The anatomy of the subscapular nerves: a new nomenclature

We propose a new nomenclature for the consistent, additional nerves that branch from the posterior cord of the brachial plexus. We hope this will aid the plexus surgeon and the evolution of plexus reconstruction for both obstetric and adult cases of injury.     

The subcoracoid impingement

Researchers must gather all anatomic and clinical information and evaluate the results of various imaging techniques and operative procedures if more is to be learned about anteromedial subcoracoid or coracohumeral impingement. Although the impingement syndrome constitutes an anatomic and clinical entity, more must be learned about the pathogenesis to arrive at well-founded surgical solutions.     

Facial fat: descriptive and functional anatomy, from a review of literature and dissections of 10 split-faces

The aim of this study is to describe the anatomy of the fat in the face, based on a review of the literature and dissections of 10 half-faces. The facial fat can be divided in two layers. The first-one is superficial, between the skin and the superficialis fascia. Its function is essentially protective and its morphological implications are major, especially according to the facial aging. The other layer is deep, under the superficialis fascia. Its principal function is mechanical and its morphological implications are less important. This layer is made of several fat pads in continuity, excepted the buccal fat pad which is separated from the others by its own capsula. The other fat pads are the intra orbialis fat pad, the sub orbicularis oculi fat pad (SOOF), the retro orbicularis oculi fat pad (ROOF), the galeal fat pad and the temporal fat pad.     

The anatomy of the subscapular artery and its effects on flap design in the rabbit

The course of the subscapular artery was studied in 20 rabbits. Its course was constant, giving two branches to the latissimus dorsi muscle after which the vessel sent a branch (S1) that perforated the panniculus carnosus to supply a large territory of skin. In a separate experiment, the contribution of the S1 branch to the viability of the rabbit latissimus dorsi musculocutaneous flap was evaluated. From this experiment it can be concluded that, first, it is possible in a rabbit to elevate a large skin flap based solely on a muscle perforator (S1), which survives completely. Second, in the rabbit latissimus dorsi musculocutaneous flap, S1 is the major blood supply to the skin component. Damage to it severely diminishes skin flap survival, even if the vascular supply to the underlying muscle is completely intact.     

The functional anatomy of forearm rotation

The elbow, forearm and wrist act as a unified structure to provide a stable, strong and highly mobile strut for positioning the hand in space and for conducting load-bearing tasks. An understanding of the relevant anatomy and biomechanics is important for the surgeon assessing and treating disorders of forearm function. This paper is concerned with illuminating the principles and concepts governing forearm rotation and load-bearing functions.     

The functional anatomy of neuropathic pain

The generation of neuropathic pain is a complex phenomenon involving a process of peripheral and central sensitization producing enhanced transmission of nociceptive inputs to the brain associated with the loss of discriminatory processing of noxious and innocuous stimuli. This increased flow of abnormally processed nociceptive inputs to the brain may overcome the ability of descending modulatory pathways to produce analgesia, causing further worsening of the pain. Several crucial locations involved in the physiologic generation of pain inputs (eg, peripheral nociceptors, dorsal horns, thalamus, cortex) show evidence of functional reorganization and altered nociceptive processing in association with chronic pain. These locations present the best targets for therapeutic intervention, including systemic administration of drugs able to counteract the chemical storm induced by neural injuries in the nociceptive afferents and dorsal horns, or for more focused intervention, such as neuroablative procedures; intrathecal drug delivery; and spinal cord, deep brain, or motor cortex stimulation.     

The anatomy and functional axes of the femur

Linear and angular measurements were made on thirty-two cadaveric femora with respect to the mechanical (functional) axes of the bone. The long axis was defined as a line from the center of the femoral head to the anterolateral attachment of the posterior cruciate ligament. The transverse axis was defined as a line through the posterior cruciate ligament parallel to the line connecting each epicondyle. The condylar width, the length of each interepicondylar line, correlated well with depth, but the projections of the condyles from the transverse plane revealed significant variations from specimen to specimen. Considerable variation also was found between femora in terms of angular dimensions (that is, the angle of anteversion and the neck-shaft angle proximally, and the valgus angle of the femoral shaft distally). Considerable interspecimen variation in the angles between the transcondylar plane and the femoral center, in accord with the valgus angle of the femoral shaft distally, was also noted. The mean transcondylar valgus angle (described as the tangent of the condyles to the perpendicular of the long axis) was 3.8 degrees. In contrast, little variation among specimens was noted for the angle made by the shaft and the long axis.     

Lymphatic anatomy: functional nodal basins

The understanding of human dermal lymphatic anatomy has rested for nearly 120 years on the original work of Sappey. Subsequently, others have added significantly to our knowledge with anatomic studies. Copious lymphoscintigraphical data have accumulated in recent years in the evaluation of cutaneous melanomas. These data suggest that the old anatomic picture of lymphatic anatomy is functionally inaccurate. Analysis of these cumulative data reveals an extensive network of feeding lymphatic connections to major nodal basins far more expansive than previously recognized. These nodal basins overlap to a significant extent, rendering drainage prediction based on location nearly impossible. Therapeutic implications are remarkable.     

Elastofibroma: a subscapular mass

A large mass protruded from beneath the inferior angle of each scapula of a 69-year-old man when he adducted and elevated either arm 90 degrees at the shoulder. The tumor is situated under the inferior angle of the scapula when the arm and scapula are in the neutral position. A chest computed tomography scan with contrast showed bilateral soft-tissue opacities below each scapula. The radiologic diagnosis of a typical subscapular elastofibroma was confirmed by core-needle biopsy of each mass. The radiologic and clinical diagnosis and surgical treatment of this benign soft-tissue tumor are discussed.     

The subcoracoid space. An anatomic study

Soft tissue impingement under the coracoid process has recently been identified as a cause of painful shoulder disability. In this study the normal space between the humeral head and the coracoid process in two functional positions of the arm was measured in an attempt to delineate anatomic risk factors predisposing to subcoracoid impingement. Forty-seven normal shoulders were studied by computerized tomography (CT) in adduction, 20 additionally in forward flexion/internal rotation, which is the position most frequently causing subcoracoid impingement. The distance between the humeral head and the coracoid tip averaged 8.7 mm for the adducted arm and 6.8 mm for the flexed arm. Modifications of the coracohumeral relationship were found to affect the subcoracoid clearance roughly 1.5 times more in flexion than with arm at the side. Subcoracoid impingement appeared particularly likely during forward flexion of a shoulder with a coracoid tip close to the scapular neck and projecting far laterally.     

Long thoracic nerve: anatomy and functional assessment

BACKGROUND: The anatomy and function of the long thoracic nerve are not fully understood. The purposes of this study were to clarify the anatomy of the long thoracic nerve and to propose a clinical test to assess the function of the upper division of the long thoracic nerve. METHODS: The long thoracic nerve and the serratus anterior muscle were studied in fifteen fresh cadavera. Six patients had an operation to treat a brachial plexus injury, and the long thoracic nerve was electrically stimulated. The resulting shoulder motion was then observed. RESULTS: The long thoracic nerve was formed by branches arising from the C5, C6, and C7 nerve roots. The C5 and C6 branches joined beneath the scalenus medius muscle to form the upper division of the long thoracic nerve, which was located 1 cm posteriorly and superiorly to the upper trunk origin. The union of the upper division with the branch from C7 occurred caudally, in the axillary region. Two branches from the upper division of the long thoracic nerve to the upper portion of the serratus anterior muscle were consistently identified. After electrical stimulation of the upper division branches, shoulder protraction was observed. CONCLUSIONS AND CLINICAL RELEVANCE: In the supraclavicular region, the long thoracic nerve has a trajectory parallel to the brachial plexus, which is contrary to the schematic representation in most textbooks. The upper division of the long thoracic nerve can be assessed by the shoulder protraction test.     

Tibial anatomy and functional axes

Articular geometry of the tibia has been studied in relation to the functional axis and extra-articular bone landmarks, using a Cartesian coordinate system. Thirty-one cadaver limbs were used, 26 of them paired. The donor age range was 61 to 89 years (17 females, 14 males), none of whom showed evidence of significant arthritic deterioration. Most linear parameters were greater in males than females (p less than 0.005), and correlations between these parameters were noted, e.g., tibial length versus plateau width (r = 0.7, p less than 0.01) with both genders combined. Gender differences occurred in only two of the angular parameters--tibial torsion (p less than 0.025) and foot rotation (p less than 0.005). For the latter, mean rotation was internal (-5 degrees) for males, and external (11 degrees) for females. No correlations between angular parameters were found. In the paired limbs, there was asymmetrical distribution of just two parameters--varus tilt of the tibial plateau margins (p less than 0.005) and lateral deviation of the tuberosity (p less than 0.025). The data complement a previous report on the femur. These studies are relevant to the kinematics of the lower limb, design and sizing of resurfacing components, and possibly to the pathogenesis of osteoarthritis.     

肩关节的功能解剖与手术入路

本文简要介绍了肩关节的功能解剖,对与临床密切相关的解剖知识进行了总结,从不同角度总结了肩关节的运动,分析了参与运动的各肌肉具体作用。结合解剖结构的分析,详细介绍了常用的肩关节前侧、外侧、后侧手术入路具体操作方法及注意事项。