Dissection of a rare accessory muscle of the leg: the tensor fasciae suralis muscle

We report a case of the rare tensor fascia suralis muscle. This muscle was found during the routine dissection of the lower extremity in an adult male cadaver. No other anomalies were noted in this specimen. The innervation of this muscle was via the tibial component of the sciatic nerve. Although seemingly rare, the tensor fascia suralis muscle may be considered by the clinician in the differential diagnosis of masses over the posterior lower extremity.     

Elevator muscle of the tendon of latissimus dorsi muscle

Muscular dispositions in the axilla acquire importance under certain surgical procedures that involve the axillary artery ligature. These supernumerary muscles make the approach to the axillary fossa and their content difficult. We dissected 108 formalized corpses from adult male individuals. The specimens belong to the topographic Anatomy Unit of the Faculty of Medicine, Universidad de La Frontera, Chile. In all dissections, a rare and infrequent muscular variation attributed to the presence of a elevator muscle at the dorsal part of the latissimus muscle on the right upper limb from an adult individual was found. This muscle was fusiform and originated at the coracoid process by a short tendon of cylindrical form inserted in the dorsal superior part of the tendon of the latissimus dorsi muscle. Muscular belly and tendons of origin and insertion were closely related to the brachial plexus and the axillar vessels that they crossed.     

Ankle bracing, plantar-flexion angle, and ankle muscle latencies during inversion stress in healthy participants

CONTEXT: Ankle braces may enhance ankle joint proprioception, which in turn may affect reflexive ankle muscle activity during a perturbation. Despite the common occurrence of plantar-flexion inversion ankle injuries, authors of previous studies of ankle muscle latencies have focused on inversion stresses only. OBJECTIVE: To examine the latency of the peroneus longus (PL), peroneus brevis (PB), and tibialis anterior (TA) muscles in response to various degrees of combined plantar-flexion and inversion stresses in braced and unbraced asymptomatic ankles. DESIGN: Repeated measures. SETTING: University biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-eight healthy females and 12 healthy males (n = 40: mean age = 23.63 years, range = 19 to 30 years; height = 172.75 +/- 7.96 cm; mass = 65.53 +/- 12.0 kg). INTERVENTION(S): Participants were tested under 2 conditions: wearing and not wearing an Active Ankle T1 brace while dropping from a custom-made platform into 10 degrees , 20 degrees , and 30 degrees of plantar flexion and 30 degrees of inversion. MAIN OUTCOME MEASURE(S): The time between platform drop and the onset of PL, PB, and TA electromyographic activity was measured to determine latencies. We calculated a series of 2-way analyses of variance to determine if latencies were different between the conditions (braced and unbraced) and among the plantar-flexion angles (alpha = .05). RESULTS: No interaction was found between condition and plantar-flexion angle. No significant main effects were found for condition or plantar-flexion angle. Overall means for braced and unbraced conditions were not significantly different for each muscle tested. Overall means for angle for the PL, PB, and TA were not significantly different. CONCLUSIONS: Reflexive activity of the PL, PB, or TA was unaffected by the amount of plantar flexion or by wearing an Active Ankle T1 brace during an unanticipated plantar-flexion inversion perturbation.     

The Reliability of Portable Fixed Dynamometry During Hip and Knee Strength Assessments

Context:Insufficient lower extremity strength may be a risk factor for lower extremity injuries such as noncontact anterior cruciate ligament tears. Therefore, clinicians need reliable instruments to assess strength deficiencies.Objective:To assess the intrarater, interrater, intrasession, and intersession reliability of a portable fixed dynamometer in measuring the strength of the hip and knee musculature.Design:Crossover study.Setting:Sports medicine research laboratory.Results:The phase 1 intrasession intraclass correlation coefficients for sessions 1, 2, and 3 ranged from 0.88 to 0.99 (SEM  =  0.08–3.02 N), 0.85 to 0.99 (SEM  =  0.26–3.88 N), and 0.92 to 0.96 (SEM  =  0.52–2.76 N), respectively. Intraclass correlation coefficients ranged from 0.57 to 0.95 (SEM  =  1.72–13.15 N) for phase 1 intersession values, 0.70 to 0.94 (SEM  =  1.42–9.20 N) for phase 2 intrarater reliability values, and 0.69 to 0.88 (SEM  =  1.20–8.50 N) for phase 2 interrater values.Conclusions:The portable fixed dynamometer showed good to high intrasession and intersession reliability values for hip and knee strength. Intrarater and interrater reliability were fair to high, except for hip internal rotation, which showed poor reliability.     

Nerve fiber analysis on the so-called accessory subscapularis muscle and its morphological significance

A rare muscular anomaly, so-called accessory subscapularis muscle, was found in the left axillary fossa of a 95-year-old male cadaver during a student dissection practise. The muscle arose near the lateral margin of the scapula from the surface of the subscapularis muscle and ran upward to fuse with the capsule of the shoulder joint via a tendon. It measured 1.0 cm in width, 7.0 cm in length and 1.5 mm in thickness, and was separated from the underlying subscapularis muscle by the axillary and inferior subscapular nerves. Macroscopically, the anomalous muscle received its nerve supply from a branch arising from the lower root of the radial nerve near the origin of the thoracodorsal nerve and entered the muscle from its ventral surface. Nerve fiber analysis showed that the supplying nerve originated from fibers of the dorsal element of C7 immediately cranial to the thoracodorsal nerve. These findings indicate that the present anomalous muscle might be close to the formation of the latissimus dorsi muscle in its derivation rather than the subscapularis muscle.     

新疆维吾尔族学龄前儿童同身寸与身高，四肢长度关系的研究

目的：了解维吾尔族学龄前儿童同身寸与身高,四肢长度的关系,为体质人类学提供数据,为生长（年龄）解剖学,法医学提供参考依据。方法：对240名（男120人,女120人）发育正常的学龄前儿童同身寸,身高,上肢长度,下肢长度进行测量。结果：按年龄,性别分组将得出的同身寸,身高,上肢长度,下肢长度的基本数据进行统计学处理（总体均数估计,u检验及回归分析）结论：男,女各年龄组同身寸均值显著性检验提示男,女3－4组间有显著性差异,其它各组及性别间均无显著性差异,并据此提出同身寸与身高,上肢长度,下肢长度推导身高简单公式。     

Arch height and maximum rearfoot eversion during jogging in 2 static neutral positions

Context:

Clinically, lowering of the medial longitudinal arch is believed to be closely related to rearfoot eversion. However, the relationship between arch height and rearfoot eversion during gait is unclear.

Objectives:

(1) To examine the influence of 2 reference positions (weight-bearing neutral position [WBNP] and subtalar neutral position [STNP]) on maximum rearfoot eversion, tibial internal rotation, knee flexion, knee internal rotation, and dorsiflexion-plantar flexion of ankle joint measures during jogging and (2) to compare the relationships among static arch height, navicular drop, and the 2 maximum rearfoot eversion measures.

Design:

Crossover study.

Setting:

Gait laboratory.

Patients or Other Participants:

Thirty-three volunteers between 18 and 40 years of age.

Intervention(s):

Each participant stood on the treadmill in 2 static positions: WBNP and STNP. Kinematic data were obtained using a 10-camera motion analysis system (120 Hz) when participants jogged at 2.65 m/s on the treadmill in bare feet.

Main Outcome Measure(s):

Rearfoot and shank angular kinematics, navicular drop, and static arch height.

Results:

Maximum rearfoot eversion was greater (WBNP: 4.03° ± 2.58°, STNP: 10.91° ± 5.34°) when STNP was the static reference (P < .001). A strong correlation was seen between maximum STNP eversion and navicular drop (r = 0.842) but not between WBNP and navicular drop (r = 0.216). Differences were noted in dorsiflexion and knee kinematics during gait between the static references; however, the effect sizes were low, and the mean differences were smaller than 2°, which was less than 5% of total excursion during gait.

Conclusions:

Using STNP rather than WBNP as the reference position affects estimates of frontal-plane rearfoot movement but not other ankle or knee motions in jogging.     

Contribution of Knee Flexor and Extensor Strength on Sex-Specific Energy Absorption and Torsional Joint Stiffness During Drop Jumping

Context:

Lower extremity injury often occurs during abrupt deceleration when attempting to change the body''s direction. Although sex-specific biomechanics have been implicated in the greater risk of acute knee injury in women than in men, it is unknown if sex differences in thigh strength affect sex-specific energy absorption and torsional joint stiffness patterns.

Objective:

To determine sex differences in energy absorption patterns and joint stiffnesses of the lower extremity during a drop jump and to determine if these sex differences were predicted by knee extensor and flexor strength.

Design:

Cross-sectional study.

Setting:

Laboratory environment.

Patients or Other Participants:

Recreationally active, college-aged students (41 women: age  =  22.1 ± 2.9 years, height  =  1.63 ± 0.07 m, mass  =  59.3 ± 8.0 kg; 40 men: age  =  22.4 ± 2.8 years, height  =  1.77 ± 0.1 m, mass  =  80.9 ± 14.1 kg).

Intervention(s):

Participants performed knee flexor and extensor maximal voluntary isometric contractions followed by double-leg drop-jump landings.

Main Outcome Measure(s):

Lower extremity joint energetics (J × N⁻¹ × m⁻¹) and torsional joint stiffnesses (Nm × N⁻¹ × m⁻¹ × degrees⁻¹) were calculated for the hip, knee, and ankle during the initial landing phase. Body weight was measured in newtons and height was measured in meters. Sex comparisons were made and sex-specific regressions determined if thigh muscle strength (Nm/kg) predicted sagittal-plane landing energetics and stiffnesses.

Results:

Women absorbed 69% more knee energy and had 36% less hip torsional stiffness than men. In women, greater knee extensor strength predicted greater knee energy absorption (R²  =  0.11, P  =  .04), and greater knee flexor strength predicted greater hip torsional stiffness (R²  =  0.12, P  =  .03).

Conclusions:

Sex-specific biomechanics during the deceleration phase of a drop jump revealed that women used a strategy to attempt to decrease system stiffness. Additionally, only female strength values were predictive of landing energetics and stiffnesses. These findings collectively demonstrated that the task may have been more difficult for women, resulting in a different movement strategy among those with different levels of thigh strength to safely complete the task. Future researchers should look at other predictive factors of observed sex differences.     

Multicentric epithelioid hemangioendothelioma involving the same lower extremity: a case report and review of literature

Epithelioid hemangioendothelioma (EH) is an uncommon low-grade malignant soft-tissue tumor; no case has been previously reported where multicentric epithelioid hemangioendothelioma occurred in the same lower extremity at different sites. We report a case involving the common peroneal nerve and subsequently the long bone and the short bones of the same lower extremity, and also review the literature. After establishing case of several lesions, we reviewed the histopathology properly and followed up the patient for a long time with serial whole body assessment to pick up any subsequent lesions.     

Electrophysiologic response recorded in the first dorsal interosseous muscle with stimulation of the tibial and deep fibular nerves

Foot intrinsic muscle innervation may demonstrate some variability. The first dorsal interosseous muscle (FDI) is innervated by the deep branch of the lateral plantar nerve (LPN) from the main trunk of the tibial nerve. Contribution from the deep fibular nerve (DFN) may also play a role in the supply of the FDI. Thirty healthy adult volunteers were studied to determine the presence and type of response in the FDI with stimulation of the tibial nerve/deep branch of the LPN and DFN. Both nerves were stimulated at the ankle and knee with a surface and needle recording from the FDI. Latency, amplitude, and conduction values were recorded for each nerve. The incidence of DFN supply to the FDI was 16.6% with a mean ankle amplitude of 152 microV. The incidence of tibial nerve/deep branch of the LPN supply to the FDI was 100%, with a mean ankle amplitude of 5.11 mV. The superficial branch of the LPN is most often studied when evaluating for tarsal tunnel syndrome because the standard recording site is the abductor digiti minimi (ADM). Recording from the ADM, however, frequently produces a less than desirable waveform, and the technical challenges encountered with this site make tarsal tunnel syndrome assessment difficult. It is also possible that selective involvement of the deep branch of the LPN may occur, and if so, recording from the FDI may prove valuable.     

Importance of dissection in learning anatomy: personal dissection versus peer teaching

Two studies or approaches to time savings in teaching gross anatomy were implemented and tested. Personal dissection vs. peer teaching of the upper and lower extremities revealed subtle effects of dissection on examination performance. Although peer teaching was generally successful, students preferred to dissect for themselves, lacking confidence in being taught by other students. ANOVA and multiple range tests carried out on the examination means indicated no difference between each student's scores on upper and lower extremity questions. However, subtle effects were reflected in significant differences (P < 0.05) in both ratio (upper%/lower%) and difference (upper%-lower%) between each student's percent scores on upper extremity and lower extremity questions, indicating enhanced performance on the extremity dissected. Students dissecting both extremities were intermediate in both ratio and difference, and not significantly different from either the "upper" or "lower" extremity groups. A questionnaire indicated that students who dissected only one extremity would have preferred to have dissected both extremities, and, contrary to overall examination performance, disagreed that they had learned both extremities at a satisfactory level. Although documenting adequate learning with time savings, the results are consistent with the contention that hands-on dissection enhances learning and confidence in the subject matter, because examination performance as well as personal satisfaction was enhanced on the extremity that was dissected.     

Characteristic pattern of skeletal muscle remodelling in different mouse strains

Muscular injury associated with local inflammatory reaction frequently occurs in sports medicine, but the individual response and capacity of regeneration vary among subjects. Inflammatory cytokines are probably implicated in activation of repair mechanisms by specifically influencing tissue microenvironment. This work aimed to compare muscle tissue repair in different mouse lineages. We used C57BL/6 and BALB/c mice genetically predisposed to either Type1 or Type2 cytokine production. The role of Type1 cytokines was also investigated in C57IFN‐γ (IFNγ‐KO) and C57IL‐12 (IL12‐KO) knockout mice. Participation of T lymphocytes was assessed in athymic BALB/c nude (nu/nu) mice. Muscular lesion was induced with bupivacaine injection in the Triceps brachii muscle. BALB/c mice showed marked collagen deposition and increased TGF‐β mRNA content, contrasting with mild fibrosis observed in C57BL/6 mice. C57‐IFNγ‐KO mice, exhibited pronounced fibrosis, but IL12‐KO collagen deposition was similar to that of C57. Twenty‐four hours after lesion, C57BL/6 and BALB/c^nu/nu presented numerous regenerating myofibres and marked increase of metalloprotease‐9 activity compared with BALB/c. These data support that skeletal muscle remodelling is greatly influenced by the genetic backgrounds, shedding light on the molecular mechanisms influencing differential muscular remodelling and tissue regeneration among individuals.     

Sex-dependent effect of post-migration adaptation on height and relative lower leg length in Polish youth

Background: Growth in tibia length is considered to be particularly sensitive to environmental stress.

Aim: To estimate the effect of parental migration status on the relative length of the tibia in their school-age children.

Subjects and methods: Data included a nationwide random sample of 17,155 schoolchildren, 7–18?years of age, examined between 1966 and 1969 in Poland who provided information on anthropometric measurements and demographic and social characteristics. Parental migration status was based on paternal migration history. After standardisation by LMS method, z-scores of relative tibia length and z-scores of height were used for analysis. Three-way ANOVA was used to evaluate the influence of migration on tibia length-to-height ratio.

Results: Sons of migrants have a significantly higher tibia length-to-height ratio compared to sons of non-migrants. Children of non-migrants were taller than children of migrants among boys in medium SES and among girls in high and low SES. Relative tibia length indicated significant effects of migration among boys in all age categories and in late adolescent girls: sons of migrants had a higher ratio and daughters of migrants had a lower tibia length-to-height ratio.

Conclusion: It is possible that migration experiences of the parents may have influenced the growth of their offspring. The results emphasise the potential importance of research addressing the impact of different types of migration on growth of children.     

Anatomical study of the perforating vessels of the lower leg

Difficulty of soft tissue defects of the lower leg demands the development of new methods to treat such defects. The aim of this study is the examination of perforators and the various ways of blood supply to the skin in the lower leg. Provided with certain regularity, we would be able to cure soft‐tissue defects also in the difficult zone of the distal segment and on the dorsum of the foot not harming vessels and not affecting mobility of muscles. Subcutaneous island‐flaps supplied by perforating vessels could replace free flaps. By saving the crural fascia of 10 lower legs we flayed layers of skin and fat, marked the perforating vessels with pins, and photographed and documented them. Specimens were divided into a proximal, an intermediate and a distal segment, each of them subdivided into a medial, lateral and dorsal section. The perforators, which can be classified as septocutaneous and musculocutaneous vessels, followed a reproducible pattern all over the lower leg. All vessels were sufficient in number as well as in size. Additionally these perforators can easily be identified by colour‐coded sonography. The knowledge that perforators in the lower leg occur regularly enables the development of a new operative approach in therapy of soft‐tissue defects in this region with the advantage, that the vessels used can be selected preoperatively. Anat Rec 255:374–379, 1999. © 1999 Wiley‐Liss, Inc.     

中国汉族人的上、下肢长度

目的:探讨汉族人身高、指距、上肢全长、身高指距指数、身高上肢长指数、身高下肢长指数、上下肢长指数值与纬度的关系。方法:按学术界统一的方法,统计中国22个省26952例汉族人(乡村男性8174例,乡村女性8327例,城市男性5048例,城市女性5403例)的身高等7项指标值和4项指数值。结果:随纬度增高,汉族人指距、上肢全长与纬度无相关,身高、下肢全长值呈线性增大。城市汉族男性、女性身高下肢长指数与纬度呈正相关。城市男性、乡村男性、城市女性身高指距指数、身高上肢长指数与纬度呈负相关。结论:中国从南方到北方,汉族的身高、下肢全长值均线性增大,但上肢长值并没有明显的增大。随纬度增高,从上下肢长指数来看,城市男性、乡村男性、城市女性逐渐呈现腿长臂短的特征。     

急性下肢动脉缺血程度分级相关因素探讨

目的探讨影响急性下肢动脉缺血分级的相关因素。方法回顾性分析笔者2005年5月至2010年6月收治的73例经造影证实为急性下肢动脉栓塞或急性下肢动脉血栓形成的患者,其中男性40例,女性33例;年龄35~90岁,平均年龄68.5岁。采集临床相关资料,对性别、年龄、缺血时间、吸烟史、其他合并症、肢体动脉栓塞史、梗阻原因(栓塞/血栓形成)等可能影响急性缺血分级的因素,使用SPSS 11.5软件进行多因素逻辑回归分析。结果该组患者73例,79条患肢,急性缺血分级:Ⅰ级2例(3条患肢);Ⅱ级65例,其中Ⅱa级32例(34条患肢),Ⅱb级33例(36条患肢);Ⅲ级6例(6条患肢)。缺血时间、糖尿病及梗阻性质可影响患者缺血程度(P<0.05)。随着缺血时间的延长,缺血程度逐渐加重;糖尿病患者下肢缺血程度倾向于Ⅱa级以下;急性动脉血栓形成缺血程度倾向于Ⅱa级,急性动脉栓塞缺血程度更趋向于Ⅱb级。结论缺血时间、糖尿病及梗阻性质与急性肢体缺血分级有相关性。     

Concentric and Eccentric Torque of the Hip Musculature in Individuals With and Without Patellofemoral Pain

Context:

Individuals suffering from patellofemoral pain have previously been reported to have decreased isometric strength of the hip musculature; however, no researchers have investigated concentric and eccentric torque of the hip musculature in individuals with patellofemoral pain.

Objective:

To compare concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain.

Design:

Case control.

Setting:

Research laboratory.

Patients or Other Participants:

Twenty participants with patellofemoral pain (age  =  26.8 ± 4.5 years, height  =  171.8 ± 8.4 cm, mass  =  72.4 ± 16.8 kg) and 20 control participants (age  =  25.6 ± 2.8 years, height  =  169.5 ± 8.9 cm, mass  =  70.0 ± 16.9 kg) were tested. Volunteers with patellofemoral pain met the following criteria: knee pain greater than or equal to 3 cm on a 10-cm visual analog scale, insidious onset of symptoms not related to trauma, pain with palpation of the patellar facets, and knee pain during 2 of the following activities: stair climbing, jumping or running, squatting, kneeling, or prolonged sitting. Control participants were excluded if they had a prior history of patellofemoral pain, knee surgery in the past 2 years, or current lower extremity injury that limited participation in physical activity.

Intervention(s):

Concentric and eccentric torque of the hip musculature was measured on an isokinetic dynamometer. All volunteers performed 5 repetitions of each strength test. Separate multivariate analyses of variance were performed to compare concentric and eccentric torque of the hip extensors, abductors, and external rotators between groups.

Main Outcome Measure(s):

Average and peak concentric and eccentric torque of the hip extensors, abductors, and external rotators. Torque measures were normalized to the participant''s body weight multiplied by height.

Results:

The patellofemoral pain group was weaker than the control group for peak eccentric hip abduction torque (F_1,38  =  6.630, P  =  .014), and average concentric (F_1,38  =  4.156, P  =  .048) and eccentric (F_1,38  =  4.963, P  =  .032) hip external rotation torque.

Conclusions:

The patellofemoral pain group displayed weakness in eccentric hip abduction and hip external rotation, which may allow for increased hip adduction and internal rotation during functional movements.     

Balance control in patients with distal versus proximal muscle weakness

Muscle weakness is consistently associated with falls in the elderly people, typically when present along with other risk factors. However, it remains unknown whether and how muscle weakness alone affects balance. This hampers development of more effective fall prevention strategies. Clinical observations suggest that the amount and distribution of muscle weakness influences balance control. We therefore investigated balance corrections in patients with either predominantly proximal (limb girdle muscular dystrophy (LGMD); n=8) or distal (distal spinal muscular atrophy; n=5) leg weakness, and 27 matched healthy controls. Balance was perturbed using surface tilt rotations that were delivered randomly in eight directions. Balance measures were full body kinematics and surface electromyographic activity (EMG) of leg, arm, and trunk muscles. Both patient groups were more unstable than controls, as reflected by greater excursions of the centre of mass (COM), especially in the pitch (anterior–posterior (AP)) plane. COM displacements were greater in distal weakness patients. Patients with distal weakness had excessive and unstable trunk, knee and ankle movements, and this was present following both forward and backward directed balance perturbations, possibly reflecting the greater use of distal leg muscles in these directions. In contrast, the less weak proximal weakness patients demonstrated unstable trunk and ankle movements only for backward directed balance perturbations. Both patient groups used arm movements to compensate for their instability. We conclude that primarily distal but also proximal muscle weakness leads to significant postural instability. This observation, together with the retained ability of patients to use compensatory arm movements, provides targets that may be amenable to improvement with therapeutic intervention.     

彩色多普勒诊断下肢深静脉血栓

目的　探讨彩色多普勒血流显像在下肢深静脉血栓诊断中的价值。方法　应用彩色多普勒血流显像仪,报道30条下肢深静脉血栓,描述了其声像图特征,并与X线血管造影相对照。结果　血栓存在部位与X线血管造影相符。彩色多普勒诊断下肢深静脉血栓的敏感性为92%～95%,特异性97%～100%。结论　彩色多普勒无创、方便,可作为诊断下肢深静脉血栓的首选方法。