PURPOSE: Knowledge of the unusual arrangement of the flexor pollicis longus (FPL) muscle is important as the variable tendon may be a rare cause of carpal tunnel syndrome. METHODS: During a routine dissection at the Department of Anatomy, an unusual formation of the FPL muscle was observed in a formalin embalmed Central European cadaver. RESULTS: This report presents a variation of the FPL muscle, where the muscle split and formed a separate accessory head inserting into the first lumbrical muscle. Moreover, a tendinous interconnection was present between the FPL muscle tendon and the tendon of the aberrant muscle head. CONCLUSION: The cases described by previous literature, concerning the Linburg-Comstock variation or the accessory head of the first lumbrical muscle originating from the FPL muscle, are closest to the present case. Such variation has a clinical significance ranging from the functional limitation of the thumb and index finger movement to the potential median nerve compression.
INTRODUCTION: The anatomy of the brachial plexus has been a subject of interest to many researchers over time resulting in an inconsistent amount of data. Previously, our team had published two evidence-based studies on the anatomical variations involving the brachial plexus, therefore the aim of this study was to analyze the findings regarding the infraclavicular part of the brachial plexus with the use of meta-analytic techniques to complete the comprehensive series. MATERIAL AND METHODS: Major scientific databases were extensively searched to compile anatomical studies investigating the morphology of the infraclavicular part of the brachial plexus. Extracted data were classified based on our proposed classification system and subsequently analyzed with the use of random effects meta-analysis to state the pooled prevalence estimates of the distinct variation patterns. RESULTS: A total of 75 studies (4772 upper limbs) were selected for the meta-analysis. The branches of the lateral cord, including the lateral pectoral nerve and musculocutaneous nerve, resembled their usual origin in 76.8% (95% CI 50-96%) and 98.8% (95% CI 98-100%), respectively. The medial pectoral nerve, medial brachial cutaneous nerves, medial antebrachial cutaneous nerve and ulnar nerve emerging from the medial cord were observed originating from their usual origins in 90.9% (95% CI 68-100%), 90.7% (95% CI 73-100%), 87.9% (95% CI 67-99%) and 97.7% (95% CI 94-100%), respectively. Lastly, nerves branching from the posterior cord, including the superior and inferior subscapular nerves, thoracodorsal nerve, axillary nerve and radial nerve, originated as per textbook description in 90.7% (95% CI 80-98%), 76.1% (95% CI 61-89%), 90.1% (95% CI 84-95%), 79.8% (95% CI 68-90%) and 99.0% (95% CI 96-100%), respectively. Moreover, the usual origin of the median nerve from the lateral and medial cord via the corresponding roots was encountered in 89.7% (95% CI 84-95%) of cases. CONCLUSIONS: The nerves originating from the infraclavicular part of the brachial plexus exhibit a wide spectrum of possible origins. However, the usual patterns were significantly the most common types present in more than three quarters of cases. Especially clinicians might profit from the enhanced understanding of the brachial plexus anatomy presented herein, since we offer a strong guide for handling the anatomically challenging pathologies in this specific area.
INTRODUCTION: The anatomy of the supraclavicular part of the brachial plexus is highly variable, therefore the aim of this study was to perform a systematic review and meta-analysis of the various origins of the long thoracic, dorsal scapular, suprascapular and subclavian nerves. MATERIALS AND METHODS: Major electronic databases were searched to identify all cadaveric studies investigating the morphology of the supraclavicular part of the brachial plexus. Data on the origins of these nerves were extracted and classified. A random effects meta-analysis was performed to state the pooled prevalence estimates. RESULTS: A total of 26 studies, constituting a total of 1021 cases, were deemed eligible for inclusion into the meta-analysis. The usual origin of the long thoracic nerve from the C5, C6 and C7 roots was observed in 78.1% (95% CI 69.4-86.7%) of cases and 21.9% (95% CI 13.3-30.6%) had unusual origins. An accessory long thoracic nerve occurred in 0.3% (95% CI 0-0.7%) of cases. The overall prevalence of the dorsal scapular nerve arising from its usual origin the C5 root was found in 85.2% (95% CI 75.7-94.6%) of cases, while 14.8% (95% CI 5.4-24.3%) appeared abnormal. The suprascapular nerve emerged from its usual point on the superior trunk in 89.8% (95% CI 85.1-94.4%) of cases and in 10.2% (95% CI 5.6-14.9%) of cases had a variable origin. An accessory suprascapular nerve was present in 0.2% (95% CI 0-0.6%). Two possible sites of origin of the subclavian nerve were noted and the typical origin from the superior trunk was found in 98.3% (95% CI 96.3-100%) of cases and variable origin from the C5 root in 1.7% (95% CI 0-3.7%). All unusual origins of each nerve were much less common. CONCLUSIONS: The nerves emerging from the supraclavicular part of the brachial plexus express a wide spectrum of potential origins. Based on their various origins, a new classification system for all the nerves belonging to the supraclavicular part was proposed. Knowledge of these variations and their prevalence data is important to prevent iatrogenic injuries and to state useful landmarks for interventions in the axilla.
- MeSH
- krk MeSH
- lidé MeSH
- nervový transfer * MeSH
- nervus accessorius MeSH
- plexus brachialis * MeSH
- rameno MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
INTRODUCTION: The brachial plexus is a complex anatomical structure that gives rise to all the nerves of the upper limb. Its variability is frequently observed and represents a challenge for interventions in the lower neck and axilla. The aim of this study was to present a comprehensive and evidence-based review with meta-analytic techniques on the variability of roots, trunks, divisions and cords of the brachial plexus. MATERIALS AND METHODS: Major medical databases were searched to identify all anatomical studies investigating the variability in the formation of the brachial plexus. Data extracted consisted of demographic information, morphometric parameters, the arrangement of the brachial plexus at the level of the roots, trunks, divisions and cords and the relationship of the brachial plexus to the axillary artery and scalene muscles. The different configurations of the brachial plexus were put into a new classification, and the pooled prevalence of each case was calculated using a random effects model. A sub-analysis on age and geographical location was also performed. RESULTS: A total of 40 studies (3055 upper limbs) were included in the meta-analysis. The regular arrangement of roots forming trunks was identified in 84% (95% CI 79-89%) of cases. The overall prevalence of the prefixed and postfixed brachial plexus was 11% (95% CI 6-17%) and 1% (95% CI 0-1%), respectively and in less than 0.1% of cases the brachial plexus received a branch from both C4 and T2. For divisions forming cords, the regular arrangement was observed in 96% (95% CI 93-98%) of cases. Additional communicating branches between the components of the brachial plexus appeared in 5% (95% CI 3-7%) of cases. The relationship of the brachial plexus to the axillary artery and scalene muscles was considered regular in 96% (95% CI 89-100%) and 86% (95% CI 66-98%) of cases, respectively. Analysis of the morphometric parameters revealed the proportional consistency between the components forming the plexus during aging. CONCLUSIONS: Knowledge of anatomical variations of the brachial plexus is important for examinations and interventions in the lower neck and axilla. The variability was observed especially in the roots forming trunks, while divisions forming cords showed quite stable appearance. The results of this evidence-based review and meta-analysis can be applied in many different medical disciplines.
- MeSH
- arteria axillaris MeSH
- horní končetina MeSH
- krční svaly MeSH
- krk MeSH
- plexus brachialis * MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
INTRODUCTION: The vermian fossa (VF1) is a small midline depression at the inferior end of the internal occipital crest (IOC2) near the foramen magnum. This study aims to accurately define the usual arrangement ("the norm") of the inferior end of the internal occipital crest, to determine the prevalence and dimensions of the VF in Central European population, and to state a possible correlation of the VF with anatomical variations and developmental abnormalities. MATERIALS AND METHODS: We analyzed the prevalence of the VF in 1042 dry skulls. The variable anatomy was classified into either the VF (four categories) or norm. Some rare variations of this region were also encountered. RESULTS: The norm was defined as a flat triangular prominence at the inferior end of the IOC, without any depression. As the most frequent arrangement, the norm appeared in 710 (68.14%) skulls. We observed the fossa in 309 (29.65%), type I in 264 (25.34%), type II in 45 (4.32%) and other rarer variations in 23 (2.21%), skulls, by our new classification system. CONCLUSION: Despite many different variations can be encountered in the posterior cranial fossa, the proper definition of the usual arrangement at the inferior end of the IOC is still missing. The knowledge of such anatomical variations is essential to decrease the risk of the hemorrhage from dural venous sinuses during surgical approach. Based on prevalence, the underdeveloped posterior cerebellomedullary cistern may occur along with the VF, and their common occurrence seems probable to have a relationship to Chiari malformation type I. As for the terminology, the term median occipital fossa seems to be more appropriate.
- MeSH
- foramen magnum anatomie a histologie MeSH
- lidé MeSH
- týlní kost anatomie a histologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
At first sight, the issue of morphological terminology may seem to be a "closed and unchanging chapter", as many of the structures within the human body have been known for decades or even centuries. However, the exact opposite is true. The initial knowledge of the microscopic structure of the human body has been continuously broadening thanks to the development of new specialized staining techniques, discovery of the electron microscope, or later application of histochemical and immunohistochemical methods into routine tissue examination. Contrary to popular belief, histology has a status of constantly developing scientific discipline, with continuous influx of new knowledge, resulting in an unavoidable necessity to revise the histological nomenclature at regular intervals. The team of experts of the Federative International Programme on Anatomical Terminology, a working group of the International Federation of Associations of Anatomists, published in 2008 the First Edition of Terminologia Histologica. Terminologia Histologica (TH) is the best and most extensive of all the histological nomenclatures ever issued. However, here we suggest that several terms of important histological structures are still missing while several other terms are disputable. First, we present some clinically important terms of cells and tissue structures for inclusion in the next TH and, in a second part, we refer to some new terms in the current edition of the TH which are not yet mentioned in current histology textbooks (e.g., fusocellular connective tissue, bundle bone as the third type of bone tissue, spongy layer of vagina or arteria vaginata from the splenic white pulp). With this article we hope to start a wide scientific discussion which will lead to an inambiguous definition and demonstration of typical examples of all terms in the TH, with the result that the new edition of the Terminologia Histologica will become an internationally accepted communication tool for all practitioners and teachers of histology alike.
- MeSH
- anatomie normy MeSH
- anatomové MeSH
- buňky klasifikace MeSH
- histologie normy trendy MeSH
- lidé MeSH
- příručky lékařské MeSH
- terminologie jako téma * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
This article details our experience with the Terminologia Histologica (TH) and its utility in the teaching of histology, cytology, and clinical medicine (e.g., pathology and hematology). Latin histological nomenclature has been used for 43years, and the latest version of the TH has been in use for 15years (although it was only issued publicly within the past 10years). The following findings and ensuing proposals allow us to discuss key points pertaining to the TH and make important suggestions for potential changes to the TH (such as the exclusion and inclusion of various terms). We classify these changes into six groups: 1.) mistakes in the TH, 2.) discrepancies among various Terminologiae, 3.) discrepancies within the TH, 4.) the repetition of terms, 5.) synonyms in the TH, and 6.) missing terms in the TH. Surprisingly, unlike the anatomical nomenclature, the histological nomenclature has been neglected in the literature. This article addresses this problem by reviewing and summarizing the state of this field, pointing out key discrepancies, offering solutions, and highlighting topics for further discussion.
- MeSH
- anatomie * dějiny MeSH
- dějiny 17. století MeSH
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- jazyk (prostředek komunikace) dějiny MeSH
- terminologie jako téma * MeSH
- Check Tag
- dějiny 17. století MeSH
- dějiny 20. století MeSH
- dějiny 21. století MeSH
- Publikační typ
- časopisecké články MeSH
- historické články MeSH
