The sartorius muscle is typically innervated by two branches of the femoral nerve arising from the lumbar plexus. We present an unreported variant where the sartorius muscle was innervated by an accessory branch arising from the ilioinguinal nerve in addition to the proper two branches from the femoral nerve. The iliohypogastric nerve was fused with the ilioinguinal nerve. More proximally, the lumbar plexus also showed unusual arrangement. The anterior branch of the lateral femoral cutaneous nerve arose from the femoral branch of the genitofemoral nerve while the posterior branch arose directly from the second lumbar nerve. The genital branch of the genitofemoral nerve pierced the psoas major muscle more distally than usual, and featured a close proximity with the femoral nerve. Possible variable appearance of these nerves should be kept in mind during several surgical and diagnostic procedures since their iatrogenic or traumatic damage, or their susceptibility to entrapment, pose unpredictable clinical consequences.
PURPOSE: This study provides an insight on the extent of muscular variability at the suprascapular notch and elaborates on its anatomical interference in suprascapular nerve arthroscopic decompression procedures. METHODS: The suprascapular notch was dissected and its muscular topography was observed in 115 cadaveric specimens. High resolution imaging of the suprascapular notch was captured by a handheld digital microscope (Q-scope). The supraspinatus and subscapularis muscles were traced as they course at the suprascapular notch vicinity. The omohyoid muscle attachment onto the suprascapular ligament was measured. A scoping review and meta-analysis were done to investigate the observed rare muscular variants. RESULTS: In 3.48%, the suprascapular notch anterior surface was fully covered by the subscapularis muscle. The omohyoid muscle inserted onto the suprascapular ligament in 31.25% and extended up to 3/4th of the suprascapular ligament length in 2.61%. Two rare variant muscles were encountered: subclavius posticus muscle and a newly reported "coracoscapularis muscle". CONCLUSIONS: Four categories of muscles with topographical relationship to the suprascapular notch and its arthroscopic feasibility have been classified: (1) constant muscles not intervening with the suprascapular notch space - supraspinatus muscle; (2) constant muscles with variable positions that can intervene with the suprascapular notch space - subscapularis muscle; (3) constant muscles with variable positions that can intervene with the surgical approach - omohyoid muscle; (4) variable muscles intervening with the suprascapular notch space and surgical approach - subclavius posticus and coracoscapularis muscles. This study elucidates the necessity to assess/secure the omohyoid muscle attachment onto the suprascapular ligament in suprascapular nerve decompression ligamentectomy. LEVEL OF EVIDENCE: V Basic Science Research.
- MeSH
- Anatomic Variation * MeSH
- Arthroscopy * methods MeSH
- Decompression, Surgical methods MeSH
- Muscle, Skeletal * innervation anatomy & histology MeSH
- Middle Aged MeSH
- Humans MeSH
- Scapula innervation anatomy & histology MeSH
- Cadaver * MeSH
- Shoulder Joint innervation surgery anatomy & histology MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Feasibility Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Several muscle variations have been observed in flexor aspect of forearm which can hamper normal functioning of hand or may remain silent. One such unreported variation has been described in this report. An accessory muscle in the left forearm was found involving flexor carpi ulnaris (FCU) and palmaris longus (PL). This muscle was originating from the distal part of both FCU and PL through a slip from each tendon. After merging, it passed above the ulnar nerve and artery in the roof of Guyon's canal. This type of variation can cause neurovascular compression and can also mimic soft tissue mass, tumour or neuroma and can be misdiagnosed. Knowledge about this type of variation is important in cases of neurovascular decompression, forearm, and hand surgeries and these can be utilized in tendon transfer or free muscle flap for reconstruction purposes.
- MeSH
- Anatomic Variation MeSH
- Adult MeSH
- Muscle, Skeletal * abnormalities MeSH
- Humans MeSH
- Forearm * abnormalities MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
The hand is a unique structure in human body performing complex activities of daily life making it prone to injuries. While operating on zone VI extensor tendon injury, a surprising entity was observed. The extensor digitorum to the right index finger was absent. This is an extremely rare entity in the literature. Also, all previous studies on the extensor digitorum are cadaveric. Our findings are first of its kind intraoperative, incidental, and confirmed on MRI. Thus, it becomes a case report of special worth mentioning in literature.
- Keywords
- extensor digitorum communis,
- MeSH
- Anatomic Variation MeSH
- Adult MeSH
- Humans MeSH
- Finger Injuries * surgery diagnosis MeSH
- Tendon Injuries surgery diagnosis MeSH
- Fingers abnormalities surgery diagnostic imaging MeSH
- Tendons * abnormalities surgery diagnostic imaging MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
PURPOSE: The accessory bones around the elbow are very rare variant structures, present in approximately 0.7% of cases. They can cause diagnostic problems and can be mistaken for pathological structures, especially when pain and limitation of elbow movements are present and a trauma can be traced in the patient's history. They are of different nature, either presenting within muscle tendons as sesamoids (brachialis and triceps brachii muscles) or presenting intra-articularly probably as separated or accessory ossification centres. The least common is the os supratrochleare anterius. METHODS: We present a case of a young male, featuring chronic blocking and 20° limited flexion of his right elbow, which bothered him during his occupation as a locksmith. In history, he suffered minor trauma to the elbow 20 years ago. X-ray and CT showed a large ossicle in the coronoid fossa of the humerus. RESULTS: The ossicle was surgically extracted in small pieces. The patient left satisfied with no mention of complaints. CONCLUSION: The os supratrochleare anterius is a very rare accessory bone of the elbow, located in the coronoid fossa of the humerus which can mimic many pathological states, and limit movements and causing pain around the elbow.
- MeSH
- Anatomic Variation MeSH
- Adult MeSH
- Humerus abnormalities diagnostic imaging MeSH
- Humans MeSH
- Elbow Joint * MeSH
- Tomography, X-Ray Computed MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Review MeSH
Awareness of unique path of the superficial branch of the radial nerve and its unusual sensory distribution can help avoid potential diagnostic confusion. We present a unique case encountered during a routine dissection of a Central European male cadaver. An unusual course of the superficial branch of the radial nerve was found in the right forearm, where the superficial branch of the radial nerve originated from the radial nerve distally, within the supinator canal, emerged between the extensor digitorum and abductor pollicis longus muscles and supplied the second and a radial half of the third digit, featuring communications with the lateral antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve. Due to dorsal emerging of the superficial branch of the radial nerve the dorsal aspect of the thumb was innervated by the lateral antebrachial cutaneous nerve. To our best knowledge such variation of the superficial branch of the radial nerve has never been reported before. This variation dramatically changes aetiology and manifestation of possible entrapment syndromes which clinicians should be aware of.
- MeSH
- Anatomic Variation * MeSH
- Dissection MeSH
- Muscle, Skeletal * innervation abnormalities MeSH
- Humans MeSH
- Cadaver * MeSH
- Radial Nerve * anatomy & histology abnormalities MeSH
- Forearm * innervation abnormalities MeSH
- Fingers * innervation MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
BACKGROUND: Contrary to the classic anatomical description, many recent studies have reported wide variations in branching patterns and location of motor branches that are supplying the pronator teres muscle. To understand these variations and their implications in surgical procedures of the nerve transfers, a systematic review was performed on the innervation of pronator teres muscle from cadaveric studies. METHODS: A systematic literature search was performed in databases such as Medline, PubMed, Google Scholar, SciELO, ScienceDirect, Cochrane reviews and orthopedics textbooks using the search terms "pronator teres nerve branches"; AND "number" OR "location" OR "length" OR "diameter" yielded 545 article links. Articles were evaluated according to PRISMA guidelines. RESULTS: A total of twenty cadaveric studies including 648 branches have registered 52.9% of two branch innervation pattern followed by 31.3%-single branch pattern; 13.5%-three branch pattern; 1.7%-four branch pattern, and 0.4%-five branch patterns, respectively. Of the 403 branches studied for their location in relation with the humeral intercondylar line, most branches were located distal to the line (50.3%), followed by 32.7% (proximal to it) and 16.8% at the line, respectively. The distance of branches located proximal and distal to humeral intercondylar line was in the range of 1.25-10 cm, and 1.1-7.5 cm, respectively. The mean length and diameter of nerves reported were 4.37 ± 2.43 cm, and 1.5 mm, respectively. CONCLUSIONS: Our data defined the morphometrics of nerve branches and they often met the required diameter for neurotization procedures. Our findings also demonstrated that the morphometrics, branching pattern and their location vary between populations and this information is very vital for surgeons during the nerve transfers.
- MeSH
- Anatomic Variation * MeSH
- Muscle, Skeletal innervation MeSH
- Humans MeSH
- Cadaver MeSH
- Nerve Transfer methods MeSH
- Median Nerve anatomy & histology MeSH
- Ulnar Nerve anatomy & histology MeSH
- Forearm innervation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Systematic Review MeSH
INTRODUCTION: The superior surface of the anatomical neck is presented in the classification of scapular fractures as a 2-cm-long structure, which does not correspond to reality. This issue has not yet been adequately addressed in the literature. The aim of the study was to assess the variability of a notch between the upper rim of the glenoid and the coracoid base, the so-called coracoglenoid notch (CGN), and its clinical significance. MATERIALS AND METHODS: The study was based on the examination of 204 dry bone specimens of adult scapulae (92 male and 112 female). We have determined quantitative criteria for the evaluation of the CGN type, measuring the offset of anatomical neck using a digital caliper. The findings were compared with 3D CT reconstructions of fractures of the scapular anatomical neck. RESULTS: Three basic types of CGN have been identified: type A-a well-developed notch in 31%, type B-a shallow notch in 53% and type C-an absent notch in 16%. No significant difference in CGN was found between the sexes, or between the right and left sides. When compared with our six cases of the anatomical neck fracture of the scapula, two patients displayed CGN type A and type B, respectively; but in four patients, it was impossible to distinguish between types A and B. CONCLUSION: The study has documented a high variability of CGN. Its presentation in the classification schemes does not correspond to anatomical reality. The presence of a deep, or shallow, notch may constitute an anatomical predisposition to a fracture of the anatomical neck.
- MeSH
- Anatomic Variation MeSH
- Adult MeSH
- Fractures, Bone diagnostic imaging etiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Scapula anatomy & histology diagnostic imaging injuries MeSH
- Adolescent MeSH
- Young Adult MeSH
- Tomography, X-Ray Computed MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE: Variations of the peripheral nervous system in the upper limb, especially of the musculocutaneous and median nerves, are common, but closer attention to the knowledge of the variant anatomy should be paid to avoid iatrogenic injury or to understand the unusual clinical signs. METHODS: During a routine dissection course, bilateral variations were observed in a Central European male cadaver. RESULTS: Variable branching of the musculocutaneous and median nerves associated with atypical innervation of the muscles in the anterior compartment of the arm and other concomitant variations were found bilaterally. In both cases, the musculocutaneous nerve innervated only the coracobrachialis muscle and terminated inside the muscle belly. Branches to the biceps brachii and brachialis muscles arose either directly from the median nerve or its branches. On the right side, two communicating branches between the roots of the median nerve were noted, and a common medial cutaneous trunk originated from the lateral cord. On the left side, a communicating branch extended from the lateral cord to the medial root of the median nerve and a tributary to the axillary vein passed through a window formed by the roots of the median nerve and the communicating branch. CONCLUSION: There exist only few cases in the literature describing similar variations, but the present arrangement has not yet been reported to the best of our knowledge. With the proposed extension to the existing classification system, we aim to provide clearer orientation in the variability of the musculocutaneous and median nerves.
- MeSH
- Anatomic Variation * MeSH
- Dissection MeSH
- Muscle, Skeletal innervation MeSH
- Humans MeSH
- Cadaver MeSH
- Median Nerve abnormalities MeSH
- Musculocutaneous Nerve abnormalities MeSH
- Arm innervation MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
