Terminologia Anatomica 2nd edition: perspectives from anatomy educators in the United Kingdom.

English anatomical terminology has evolved over the long history of anatomical practice, with major influences from ancient Greek, classical Latin, Arabic, and post-classical Latin. Beginning in the nineteenth century, there have been various attempts to standardise and rationalise anatomical language, beginning in 1887, and culminating in the publication in 2019 of the second edition of the Terminologia Anatomica. This paper presents a brief historical overview of the development of anatomical terminology and usage in English, followed by a summary of the results of an anonymised survey of current practices that was sent out by email to anatomy educators at 45 medical schools in the United Kingdom. This is followed by personal reflections by six senior academics and/or clinicians, reviewing their extensive experience of teaching, researching, and communicating the language of anatomy within United Kingdom medical and clinical institutions.

Ultrasound Measurement of Lateral Patellar Displacement: A Cadaveric Validation Study.

Background: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal complaints seen in outpatient settings. It has been suggested that hip adduction creates loads on the iliotibial band and causes lateral displacement of the patella (patellar tilt), which can lead to uneven patellofemoral joint loading, and hence, cause patellofemoral pain. In previous studies in the literature, ultrasound has been used to measure lateral patellar displacement. However, the method lacks validity data. Purpose/Hypothesis: The aim of this study was to validate the use of ultrasound to measure lateral displacement of the patella, by comparing the position of the patella as measured first by ultrasound, and then by direct measurement. Study Design: Descriptive Laboratory Study. Methods: Nine soft-fixed cadavers were used in this study. The cadavers had been donated for anatomical examination and research under the Human Tissue Act (2004). The distance between the lateral femoral condyle and the lateral edge of the patella were measured by B-mode real-time ultrasound, and then by direct measurement, in two positions, neutral and at 20° hip adduction. Results: The mean difference in the patella-to-lateral femoral condyle distance in the neutral position and at 20° adduction was 0.27 cm (ultrasound), and 0.34 cm (direct measurement), respectively. There were no significant differences between the measurements obtained by US and by direct measurement (Pearson correlation= 0.97, p=0.83). Conclusion: Ultrasound is a valid and reliable method for measuring patellar position relative to the femoral condyle, and the validity data reported here suggest that it can be used with confidence in clinic to assess lateral patellar displacement. Level of Evidence: 3.

The Effect of Self-Myofascial Release on the Pennation Angle of the Vastus Medialis Oblique and the Vastus Lateralis in Athletic Male Individuals: An Ultrasound Investigation.

Background: Maintenance of patellar stability requires a balance between the vastus medialis oblique (VMO) and the vastus lateralis (VL). The imbalance between these muscles is thought to be implicated in the etiology of patellofemoral pain (PFP). Where there is hypertrophy of the VL in PFP patients, self-myofascial release (SMR) may be utilized for its management. However, there is no current evidence regarding SMR and its effects on VMO and VL architecture. The aim of this study, therefore, was to use ultrasound to gain further understanding of the effects of a program of SMR on the fiber angles of the VMO and VL. Hypothesis: There will be a significant decrease in the pennation angles of the VMO and VL after seven weeks of SMR using a foam roller. Study Design: Cohort Study. Methods: Twenty-five young, athletic, male participants were recruited to use a foam roller, along the full length of both anterior thighs, three times weekly, on three separate days, for seven weeks. Ultrasound was used to determine the initial and final VMO and VL pennation angles on both limbs. One eligible participant was chosen as an intra-rater control and did not partake in the SMR regimen. Results: There was a statistically significant (p < 0.001) decrease in the pennation angles of the VMO and VL after the SMR regime. Mean combined right and left VL angle change was -6.65° (-18% mean change) and the mean combined right and left VMO angle change was -7.65° (-11.5% mean change). A weak negative correlation was found between initial VMO fiber angle and the angle change (Rsquared = -0.21), as well as moderate negative correlation for the VL (Rsquared = -0.51). Conclusion: A program of SMR on the anterior thighs of young, asymptomatic males resulted in changes to the fiber angles of both the VMO and VL. There was a significant decrease in pennation angle after seven weeks of SMR using a foam roller.

The effect of stretching exercises on the fibre angle of the vastus lateralis and vastus medialis oblique: an ultrasound study.

[Purpose] To investigate the effects of a seven-week quadriceps stretching program on the muscle fibre orientation of the vastus medialis oblique and vastus lateralis in the lower limbs by ultrasound imaging. [Participants and Methods] Twenty-seven healthy, physically fit, asymptomatic females and males (age 21.5 ± 1.3, Tegner activity level score ≥4) were recruited. Their initial vastus medialis oblique and vastus lateralis fibre angles were determined using ultrasound. They then undertook a seven-week quadriceps stretching program, 3 sets of stretches to be performed on both lower limbs, 3 times a week on 3 separate days. One volunteer was assigned as an intra-rater control and did not take part in the stretching program. The vastus lateralis and vastus medialis oblique fibre angles were measured again on completion of the exercise regime. [Results] A statistically significant decrease in muscle fibre angle was observed in both the right and left vastus medialis oblique, and the right and left vastus lateralis. [Conclusion] A 7-week stretching program can result in a significant decrease in muscle fibre angle in both the vastus medialis oblique and the vastus lateralis. This can help in understanding the effects of prescribed stretching exercises on athletic patients with PFP.

The innominate tubercle of the femur is a consistent surgical landmark and shows no variation between sex and side: An osteological study.

INTRODUCTION: During direct anterior approach hip arthroplasty, the innominate tubercle (IT) of the femur is used as a reference point for femoral neck osteotomy. A recent study found that IT dimensions are unaffected by femoral length, neck-shaft angle, and neck length. This study investigated the position of the tubercle relative to femoral side, sex and femoral neck dimensions. MATERIALS AND METHODS: One hundred and ninety femora (95 pairs, complete with biographical data) from St. Bride's Church, London, were photographed with the apex of the tubercle marked. Using imaging software, axes were superimposed onto the image, allowing the X and Y co-ordinates of the tubercle apex to be derived. Statistical analysis was carried out. RESULTS: The position of the tubercle did not vary significantly and did not correlate with femoral side (p > .05). P values for variation of the X and Y coordinates were 0.351 and 0.996 in left and right femora, respectively. The tubercle position did not vary significantly with sex (p > .05). p Values for variation of the X and Y coordinates were 0.254 and 0.634 in males and females, respectively. There was little variation between tubercle position and femoral neck dimensions: correlation coefficient -0.20 (x coordinate) and -0.12 (y coordinate). CONCLUSIONS: The data showed that the position of the IT did not vary significantly with either sex or side and that, therefore, the tubercle can be considered a reliable surgical landmark during arthroplasty surgery.

The International Society for Plastination.

The International Society for Plastination (ISP) was conceived as a means of defining plastination as an area of professional activity and serving as an agency for disseminating information relative to the art and science of plastination. In this paper, we present the purpose of ISP, the Journal of Plastination, the Plastination Index and the different international meetings organised by ISP.

An effective and novel method for teaching applied facial anatomy and related procedural skills to esthetic physicians.

BACKGROUND: An understanding of facial anatomy is crucial for the safe practice of nonsurgical facial esthetic procedures. Contextual learning, aided with instructional design, enhances the trainees' overall learning experience and retention, and makes a positive impact on the performance of procedural skills. The present study aimed to develop a teaching approach based on Bloom's taxonomy involving cognitive, affective, and psychomotor learning domains. MATERIALS AND METHODS: The practicability of Assess & Aware, Demonstrate, Decode, Act & Accomplish, Perform, Teach & Test (ADDAPT), a new approach to teaching applied facial anatomy and procedural skills to esthetic physicians in a large group setting, was evaluated in this study. Study participants were from two cohorts (n=124) who underwent 2 days of applied anatomy training in Singapore. Pre- and post-course multiple choice questions and objective structured practical examination were conducted to measure the effectiveness and applicability of the teaching model. Expert raters, table demonstrators, and participants rated the steps involved in the ADDAPT model on an 11-point Likert scale. RESULTS: Pre- and post-course evaluation mean scores for multiple choice questions were 17.32 (SD ±3.36) and 22.61 (SD ±1.77) and for objective structured practical examination were 24.53 (SD ±4.63) and 43.57 (SD ±5.35), respectively (P<0.001). Inter-rater agreement, expressed as the intraclass correlation coefficient, was 0.91 (95% CI: 0.62-0.98) for expert raters and 0.90 (95% CI: 0.78-0.97) for table demonstrators, which reflects the real strength of sound educational practice. The trainees well accepted the model and found the sessions intellectually stimulating. Trainees' feedback stated that the learning experience was enhanced by the repeated observation and constructive feedback provided by the tutors. CONCLUSION: The ADDAPT model is practical to instruct a large group of trainees in clinical anatomy and procedural skill training. This approach to instructional design may be feasible and transferable to other areas of psychomotor skill training in medical education.

Interprofessional anatomy education in the United Kingdom and Ireland: Perspectives from students and teachers.

There is increasing recognition of multiprofessional learning in anatomy and its role in medical and healthcare professions. This study utilized two components to investigate anatomy interprofessional education (AIPE) in the United Kingdom and Ireland. First, a survey involving qualitative and quantitative components asked Heads of Anatomy to report on their institutions' uptake of AIPE. Second, a series of case studies explored the experiences of students by using evaluation forms and an in-depth analysis of thematic concepts to understand the learners' perspectives on designing and delivering AIPE. Out of the 13 institutions that took part in the survey, eight did not offer an AIPE program. Between the remaining five institutions that deliver AIPE programs, 10 different modules are offered with the majority involving healthcare professions. The AIPE component is rated highly by students. The themes from the case studies highlight how valuable AIPE is from the student perspective both in terms of engaging them in anatomy as well as in the broader skills of teamwork and communication. The case studies also revealed how AIPE can be engaging for groups of students who might not have previously had access to cadaveric anatomy, for example, engineers and archeologists. The results of this study have implications for curriculum design in medicine and healthcare but also for further engagement of professional groups from non-healthcare backgrounds.

Rare Variant of Vastus Medialis Detected in vivo by Ultrasound and Confirmed by High-resolution MRI.

[Purpose] This report describes an unusual incidental finding during ultrasound investigation of the vastus medialis muscle. Volunteers underwent ultrasound scanning as part of an on-going investigation into the architecture of the vastus medialis muscle. [Subjects and Methods] The distal thighs of forty-one subjects were scanned using the Philips iU22 US system. An unusual muscle morphology was detected bilaterally in one subject, who then underwent a 3T Magnetic Resonance Imaging (MRI) scan in order to further investigate the muscle morphology. The subject in question was a 32 year-old female who suffers from recurrent bilateral patellar dislocations. [Results] The MRI scan confirmed the ultrasound findings, and indicated the presence of the vastus medialis in two layers, with the VML continuing deep, separate from the VMO. [Conclusion] Although this rare variant has been been reported in previous cadaveric studies, we believe this to be the first report in the literature of this morphology in vivo. The biomechanical implications of this muscle arrangement are unknown, but it may not be without significance that this individual suffers from recurrent patellar dislocations.

Supraorbital notch and foramen: positional variation and relevance to direct brow lift.

PURPOSE: Forehead paresthesia after brow lift is well-documented with rates as high as 40.7%. The authors describe an anatomical study to identify the variation in position of the supraorbital notch/foramen to define safe limits for deep dissection during this procedure. METHODS: Sixty-six orbits from 23 dry skulls and 9 formalin-fixed cadavers were analyzed photographically using ImageJ software. The cadaveric specimens were dissected using a coronal incision, which allowed the inferior resection of the frontalis muscle and periosteum. The exit point of the supraorbital neurovascular bundle was noted as a foramen or notch. The position of the supraorbital notch or foramen was recorded in relation to the midline as defined by the sagittal suture at the level of the highest point of the supraorbital rim. The distance and angle for each foramen/notch were calculated. RESULTS: Thirty-three percent of orbits had a foramen. The average distance from the midpoint to the foramen was 25.24 mm (standard deviation 3.78 mm) and to the notch was 22.69 mm (22.69 mm). The range of distance between the midpoint and the foramen/notch was 17.62 to 32.35 mm. The average angle between the horizontal meridian and the foramen was 81/57° (standard deviation 4.69°). CONCLUSIONS: A wide variation in anatomy was seen. Greater caution is required when performing deep dissection around the supraorbital notch because of the variation in position of the supraorbital foramen.

Lessons from the past: cribra orbitalia, an orbital roof pathology.

AIMS: To define a computed tomography protocol that may be used in future clinical practice for the reliable detection and analysis of cribra orbitalia. MATERIALS AND METHODS: Two osteological assemblages from the Museum of London were used to select 13 cribratous skulls and 5 non-cribratous skulls. Area of cribra orbitalia was measured using image analysis. Morphology of cribra orbitalia, orbital roof density and the associated optic canal diameter was analysed using computed tomography reconstructions. RESULTS: The presence of cribra orbitalia was associated with changes in the internal diploë layer as well as the cortical bone table. A novel radiological grading system and protocol was developed to identify the pathology. A decrease in the orbital roof density by 210 Hounsfield units and a reduction in the optic canal diameter, up to 1 mm, were found to be associated with the presence of cribra orbitalia. CONCLUSIONS: The occurrence of cribra orbitalia is found to be associated with stenosis of the optic canal, and could explain a proportion of cases ofoptic nerve entrapment. This study provides a guideline for radiologists and oculoplastic surgeons to help detect the presence of cribra orbitalia in suspected patients.

A cadaveric study of the morphometric relationships and bony composition of the caucasian nasolacrimal fossa.

AIMS: To describe the morphometric relationships and bony composition of the nasolacrimal fossa in a Caucasian population with particular reference to the lacrimo-maxillary suture (LMS). METHODS: Forty-seven orbits from 24 formalin fixed cadavers were exenterated. Morphometric measurements were taken between anatomical landmarks forming the lacrimal fossa on the medial orbital wall. RESULTS: The mean recorded distance from the anterior lacrimal crest (ALC) to the posterior lacrimal crest (PLC) and the LMS were 8.8 mm (± 1.6) and 4.3 mm (± 1.1), respectively. In 25.5% of the orbits the LMS was at the mid-vertical line (MVL), defined as a line equidistant from the ALC and PLC. In 42.5% the LMS was located anterior to the MVL toward the ALC. In 66% of the orbits the LMS was at or within one standard deviation (SD) of the MVL. The LMS was >1 SD away from the MVL toward the ALC and PLC in 19% and 15% of orbits, respectively. CONCLUSIONS: In a quarter of the orbits in our Caucasian population the nasolacrimal fossa was formed equally by the maxillary and lacrimal bones. However, in nearly a third of the cases the LMS was located closer to the PLC, indicating predominance of the thicker maxillary bone. This may result in greater difficulty in initiating the surgical osteotomy when performing a dacryocystorhinostomy. These data contribute to our understanding of the variation in lacrimal fossa anatomy and encourage further studies in different racial groups.

A cadaveric study of the cranio-orbital foramen and its significance in orbital surgery.

BACKGROUND: The cranio-orbital foramen is an osseous anatomical landmark located adjacent to the superior orbital fissure. It is a potential source of hemorrhage during deep orbital dissection because it is the location of an anastomosis between the lacrimal artery and the middle meningeal artery. The purpose of this study was to determine the incidence, location, and number of cranio-orbital foramina within a Caucasian population. METHODS: Forty-seven orbits from 24 formalin-fixed Caucasian cadavers were exenterated. If the cranio-orbital foramen was present within an orbit, its distance from the frontozygomatic suture, supraorbital notch, and Whitnall's tubercle was measured. The gender variations and asymmetric presentations of foramina were studied. RESULTS: The cranio-orbital foramen was present in 26 orbits (55 percent). The average distance from the frontozygomatic suture, supraorbital notch, and Whitnall's tubercle was 30.92 mm (±4.37 mm), 37.77 mm (±3.55 ±), and 29.69 mm (±3.89 mm), respectively. In nine orbits (19 percent), an additional accessory cranio-orbital foramen was identified. The average distance from the frontozygomatic suture, supraorbital notch, and Whitnall's tubercle was 28.56 mm (±5.00 mm), 32.64 mm (±3.20 mm), and 27.78 mm (±5.24 mm), respectively. CONCLUSION: The presence of the cranio-orbital foramen and other accessory foramina represents a source of hemorrhage that surgeons should be aware of when operating along the lateral orbital wall.

A cadaveric study of ethmoidal foramina variation and its surgical significance in Caucasians.

AIMS: To describe the morphometric and geometric relationships of the medial orbital wall ethmoidal foramina and the orbital apex in a Caucasian population. METHODS: 47 orbits from 24 formalin-fixed cadavers were exenterated. Morphometric measurements were taken between anatomical landmarks located on the medial orbital wall and geometric values were calculated. RESULTS: The average distances from the anterior lacrimal crest to the anterior ethmoidal foramen, posterior ethmoidal foramen and optic canal were 25.61 mm (± 2.25), 36.09 mm (± 3.86) and 43.77 mm (± 2.52), respectively. The average distances from the anterior ethmoidal foramen to the first posterior ethmoidal foramen, last posterior ethmoidal foramen and optic canal were 13.88 mm (± 3.51), 16.60 mm (± 2.19) and 21.65 mm (± 2.59), respectively. The average distances from the first and last posterior ethmoidal foramen to the optic canal were 11.63 mm (± 3.79) and 7.25 mm (± 2.59), respectively. CONCLUSION: The distance between the posterior ethmoidal foramen and optic canal is more than double the distance quoted in the surgical literature. This is due to a high incidence of ethmoidal foramina variation. Surgeons operating on the medial orbital wall of a Caucasian population must be aware of these variations as they are a source of haemorrhage and act as landmarks of proximity to the optic canal.

Morphometric and geometric anatomy of the caucasian orbital floor.

INTRODUCTION: To describe the morphometric and geometric relationships of the orbital floor in a Caucasian population. MATERIALS AND METHODS: Exenterations of 47 orbits from 24 formalin fixed cadavers were performed. Morphometric measurements were taken between anatomical landmarks located along the orbital floor and the orbital apex. The mean measurements were used to calculate geometric data. These results were analysed according to sex and side and compared to results from other ethnic populations. RESULTS: The average distances from the infraorbital foramen to the nasolacrimal fossa, inferior orbital fissure, optic canal and inferior orbital rim were 20.67 mm (± 2.42), 25.40 mm (±2.70), 43.23 mm (±3.35) and 8.95 mm (± 1.53), respectively. The average distances from the tip of the infraorbital groove to the tip of the inferior orbital fissure, lateral aspect of the inferomedial strut, optic canal and the intersection with the inferior orbital fissure were 14.08 mm (±2.41), 12.12 mm (±2.42), 35.02 mm (±3.17) and 20.05 mm (± 2.87), respectively. The distances from the tip of the inferior orbital fissure to the optic canal and the intersection with the inferior orbital groove were 29.56 mm (±2.73) and 13.37 mm (±2.76), respectively. DISCUSSION: Orbital surgeons should be aware of the morphometric relationships of the orbital floor due to the degree of variation that exists between different ethnic groups. Geometric data may be used to provide orbital surgeons with a navigational template that can be used to plan surgery and as a guide intraoperatively.

A cadaveric study of the morphometric and geometric relationships of the orbital apex.

INTRODUCTION: To define the morphometric and geometric relationships which exist at the orbital apex. MATERIALS AND METHODS: Forty-seven orbits from twenty-four formalin-fixed Caucasian cadavers were exenterated and the relevant sutures, fissures and foramina identified. Measurements were taken from the optic canal to anatomical landmarks located along the medial wall, inferior wall and lateral wall of each orbit. Based on the mean results the geometric angles between the different anatomical structures were calculated and used to create three-dimensional models. RESULTS: The mean distances from the midpoint of the optic canal to the superior orbital fissure, inferior orbital fissure and anterior ethmoidal foramen were 10.22 mm, 29.56 mm and 21.65 mm, respectively. The mean distances from the anterior ethmoidal foramen to the superior and inferior orbital fissures were 24.27 mm and 31.93 mm, respectively. The mean distance between the tips of the superior and inferior orbital fissures was 27.70 mm. The mean distances directly from the tips of the superior and inferior orbital fissures and the anterior ethmoidal foramen to the orbital rim were 39.23 mm, 17.11 mm and 18.94 mm, respectively. These values were used to calculate geometric values and create three-dimensional models. DISCUSSION: The orbital apex is a congested structure and the practicing orbital surgeon must have an intimate knowledge of its contents. We have presented novel data, which in conjunction with radiology may be used as both a navigational aid to plan orbital surgery and to guide the surgeon intraoperatively to assess proximity to key anatomical structures.

The medial and lateral bellies of gastrocnemius: a cadaveric and ultrasound investigation.

It is commonly reported that the medial belly (MG) of the gastrocnemius muscle extends further distally than the lateral belly (LG). This observation is made in several standard anatomy texts with no explanation or quantitative data. In this study, the medial and lateral bellies of gastrocnemius in 45 embalmed cadavers were measured. The observed difference in length of the two bellies was found to be highly significant (mean difference in length = 1.74 cm, P < 0.001). In 8 out of 84 legs examined (9.5%), however, the MG was found to be shorter than the LG (three right legs, five left legs, bilateral in two individuals). Surprisingly, there was no correlation between the difference in muscle belly length in any individual and ipsilateral leg length or total body length, suggesting that the difference in belly length may be unrelated to biomechanical function. An ultrasound investigation into the activity pattern of the two bellies was carried out on five volunteers. Muscle activity was monitored during passive and active movements of the ankle and knee joints at different leg positions. During knee flexion and ankle plantarflexion, the LG contracted first in four of the five subjects, followed by the MG, then a period of either LG predomination or equal contraction. The fifth subject, who showed a reversed pattern of activity, had previously suffered an inversion injury of the ankle. We suggest that the initial activation of the LG may help to stabilize the ankle during plantarflexion. We found no evidence that gastrocnemius acts as a shunt muscle during distraction of the knee.