BACKGROUND: Although several risk factors for iliopsoas impingement after total hip arthroplasty have been determined, limited data are available whether resection or preservation of the joint capsule affects the pressure underneath the iliopsoas tendon. Therefore, this study aims to test our hypothesis that capsular resection increases the pressure forced by the iliopsoas tendon at the iliopsoas notch. METHODS: Ten cadaveric hips were used for measuring the pressure changes under the iliopsoas tendon. First, measurements were taken in a neutral position of the hip with an increasing load applied onto the iliopsoas muscle (0-70 N). Second experiment was conducted at 10° of extension, 0°, and 30° of flexion, both with and without muscle load of 20 N. In both experiments, the pressure was tested in a capsule preserving setting, and then the same measurements were obtained after capsulectomy. FINDINGS: Capsular resection increased mean subtendinous pressure in the neutral hip position (P < 0.0001). Significant differences were recorded with muscle load greater than 10 N (all P < 0.02). At 10° of hip extension, the subtendinous pressure in hips with intact capsules differed significantly from those after capsulectomy, both with and without applied load (both P < 0.0001). At 30° of hip flexion, significant difference was observed only between loaded and unloaded hips with capsulectomy (P = 0.0176). INTERPRETATION: This study suggests that capsular resection during total hip arthroplasty alters the physiological pressures at the iliopsoas notch. Based on these findings, capsular sparing could decrease the risk of iliopsoas impingement after total hip arthroplasty.

• Klíčová slova
• Capsular preservation, Capsulectomy, Hip capsule, Iliopsoas impingement, Total hip arthroplasty,
• MeSH
• bederní svaly * fyziologie   MeSH
• biomechanika MeSH
• kloubní pouzdro * chirurgie   MeSH
• kosterní svaly * MeSH
• kyčelní kloub * chirurgie   fyziologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mrtvola MeSH
• náhrada kyčelního kloubu MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• šlachy * fyziologie   patofyziologie   MeSH
• tlak MeSH
• zatížení muskuloskeletálního systému MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

This study aimed to delineate the macroscopic and microscopic topography of muscles surrounding the anterior aspect of the hip joint and the underlaying joint capsule. Seven fresh-frozen cadavers were bilaterally dissected as per study protocol. Eleven hip joints were evaluated macroscopically, while three hip joints underwent histological analysis. Additionally, twenty hip bones and femurs were examined for the osseous morphology near the anterior portion of the articulating surfaces. Macroscopically, the rectus femoris muscle contributed to the articular capsule exclusively through its reflected head. The iliocapsularis and iliopsoas muscles were in direct contact with the articular capsule. Although the iliocapsularis muscle was adherent to the capsule throughout its whole course, the iliopsoas muscle was connected to the capsule through the iliopectineal bursa. Microscopically, different spatial thickness of the capsule was observed, with the thicker regions corresponding to the capsular ligaments. Osseous landmarks, relevant to the course of the iliopsoas muscle, included the iliopsoas notch and a groove for the psoas major muscle. Furthermore, split of the anterior inferior iliac spine and the "subspine" were constant findings corresponding to the origin of the direct head of the rectus femoris and the iliocapsularis muscles, and attachment of the medial band of the iliofemoral ligament, respectively. On the head of the femur, the Poirier's facet (35.0%), the Allen's fossa (60.0%), and the so-called plaque (50.0%) were observed. Conclusively, we introduce the concept of a four-layered anterior musculocapsular complex of the hip, aiming to aid the orthopaedic surgeon in both hip replacement and preservation procedures.

• Klíčová slova
• Acetabulum, Hip capsule, Iliocapsularis muscle, Iliopsoas muscle, Proximal femur,
• Publikační typ
• časopisecké články MeSH

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.

• Klíčová slova
• Coracoscapularis, Omohyoid, Subclavius Posticus, Subscapularis, Suprascapular nerve entrapment, Suprascapular notch arthroscopy,
• MeSH
• anatomická variace * MeSH
• artroskopie * metody   MeSH
• chirurgická dekomprese metody   MeSH
• kosterní svaly * anatomie a histologie   MeSH
• lidé MeSH
• lopatka inervace   anatomie a histologie   MeSH
• mrtvola MeSH
• studie proveditelnosti MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• scoping review 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.

• Klíčová slova
• Accessory bone, Accessory ossicle, Elbow, Os supratrochleare anterius,
• MeSH
• anatomická variace * MeSH
• humerus diagnostické zobrazování   MeSH
• lidé MeSH
• loketní kloub * MeSH
• počítačová rentgenová tomografie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

BACKGROUND: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach. METHODS: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated. RESULTS: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively. CONCLUSION: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine.

• Klíčová slova
• Femoral nerve, Genitofemoral nerve, Iliohypogastric nerve, Ilioinguinal nerve, Lateral femoral cutaneous nerve, Lateral transpsoas approach, Lumbar plexus, Obturator nerve,
• MeSH
• bederní obratle * chirurgie   anatomie a histologie   MeSH
• bederní svaly * anatomie a histologie   chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• mrtvola * MeSH
• nervus femoralis anatomie a histologie   chirurgie   MeSH
• nervus obturatorius anatomie a histologie   chirurgie   MeSH
• plexus lumbosacralis * anatomie a histologie   chirurgie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Several accessory bones can be found around the wrist, which may pose a diagnostic challenge. Hereby, we report a unique case of a traumatic fracture of an aberrant os styloideum in a 66-year-old male. The patient presented with a swollen dominant right hand and a hematoma on its anterior and posterior aspects, as a result of a fall on an outstretched hand. The diagnosis was based on a CT scan, which showed a fractured accessory bone between the distal portion of the capitate bone and the base of the third metacarpus. Due to its typical location, the ossicle was identified as os styloideum. The patient was treated conservatively and the symptoms subsided on a short forearm cast after 2 weeks. At a 12-month follow-up, no other episodes were declared. Strong anatomical knowledge and sharing of such cases is essential for proper diagnosis and treatment of this very rare condition.

• Klíčová slova
• Accessory bone, Carpal bone, Fracture, Os styloideum, Variation, Wrist,
• MeSH
• fraktury kostí * MeSH
• kosti zápěstní * MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• senioři MeSH
• úrazy pádem MeSH
• zápěstní kloub MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Although the term articularis cubiti muscle is incorporated in the official anatomical nomenclature, only sparse data about its appearance are available. It is usually described as few fibres originating from the medial head of the triceps brachii muscle and inserting to the capsule of the elbow joint. However, the most recent observations regarding the morphological relations in the posterior elbow region point towards the absence of a well-defined muscle. Therefore, this study was designed to verify the existence of the articularis cubiti muscle in question and to compile more data on the topographical features of the subtricipital area near the posterior aspect of the elbow. To address these questions, 20 embalmed upper limbs were dissected, and seven samples were collected for histological analysis. The laboratory findings were then correlated with 20 magnetic resonance imaging (MRI) scans of the elbow. Consequently, a narrative review of literature was performed to gain more information on the discussed muscle in a historical context. Upon the anatomical dissection, muscular fibres running from the posterior aspect of the shaft of the humerus to the elbow joint capsule and olecranon were identified in 100% of cases. Histologically, the connection with the joint capsule was provided via winding bands of connective tissue. On MRIs, the muscular fibres resembled a well-demarcated thin muscle located underneath the medial head of the triceps brachii muscle. Combined with the review of literature, we concluded that the constant articularis cubiti muscle originates from the posterior shaft of the humerus and attaches indirectly to the posterior aspect of the elbow joint capsule and directly to the superior portion of the olecranon. The obtained results slightly differ from the modern description, but are in agreement with the original publication, which has become misinterpreted throughout time. Presumably, the misused description has led to questioning the existence of an independent muscle. Moreover, our findings attribute to the articularis cubiti muscle, a function in pulling on the posterior aspect of the elbow joint capsule to prevent its entrapment, and possibly also a minor role in extension of the forearm. The presented results should be taken into consideration when intervening with the posterior aspect of the elbow joint because the articularis cubiti muscle poses a consistently appearing landmark.

• Klíčová slova
• Lecomte's pronator of ulna, anconeus muscle, articularis cubiti muscle, elbow joint capsule, subanconeus muscle, triceps brachii muscle,
• MeSH
• horní končetina MeSH
• kosterní svaly * diagnostické zobrazování   anatomie a histologie   MeSH
• loket MeSH
• loketní kloub * diagnostické zobrazování   anatomie a histologie   MeSH
• magnetická rezonanční tomografie MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: Discrepancy between the morphology of the acetabular margin and the design of hemispheric acetabular cups used in total hip arthroplasty may produce postoperative hip pain due to an iliopsoas impingement at the iliopsoas notch. This study aimed to determine the anatomical features of the iliopsoas notch in the Central European sample, and to test whether the morphology of the proximal femur affects the size of the iliopsoas notch. METHODS: The sample was composed of 40 matched pairs of dry hip bones and corresponding femora. The depth and length of the iliopsoas notch were measured and correlated with the available demographic data. The anthropometric parameters of the proximal femur were calculated using image-analysis software, and their association with the measurements of the iliopsoas notch was tested. RESULTS: The iliopsoas notch was present in all specimens and featured four morphological configurations: curved (61.3%), angular (16.2%), irregular (16.2%), and straight (6.3%). Its size was found to be larger in males (P = 0.014 for depth, P < 0.001 for length). No significant difference existed between the sides. The height and age of the specimens did not correlate with the size of the iliopsoas notch. Furthermore, neither the femoral neck version, the lesser trochanteric version, nor the angle between the neck of the femur and the lesser trochanter influenced the dimensions of the iliopsoas notch. CONCLUSION: The iliopsoas notch is a consistent landmark of the acetabulum, although its anatomical appearance is widely variable. The iliopsoas notch arrangement cannot be predicted perioperatively based on the morphology of the proximal femur. The various shapes and sex-related differences detected in this study could be used for designing new hip implants or could be utilized during cup positioning in total hip arthroplasty.

• Klíčová slova
• Acetabulum, Anterior labral sulcus, Iliopsoas notch, Psoas U, Psoas valley, Total hip arthroplasty,
• MeSH
• acetabulum * anatomie a histologie   MeSH
• dolní končetina MeSH
• femur chirurgie   MeSH
• kosterní svaly chirurgie   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To investigate the relationship between osseous variations of the glenoid fossa and thinning of the overlaying articular cartilage. MATERIALS AND METHODS: In total, 360 dry scapulae, comprising adult, children and fetal specimens, were observed for potential presence of osseous variants inside the glenoid fossa. Subsequently, the appearance of the observed variants was evaluated using CT and MRI (each 300 scans), and in-time arthroscopic findings (20 procedures). New terminology of the observed variants was proposed by an expert panel formed by orthopaedic surgeons, anatomists and radiologists. RESULTS: Tubercle of Assaky was observed in 140 (46.7%) adult scapulae, and an innominate osseous depression was identified in 27 (9.0%) adult scapulae. Upon radiological imaging, the tubercle of Assaky was found in 128 (42.7%) CTs and 118 (39.3%) MRIs, while the depression was identified in 12 (4.0%) CTs and 14 (4.7%) MRIs. Articular cartilage above the osseous variations appeared relatively thinner and in several young individuals was found completely absent. Moreover, the tubercle of Assaky featured an increasing prevalence with aging, while the osseous depression develops in the second decade. Macroscopic articular cartilage thinning was identified in 11 (55.0%) arthroscopies. Consequently, four new terms were invented to describe the presented findings. CONCLUSION: Physiological articular cartilage thinning occurs due to the presence of the intraglenoid tubercle or the glenoid fovea. In teenagers, the cartilage above the glenoid fovea may be naturally absent. Screening for these variations increases the diagnostic accuracy of glenoid defects. In addition, implementing the proposed terminological updates would optimize communication accuracy.

• Klíčová slova
• Bare area, Bare spot, Glenoid fovea, Intraglenoid tubercle, Terminologia Anatomica, Tubercle of Assaky,
• MeSH
• dítě MeSH
• dospělí MeSH
• kloubní chrupavka * diagnostické zobrazování   MeSH
• kloubní jamka lopatky * diagnostické zobrazování   MeSH
• lidé MeSH
• lopatka MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• počítačová rentgenová tomografie MeSH
• ramenní kloub * MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH

The palmaris profundus muscle is a rare anatomical variation of the forearm muscles. It has been described in both cadaveric and clinical studies as a possible cause of carpal tunnel syndrome. We observed three cases of this variant in recent years and decided to perform a scoping review of this uncommon anatomical entity. Major databases were searched to identify all relevant clinical and anatomical studies containing anatomical descriptions of the muscle, including its origin, insertion, and concomitant presence of the proper palmaris longus muscle or the bifid median nerve. In clinical cases, we studied the surgical approach. Sixty-four articles met our inclusion criteria and contained 88 cases of palmaris profundus muscle. The most common origin was the ventral aspect of the radius in the area of insertion of the pronator teres muscle observed in 11 cases (12.5 %). We found 65 cases (73.3%) in which the tendon was inserted into the palmar aponeurosis or palmar fascia after entering the carpal canal. The concomitant presence of the proper palmaris longus muscle was described in 47 cases (53.4%). We identified 10 cases (10.8%) of the bifid median nerve. In 49 of 69 clinical cases (71%), the surgical approach was to resect the variant muscle. The importance of this variant should not be underestimated due to its potential to compress the median nerve. We found a significant disparity in the muscle origin sites, but uniformity of muscle insertion. In cases where the muscle is found during carpal canal surgery, it should be partially resected to ensure complete nerve decompression.

• Klíčová slova
• Carpal tunnel, Comitans nervi mediani muscle, Deep palmaris muscle, Palmaris profundus muscle, Variant,
• MeSH
• kosterní svaly chirurgie   MeSH
• lidé MeSH
• nervus medianus chirurgie   MeSH
• neurochirurgické výkony škodlivé účinky   MeSH
• předloktí MeSH
• syndrom karpálního tunelu * chirurgie   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• scoping review MeSH