Extensor carpi radialis brevis origin, nerve supply and its role in lateral epicondylitis.

Lateral epicondylitis (LE) or tennis elbow has been the subject of concern during the last 60 years, but the pathogenesis of the LE remains unclear. The LE can be due to the tendinogenic, articular or neurogenic reasons. Numerous theories have been put fourth in the recent past, out of which one of the most popular theories is that the condition results from repeated contraction of the wrist extensor muscles, especially the extensor carpi radialis brevis (ECRB) which may compress the posterior branch of the radial nerve (PBRN) at the elbow during pronation. We studied 72 upper limbs (36 formalin-fixed cadaver) for the origin, nerve supply and the course of PBRN in relation to the ECRB as one of the goal for the present study. The possible presence of an arch of the ECRB around the PBRN was also observed and recorded. The nerve to ECRB was a branch from the radial nerve in 11 cases (15.2%); from the PBRN in 36 cases (50%) and from the superficial branch of the radial nerve in 25 cases (34.7%), respectively. The ECRB had a tendinous arch in 21 cases (29.1%); a muscular arch in 8 (11.1%) cases and the arch was absent in 43 cases (59.7%). When the ECRB had a tendinous or muscular arch around the PBRN, it may compress the same and this condition may worsen during the repeated supination and pronation as observed in tennis and cricket players. The presence of such tendinous or muscular arch should be considered by orthopedicians and neurosurgeons, while releasing the PBRN during LE surgery.

Palmar type of median artery as a source of superficial palmar arch: a cadaveric study with its clinical significance.

The superficial palmar arch (SPA) and its contributing arteries are highly variable. The palmar type of median artery (PMA) can be involved in the formation of the SPA by replacing the superficial palmar branch of the radial artery (RA) or the ulnar artery (UA). The present study was undertaken to investigate the presence of the PMA and its contribution in the formation of SPA in 42 cadavers (84 upper limbs) of Indian origin. When there was a PMA, its outer diameter was measured in the carpal tunnel. The PMA was found in 13 upper limbs (15.4%), and of these ten incidences (11.9%), the PMA took part in the formation of SPA, and in three instances (3.5%), the PMA did not make up part of the SPA. Out of the ten cases in which the PMA contributed to the formation of SPA, in six cases (7.1%), the PMA anastomosed with the UA; in three cases (3.5%), the PMA anastomosed with both the UA and the RA, and in one incidence (1.1%), the PMA joined the arteria radialis indicis (deep branch of the RA) to complete the SPA. The outer diameters of the median arteries varied between 0.8 and 2.6 mm with the mean value of 1.7 mm. The present study concludes that the median-ulnar type of SPA was the most common type of SPA when the PMA was encountered as a source of superficial arterial arcade of the hand, followed by the radial-median-ulnar type. The vascular patterns found in this study are important to hand surgeons. The present study of PMA origin, course, and its contribution to the SPA will add to the existing knowledge of the vascular anatomy of forearm and hand.

Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers.

BACKGROUND: de Quervain's disease is a condition in which there is pain in the radial styloid process caused by stenosing tenosynovitis of the abductor pollicis longus (APL) or/and extensor pollicis brevis (EPB) tendons in the first extensor compartment of the wrist. In this study we studied variations in the tendons of the EPB in the first extensor compartment and its site of insertion. METHODS: One hundred fifty six upper limbs from adult cadavers of south Indian origin were dissected to observe the number of EPB tendons and the presence of an osseo-fibrous septum in the first extensor compartment of the wrist. RESULTS: The EPB had a single tendon in 133 limbs, double tendons in 17 limbs and triple tendons in only 6 limbs. The EPB was present in all of the upper limbs in our study. In 34.6% of cases, the tendons of the EPB were separated from the tendons of APL by an osseo-fibrous septum in the first extensor compartment. CONCLUSION: Variation in the number of EPB tendons and site of insertion should be taken into consideration by clinicians and surgeons when performing surgical decompression of the first extensor compartment of the wrist in de Quervain's syndrome. Surgical failure may occur due to overlooking variations in EPB tendons or septation of the first extensor compartment.

Case report of high origin of radial, ulnar, and profunda brachii arteries, its clinical implications and review of the literature / Relato de caso de origem alta das artérias radial, ulnar e braquial profunda, suas implicações clínicas e revisão de literatura

Arterial variations in the arm are of potential clinical implications as it is a frequent site of injury and also involved in many surgical and invasive procedures. During a dissection of the right upper extremity, an abnormal high origin of the radial and ulnar arteries was found. The brachial artery had a very short segment without any branches, divided into the radial and ulnar arteries at the upper third of the arm. The course and branching pattern of these radial and ulnar arteries in the arm are discussed. It was also observed that the profunda brachii artery was represented by two separate branches arising from the posterior circumflex humeral artery. Accurate knowledge of these variation patterns is of considerable clinical importance in the conduct of reparative surgeries around the shoulder and fracture management of the humerus. These additional data of arterial anomalies to contemporary anatomical literature are of interest to clinicians, in particular vascular and plastic surgeons and radiologists.

As variações arteriais no braço têm potenciais implicações clínicas já que o braço é um sítio de lesões frequentes, além de estar envolvido em muitos procedimentos cirúrgicos e invasivos. Durante a dissecção da extremidade superior direita, uma origem alta anormal das artérias radial e ulnar foi encontrada. A artéria braquial apresentava um segmento muito curto sem quaisquer ramos, dividindo-se nas artérias radial e ulnar no terço superior do braço. O curso e o padrão de ramificação das artérias radial e ulnar no braço são discutidos. Também se observou que a artéria braquial profunda estava representada por dois ramos separados, surgindo da artéria umeral circunflexa posterior. O conhecimento preciso sobre esses padrões de variação é de considerável importância na realização de cirurgias reparadoras na região do ombro e no manejo de fraturas de úmero. Estes dados adicionais sobre as anomalias arteriais para a literatura anatômica contemporânea são de grande interesse para os médicos, especialmente para cirurgiões plásticos e vasculares e radiologistas.

Co-existence of superficial brachio-ulno-radial arterial pattern and persistent median artery.

The arteries of the upper limbs are situated in a deep plane and are the favourable sites for intra-arterial cannulation. During routine dissection of the left upper limb of a 52-year-old female cadaver, we observed a superficial arterial pattern which was of superficial brachio-ulno-radial type. The right upper limb of the same individual did not show any abnormal arterial pattern. This superficial arterial system was also associated with a palmar type of median artery. The clinical significance of the anomalous arterial system of the upper limb is discussed.

Evidence-based assessment of antiosteoporotic activity of petroleum-ether extract of Cissus quadrangularis Linn. on ovariectomy-induced osteoporosis.

The increasing incidence of postmenopausal osteoporosis and its related fractures have become global health issues in the recent days. Postmenopausal osteoporosis is the most frequent metabolic bone disease; it is characterized by a rapid loss of mineralized bone tissue. Hormone replacement therapy has proven efficacious in preventing bone loss but not desirable to many women due to its side-effects. Therefore we are in need to search the natural compounds for a treatment of postmenopausal symptoms in women with no toxic effects. In the present study, we have evaluated the effect of petroleum-ether extract of Cissus quadrangularis Linn. (CQ), a plant used in folk medicine, on an osteoporotic rat model developed by ovariectomy. In this experiment, healthy female Wistar rats were divided into four groups of six animals each. Group 1 was sham operated. All the remaining groups were ovariectomized. Group 2 was fed with an equivolume of saline and served as ovariectomized control (OVX). Groups 3 and 4 were orally treated with raloxifene (5.4 mg/kg) and petroleum-ether extract of CQ (500 mg/kg), respectively, for 3 months. The findings were assessed on the basis of animal weight, morphology of femur, and histochemical localization of alkaline phosphatase (ALP) (an osteoblastic marker) and tartrate-resistant acid phosphatase (TRAP) (an osteoclastic marker) in upper end of femur. The study revealed for the first time that the petroleum-ether extract of CQ reduced bone loss, as evidenced by the weight gain in femur, and also reduced the osteoclastic activity there by facilitating bone formation when compared to the OVX group. The osteoclastic activity was confirmed by TRAP staining, and the bone formation was assessed by ALP staining in the femur sections. The color intensity of TRAP and ALP enzymes from the images were evaluated by image analysis software developed locally. The effect of CQ was found to be effective on both enzymes, and it might be a potential candidate for prevention and treatment of postmenopausal osteoporosis. The biological activity of CQ on bone may be attributed to the phytogenic steroids present in it.

Origin of the sinoatrial and atrioventricular nodal arteries in South Indians: an angiographic study.

BACKGROUND: To study the arterial supply of the conducting system and its correlation with the dominance of the coronary arteries in the South Indian population. OBJECTIVE: To determine angiographically the origins of the sinoatrial nodal artery (SAna) and atrioventricular nodal artery (AVna) in Indians. METHODS: The study included 300 consecutive patients (114 females, 186 males; mean age, 55 years) living in the southern coastal region of India, who underwent coronary angiography either for the symptoms of chest pain, angina pectoris or positive Treadmill Test. The angiograms contained both coronary arteries (right and left) in the right and left anterior oblique position. The origin of SAna and AVna from the coronary arteries was observed and correlated with the arterial dominance. RESULTS: The SA (sinoatrial) node was supplied by the right coronary artery (RCA) in 53% of the cases, by the circumflex (Cx) branch of left coronary artery (LCA) in 42.66%, and by both coronary arteries in 4.33% of cases. The AV (atrioventricular) node was also more often supplied by the RCA (72.33% of cases) than by the Cx branch of the LCA (27.66%), and surprisingly in none of the cases was this node supplied by both coronary arteries. CONCLUSION: The results of the present study may help cardiac surgeons, particularly in surgeries related to certain valvular disorders, due to the proximity of the nodal branches to the valve complex.

Origem das artérias dos nós sinoatrial e atrioventricular em população do sul da Índia: um estudo angiográfico / Origin of the sinoatrial and atrioventricular nodal arteries in South Indians: an angiographic study / Origen de las arterias de los nódulos sinusal y atrioventricular en población del Sur de la India: un estudio angiográfico

Fundamento: Estudar o suprimento arterial do sistema condutor e sua correlação com a dominância das artérias coronárias em população do sul da Índia. Objetivo: Determinar angiograficamente as origens da artéria do nó sinoatrial (AnSA) e artéria do nó atrioventricular (AnAV) em indianos.Métodos: O estudo incluiu 300 pacientes consecutivos (114 do sexo feminino e 186 do sexo masculino; idade média, 55 anos), habitantes da região costeira ao sul da Índia, submetidos a cineangiocoronariografia devido a sintomas como dor no peito, angina pectoris ou teste ergométrico positivo. As angiografias incluíram ambas as artérias coronárias (direita e esquerda) em posição oblíqua anterior direita e esquerda. A origem da AnSA e AnAV a partir das artérias coronárias foi observada e correlacionada à dominância arterial. Resultados: O nó SA (sinoatrial) recebeu suprimento pela artéria coronária direita (ACD) em 53% dos casos, pelo ramo circunflexo (Cx) da artéria coronária esquerda (ACE) em 42,66% dos casos, e em 4,33% dos casos esse nó foi irrigado por ambas as artérias coronárias. O nó AV (atrioventricular) também recebeu suprimento sanguíneo com mais frequência da ACD (72,33% dos casos) do que do ramo Cx da ACE (27,66%). Surpreendentemente, em nenhum caso este nó recebeu suprimento de ambas as artérias coronárias. Conclusão: Os resultados do presente estudo podem auxiliar os cirurgiões cardíacos, sobretudo em cirurgias relacionadas a valvopatias, devido à franca proximidade entre os ramos nodais e o complexo valvar.

Background: To study the arterial supply of the conducting system and its correlation with the dominance of the coronary arteries in the South Indian population. Objective: To determine angiographically the origins of the sinoatrial nodal artery (SAna) and atrioventricular nodal artery (AVna) in Indians. Methods: The study included 300 consecutive patients (114 females, 186 males; mean age, 55 years) living in the southern coastal region of India, who underwent coronary angiography either for the symptoms of chest pain, angina pectoris or positive Treadmill Test. The angiograms contained both coronary arteries (right and left) in the right and left anterior oblique position. The origin of SAna and AVna from the coronary arteries was observed and correlated with the arterial dominance.Results: The SA (sinoatrial) node was supplied by the right coronary artery (RCA) in 53% of the cases, by the circumflex (Cx) branch of left coronary artery (LCA) in 42.66%, and by both coronary arteries in 4.33% of cases. The AV (atrioventricular) node was also more often supplied by the RCA (72.33% of cases) than by the Cx branch of the LCA (27.66%), and surprisingly in none of the cases was this node supplied by both coronary arteries. Conclusion: The results of the present study may help cardiac surgeons, particularly in surgeries related to certain valvular disorders, due to the proximity of the nodal branches to the valve complex.

Fundamento: Estudiar el suministro arterial del sistema conductor y su correlación con la dominancia de las arterias coronarias en población del Sur de la India. Objetivo: Determinar angiográficamente los orígenes de la arteria del nódulo sinusal (AnSA) y la arteria del nódulo atrioventricular (AnAV) en indios. Métodos: El estudio incluyó 300 pacientes consecutivos (114 del sexo femenino y 186 del sexo masculino; edad promedio, 55 años), habitantes de la región costera al Sur de la India, sometidos a cineangiocoronariografía debido a síntomas como dolor en el pecho, angina pectoris o test ergométrico positivo. Las angiografías incluyeron ambas arterias coronarias (derecha e izquierda) en posición oblicua anterior derecha e izquierda. El origen de la AnSA y AnAV a partir de las arterias coronarias se observó y se correlacionó con la dominancia arterial. Resultados: El nódulo SA (sinusal) recibió suministro por la arteria coronaria derecha (ACD) en el 53% de los casos, por la rama circunfleja (Cx) de la arteria coronaria izquierda (ACI) en el 42,66% de los casos, y en el 4,33% de los casos este nódulo fue irrigado por ambas arterias coronarias. El nódulo AV (atrioventricular) también recibió suministro sanguíneo con más frecuencia de la ACD (72,33% de los casos) que la rama Cx de la ACI (27,66%). Sorprendentemente, en ningún caso este nódulo recibió suministro de ambas arterias coronarias.Conclusión: Los resultados del presente estudio pueden auxiliar a los cirujanos cardíacos, sobre todo en cirugías relacionadas a valvulopatías, debido a la franca proximidad entre las ramas nodales y el complejo valvular.

Supratrochlear foramen of the humerus: an anatomico-radiological study with clinical implications.

BACKGROUND: The supratrochlear foramen (STF) of the humerus has been a neglected entity in standard anatomy and orthopaedics text-books. The knowledge of the presence of STF in a humerus may be important for preoperative planning for treatment of supracondylar fractures. The presence of STF may also result in erroneous interpretation of radiographs. METHODS: The STF was studied in detail in 384 (220 left side and 164 right side) human dried humeri of unknown sex and age. The topographical anatomy of the STF was studied in detail, morphometric measurements were taken, and the specimens were photographed. The humerus was also taken for radiological assessment of the STF and supratrochlear septum. RESULTS: Out of the 384 bones studied, 132 cases (34.3%) showed the presence of STF. The STF was oval, round, and triangular in shape in 123, 7, and 2 cases, respectively. The mean length of the transverse diameter for supratrochlear foramen was 6.55 mm and 5.99 mm on the left and right sides, respectively. The mean length of the vertical diameter for STF was 4.85 mm and 3.81 mm on the left and right sides, respectively. Most of the bones that had no STF showed a translucency of septum, in 56.7% of the bones. CONCLUSIONS: The results of our study show that STF is more common on the right side, with the oval shape being more common. The respective sides did not exhibit any statistical significant differences. Presence of STF may be important for anthropological, clinical, and academic purpose.

Morphology of the lacrimal sac and nasolacrimal duct in adult human cadaver.

The lacrimal sac (LS) is a dilated structure that lies in the lacrimal fossa, and the nasolacrimal duct (NLD) is the continuation of LS from its neck up to the inferior meatus of the nose. A study of 50 specimens of formalin-fixed adult cadavers of both sexes of Indian origin was conducted. The morphological features like length and breadth of LS and NLD, along with the histology of LS has been observed. The mean length of LS and NLD on the right side was 10.5 mm (1.04) and 16 mm (2.6) respectively, whereas the mean breadth of the above structures, on the right side was 6 mm (0.63) and 5.66 mm (0.81) respectively. The mean length of LS and NLD on the left side was 10.57 mm (1.13) and 16.42 mm (2.29), whereas, the mean breadth of the same structure on the left side was 6.71 mm (0.95) and 5 mm (0.81) respectively. The sides did not show any significant statistical difference but when the correlation between the length and breadth of LS is considered, significance was observed in the lacrimal sac of the left side. No variations were observed in the gross structure of LS and NLD. Microscopic study showed the presence of elastic fibers in LS. The importance of LS and NLD is that the blockage of this lacrimal passage is the most common cause of epiphora (watering of the eye). The presence of elastic fibers in this study confirms the hypothesis that the sac elasticity may perform a dynamic role, in forceful evacuation of lacrimal fluid in reverse direction (Tab. 2, Fig. 3, Ref. 10). Full Text (Free, PDF) www.bmj.sk.

Variant insertion of coracobrachialis muscle in a South Karnataka cadaver.

BACKGROUND: The coracobrachialis is a muscle of arm has been known for its morphological variations. The variation of the coracobrachialis reported in this case is unique and to the best of our knowledge this variation is not reported in south karnataka population. CASE PRESENTATION: During routine dissection, we observed an unusual insertion of a coracobrachialis muscle with an accessory slip in the right arm of an old male cadaver. It extended from the superficial fibres of coracobrachialis downwards and medially in front of the median nerve and brachial artery and finally inserted on anteromedial aspect of the medial epicondyle. CONCLUSION: The existence of abnormal insertion of the coracobrachialis muscle presented in this case should be kept in mind in a patient presenting with high median nerve palsy together with symptoms of brachial artery compression.

Hypoplastic posterior tibial artery and the enlarged peroneal artery supplying the posterior crural region: a rare variation / Artéria tibial posterior hipoplásica e a artéria peroneal aumentada suprindo a região crural posterior: uma variação rara

Arterial variations of distal parts of lower extremities are well-documented and can be demonstrated with the help of Doppler ultrasound or by arteriography. However, absence or variation of posterior tibial artery is considered a rare finding. We present a case of hypoplastic posterior tibial artery that terminated by supplying soleus muscle. The variant arterial supply to the sole was provided by the enlarged peroneal artery that continued as the lateral plantar artery. The awareness of these variations is important to vascular surgeons while performing arterial reconstructions in femorodistal bypass graft procedures, and also to orthopedists during surgical clubfoot release.

Variações arteriais de partes distais dos membros inferiores estão bem documentadas e podem ser demonstradas com o auxílio de ultra-sonografia Doppler ou por arteriografia. Entretanto, a ausência ou variação da artéria tibial posterior é um raro achado. Apresentamos um caso de artéria tibial posterior hipoplásica que terminava suprindo o músculo solear. Esse suprimento arterial variante foi fornecido pela artéria peroneal aumentada que continuava como artéria plantar lateral. Estar consciente dessas variações é importante para cirurgiões vasculares ao realizarem reconstruções arteriais em procedimentos de derivação femorodistal, bem como para ortopedistas durante correção cirúrgica do pé torto.

A variant of Buhler's arc formed by the unusually long dorsal pancreatic artery.

The knowledge of anatomical variations of the vascular junction between the celiac trunk and superior mesenteric artery is surgically significant. A case of unusually long dorsal pancreatic artery that originated from the common hepatic artery and directly anastomosed with the middle colic artery thus forming a rarely reported variant of Bühler's arcade is presented (Fig. 1, Ref. 14).

An additional muscle belly of the first lumbrical muscle.

INTRODUCTION: Lumbrical muscles play a vital role in the precision movements of the hand, along with the thenar, hypothenar and interossei muscles. The variation in the lumbrical muscle is clinically significant. CASE PRESENTATION: During routine dissection of an adult male cadaver, we observed an additional muscle belly of the first lumbrical muscle took origin from the tendon of the flexor digitorum superficialis (FDS) to the index finger, close to the proximal margin of the flexor retinaculum. CONCLUSION: The presence of such an additional muscle in the carpal tunnel should be considered in the aetiology of carpal tunnel syndrome (CTS).

The scalenus accessorious muscle / El músculo escaleno accesorio

Many of the anatomical variations that are inadequately described or quantified are actually more clinically and surgically significant than being just anatomical curiosities. We report about such a variation where an aberrant slip existed in the scalene group, in a 56 year old embalmed female cadaver. This kind of variation may affect the size of the scalene triangle, and thus, may potentially result in varied signs and symptoms in patients vulnerable to thoracic outlet syndrome (TOS). Proximity of the scalene muscles to the brachial plexus, subclavian artery and vein, coexisting with aberrant slips or bundles may also predispose to compression syndromes.

Muchas de las variaciones anatómicas no están suficientemente descritas o cuantificadas y son actualmente clínica y quirúrgicamente significativas más que curiosidades anatómicas. Reportamos una variación anatómica en el grupo de los músculos escalenos, presente en un cadáver de una mujer de 56 años. Este tipo de variación puede afectar el tamaño del triángulo escalénico y por lo tanto, puede potencialmente resultar en variados signos y síntomas en pacientes vulnerables al síndrome de salida torácica. La proximidad de los músculos escalenos con el plexo braquial, arteria y vena suclavias, coexistiendo con fascículos aberrantes pueden predisponer a síndromes de compresión.