles is compared with that found in frog muscles. The rat spindle system occasionally included extrafusal fibres.3. It was evident that there are basic Class differences between the frog and rat tail parallel spindles, but it is suggested that they may serve a similar proprioceptive role in muscles having almost isometric contractions.4. Other short muscles of the rat that might have an analogous function to the tail muscles were examined, but only the capitus and deep masseter muscles showed parallel spindle systems, and none contained extrafusal fibres.5. Of other mammals examined, the muscles of the tails of the cat, rabbit, mouse and guinea-pig contained parallel spindles, while the dog and mole showed none in the small sample taken.6. Nerve trunk fibre size histograms, including de-efferented trunks, indicated a high proportion of sensory nerve fibres from the tail (55%), a low motor unit ratio (1:60) and a beta axon motor supply both to the spindles and to the small muscles of the tail.7. A generalized schema of the rat tail anatomy is presented, and a tabulation of the large sensory endings expected to be found in any particular small tail muscle.8. It was concluded that the rat tail has a spindle density enough to provide a proprioceptive sensitivity equivalent to that of a caudal digit.