Evaluation of lumbar lordosis in symptomatic individuals and comparative analysis of six different techniques: a retrospective radiologic study.

PURPOSE: The aim of this study; evaluate lumbar lordosis (LL) in symptomatic individuals with six different techniques and to examine the techniques comparatively. Thus, to provide an overview of lumbal lordosis and techniques. METHODS: Cobb L1-L5, Cobb L1-S1, Posterior Tangent, tangential radiologic assessment of lumbar lordosis (TRALL), vertebral centroid measurement of lumbar lordosis (CLL) and Risser Ferguson measurement techniques were used to assess LL from radiographs of 175 symptomatic adults. Correlations between techniques and relationship between the measurements obtained, gender and age were analyzed. Also interclass correlation (ICC) analyzed. Bland-Altman plots were performed to compare the techniques with Cobb. RESULTS: ICC for all methods were greater than 0.96. For each method, no difference in LL was observed with respect to gender or age (p > 0.05). High positive correlation was observed between the Risser Ferguson, Posterior Tangent, Cobb L1-L5, Cobb L1-S1 and CLL techniques (p < 0.001), and moderate positive correlation between TRALL and all other techniques (p < 0.001). CONCLUSION: In this study, it was found that the mean lumbar lordosis values of symptomatic participants were lower than most of the other asymptomatic studies in the literature and there was no significant difference in lumbar lordosis values in terms of gender and age in symptomatic individuals. Based on statistical findings, Risser Ferguson can be used to assess LL. These results and the data obtained as a result of the comparative examination of techniques according to age groups and gender will benefit clinicians and those working in the field by providing a better understanding LL.

Morphometric analysis of the infratemporal fossa using three-dimensional (3D) digital models.

PURPOSE: The infratemporal fossa contains important neurovascular components and is directly related to other anatomical regions and structures. The morphometric distances between the bones forming its borders have not been thoroughly investigated. The aim of this study was to determine the morphometry of the infratemporal fossa. METHODS: 3D models of the skull of 83 individuals were reconstructed from DICOM datasets, from which length, depth and width measurements were determined and compared between genders and the right and left sides. RESULTS: All measurements obtained were significantly different between males and females. There were also significant differences between the left and right sides for depth and width measurements. CONCLUSION: This is the first study to determine and investigate measurements of the infratemporal fossa; as such it provides a comprehensive view of the morphology of the fossa. It provides valuable information for surgical interventions and differential diagnoses of pathologies in this region, as well as enhancing its understanding in medical education.

The association between coracoacromial ligament morphology and rotator cuff tears: A cadaveric study.

To determine the association between coracoacromial ligament (CAL) morphology and rotator cuff tears. The present study is a prospective cohort study based on the dissection of 172 shoulders from 86 (46 female, 40 male) formalin embalmed European Caucasian cadavers, with a median age of 82 years. The anatomy of CAL was examined, including its morphology and parametric measurements, while the rotator cuff tendons were inspected for the presence of tears. Gross examination of the CAL in 155 shoulders revealed a variable number of bands as follows: 28 (18%) had one band, 56 (36%) two bands and 71 (46%) three or more bands. Inspection of the rotator cuff tendons showed the presence of tears in 77 (50%) shoulders, of which 37 (24%) were partial and 40 (26%) were full-thickness tears. Statistical analysis showed a significant association (P < 0.05) between CAL band number and the prevalence of a rotator cuff tear. A high proportion of rotator cuff tears were observed in shoulders with two (52%) and three or more CAL bands (56%) compared to single band ligaments (29%). Parametric assessment of the CAL in shoulders with rotator cuff tears showed significantly greater (P < 0.05) attachment widths and ratios, thicker ligament bands, and larger cross-sectional areas compared to the control group. Coracoacromial ligaments with more than a single band have a strong association with rotator cuff tears.

Axial and sciatic arteries: a new interpretation / Arterias axiales y ciáticas: una nueva interpretación

SUMMARY: In an investigation of 92 female and 79 male cadavers persistent sciatic and axial arteries were identified and classified based on their origin and location. Sciatic arteries were observed to arise from a number of different arteries in 68 specimens: anterior trunk of the internal iliac artery (12 specimen); internal pudendal artery (1 specimen); posterior trunk of the internal iliac artery (44 specimens); anterior and posterior trunks as a double artery (4 specimens); superior gluteal artery (7 specimens). In addition, the sciatic arteries were observed to give the superior and inferior gluteal arteries (12 and 9 specimens respectively). It is of note that a persistent sciatic artery was observed to give the superior or inferior gluteal artery rather than the superior or inferior gluteal artery giving the persistent sciatic artery: a persistent sciatic artery was also observed to exist with the superior or inferior gluteal artery. This questions the general embryological origin of a persistent sciatic artery. The embryological origin of the proximal part of the axial artery and whether it forms the superior or inferior gluteal artery is discussed, together with the general arrangement of the internal iliac and femoral arterial systems. Presentation of the sciatic artery is also discussed with respect to existing embryological theories and from a new perspective. A number of embryological vascular anomalies are also discussed.

RESUMEN: En este studio se identificaron y clasificaron las arterias ciáticas y axiales persistentes según su origen y ubicación en 92 cadáveres femeninos y 79 masculinos, Se observó que las arterias ciáticas surgían de varias arterias diferentes en 68 especímenes: tronco anterior de la arteria ilíaca interna (12 especímenes); arteria pudenda interna (1 espécimen); tronco posterior de la arteria ilíaca interna (44 especímenes); troncos anterior y posterior como una arteria doble (4 especímenes); arteria glútea superior (7 especímenes). Además, se observó que las arterias ciáticas daban las arterias glúteas superior e inferior (12 y 9 especímenes respectivamente). Cabe señalar que se observó que una arteria ciática persistente daba lugar a la arteria glútea superior o inferior en lugar de que la arteria glútea superior o inferior diera lugar a la arteria ciática persistente: también se observó que existía una arteria ciática persistente con la arteria glútea superior o inferior. Esto cuestiona el origen embriológico general de una arteria ciática persistente. Se discute el origen embriológico de la parte proximal de la arteria axial y si forma la arteria glútea superior o inferior, junto con la disposición general de los sistemas arteriales ilíaco interno y femoral. También se observó desde una nueva perspectiva la presentación de la arteria ciática con respecto a las teorías embriológicas existentes. Además se discuten varias anomalías vasculares embriológicas.

The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review.

The key management of glenohumeral osteoarthritis is shoulder arthroplasty which aims to reduce pain and restore full shoulder function: it has increased in recent years. A detailed understanding of the anatomy of the glenoid and humeral head, as well as morphological changes of the glenoid in osteoarthritis, are important factors to consider when deciding on replacement components. This review begins with a brief introduction of the glenohumeral joint itself, and then considers the detailed anatomy of the glenoid fossa and humeral head, both of which are reported to have variable morphology. Several studies have been undertaken to assess various parameters, especially of the glenoid fossa including its shape, height, width, and articular surface area, version and inclination, in an attempt to define a standard classification that can be applied to surgical intervention. Nevertheless, no definitive consensus concerning the classification of these morphologies has been forthcoming, hence the need for this review. Following a consideration of these morphologies, the current state of knowledge regarding glenoid deformity in osteoarthritis, as well as its surgical management, is considered.

The prevalence of acromial spurs in relation to study type and specimens examined

Advanced cases of subacromial impingement syndrome usually present with acromial spurs. However, previous studies have reported variations in the prevalence of acromial spurs in shoulders with or without subacromial impingement syndrome as well as with age, sex, and side. Therefore, this study is aimed at investigating the prevalence of acromial spurs in cadaveric shoulders and reviewing the factors leading to the reported variable frequencies. The study examined 220 cadaveric shoulders (110 male and 110 female), with a median age of 82 years (with a range of 53 to 102 years). In 155 shoulders, the rotator cuff tendons were evaluated for tears; acromial spurs were observed in 95 shoulders (43%). No significant association was observed between the prevalence of acromial spurs and sex or side. However, a significant prevalence of spurs (57%) was observed in the oldest-old group, aged ≥ 85 years. Those with acromial spurs also tended to be older (84 years) than those without spurs (81 years). A significant difference in the prevalence of acromial spurs was observed in shoulders with rotator cuff tears compared to those without them: 80% compared to 20%, respectively. Analysis showed a significant number of acromial spurs in shoulders with full-thickness tears (46%) and partial tears (34%). A significant prevalence of acromial spurs was found in shoulders with rotator cuff tears, as well as in aged shoulders. In relevant literature, the prevalence of acromial spurs varies with the type of study undertaken, age, prevalence of rotator cuff tears, and type of radiograph examined

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Thiel embalming: Quantifying histological changes in skeletal muscle and tendon and investigating the role of boric acid.

Cadaver preservation methods impact their utilization in anatomical research and teaching. Thiel-embalmed cadavers show flexibility, however, the cause remains poorly understood. This study aimed to (1) describe qualitative and quantitative histological differences between Thiel-embalmed and formalin-fixed skeletal muscle and tendon tissue; (2) investigate whether boric acid in Thiel solution is solely responsible for modification of tissues; and (3) explore whether the modifications observed could potentially explain the mechanisms underpinning flexibility of Thiel cadavers. Skeletal muscle and tendon samples were harvested from mice preserved using formalin, Thiel solution, or modified-Thiel solution (without boric acid). Using standard H&E and Gomori's trichrome histological methods, tissues were examined to determine whether differences were apparent between the preservative treatments. Differences were present between the Thiel and formalin-fixed tissues; formalin-fixed samples remained substantially more intact while Thiel-embalmed samples showed fiber fragmentation and lack of nuclei. The mean cell diameter of Thiel-embalmed muscle (24.4 µm) was significantly smaller (P < 0.005) than formalin-fixed muscle (40.7 µm). There was significantly greater (P < 0.005) fragmentation in Thiel-embalmed muscle (631.5 per 1 mm2 ) compared to formalin-fixed muscle (75.4 per 1 mm2 ). Samples embalmed using modified-Thiel showed a severe lack of integrity within internal tissue structure. This suggests that Thiel solution significantly alters tissue structure at cellular level, with quantitative data demonstrating measurable differences between Thiel and formalin-fixed specimens. While the precise mechanism for these alterations remains unknown, it is shown that boric acid is not the only component of Thiel responsible for degradation of internal tissue structure. Clin. Anat., 33:696-704, 2020. © 2019 Wiley Periodicals, Inc.

Morphometric parameters of the glenoid labrum

The glenoid labrum has an important role in glenohumeral joint stability, yet its morphometric parameters are seldom reported. This study aimed to (I) investigate the thickness and height of the glenoid labrum, and (ii) determine whether there is any significant difference between side and sex. A total of 140 shoulders (30 male and 40 female cadavers, average age of 81.5 years) were obtained for this study. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were inspected and then removed to expose the glenoid fossa with the labrum attached. Measurement of labral height and thickness at the superior (12 o'clock), anterior (3 o'clock), inferior (6 o'clock) and posterior (9 o'clock) regions were taken. Gender, side and thickness and height measurements of the glenoid labrum were double- entered into the Statistical Package for Social Sciences. ANOVA and MANOVA tests were conducted to determine statistical significance, which was set at P<0.05. Significant differences in thickness (at the superior, inferior and posterior aspects) and height (at the superior and inferior aspects) of the glenoid labrum were observed between males and females, being thicker and taller in males in all regions. Based on the side of the limb, no differences in labral thickness and height were observed with respect to side. The current observations confirm that the glenoid labrum height and thickness are associated with sex, but not with side

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Is the existence of sublabral foramen age-related?

Although a sublabral foramen does not require treatment, its association with age, sex or side remains unknown. Therefore, the aim of the current study was to investigate the incidence of a sublabral foramen and age, sex and side in a British population. A total of 140 shoulders (30 male and 40 female cadavers, with an average age of 81.5 years), were obtained from the Centre for Anatomy and Human Identification University of Dundee, in accordance with the Human Tissue (Scotland) Act 2006. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were inspected and then removed to expose the glenoid fossa with the glenoid labrum attached. The gender, age, side and presence of a sublabral foramen were double-entered into the Statistical Package for Social Sciences (Version 21; IBM, Armonk, NY, USA). Chi Square tests were conducted to determine statistical significance, which was set at P<0.05. A sublabral foramen was observed in 28.6% (n=40) of shoulders, being marginally more in females than males. A sublabral foramen was more common in elderly individuals (>70 years old), no significant difference being observed between the presence of a sublabral foramen and age. It was also more common on the right than the left side in both genders with no significant difference between the presence of a sublabral foramen and sex or side. The current observations confirm that a sublabral foramen was more common in older individuals, but was not significantly different from other age groups

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Examining changes in acromial morphology in relation to spurs at the anterior edge of acromion.

BACKGROUND: Although acromial morphology is classified as flat, curved, and hooked, whether the morphology is primary or acquired is debated. There have been no investigations on the effect of acromial spurs on acromial morphology. This study therefore aimed to evaluate acromial morphology in relation to spur formation at the anterior edge of the acromion. MATERIALS AND METHODS: Acromial morphology was investigated in 40 scapulae taken from 20 cadavers (10 male and 10 female), with a median age of 82 years (range 62-97 years). Ink prints of the anteroposterior aspect of the acromion were used to evaluate acromial slope angle and curvature height in relation to spur incidence, length, and shape at the anterior edge of the acromion. RESULTS: Differences were observed in acromial morphology and acromial curvature in relation to acromial spurs (incidence, size, and shape). A hooked acromion was observed as a primary structure in 25% of specimens, which increased to 43% when acromial spurs were involved. No differences were observed in relation to sex or side, while a significant correlation was observed between acromial curvature and the age of the specimens. CONCLUSION: Acromial spurs increase acromial curvature and therefore change acromion morphology. Nevertheless, it is concluded that a hooked acromion occurs as a primary formed structure. LEVEL OF EVIDENCE: Basic science study, anatomy, cadaver dissection.

Assessment of scapular morphometry / Evaluación de la morfometría escapular

The current study was undertaken to assess the incidence of different types of suprascapular notch, acromion dimensions and the lower and upper scapular angles. The suprascapular notch and variations of the acromion are clinically important in suprascapular nerve compression and subacromial impingement. Measurements were taken from 73 Anatolian dry scapulae of unknown age or sex. The suprascapuar notch was classified according to that of Rengachary et al. (1979). Its width and depth, the distance between supraglenoid tubercle and the deepest point of notch, as well as the upper and lower scapular angles were also determine measured. The type of acromion was assessed according to shape (type I (cobra), type II (square), type III (intermediate)) and tilt (type I (flat), type II (curve). Acrmion length and the distance between acromion and coracoid process were also measured. The frequency of different types of suprascapular notch were type I (28.8 %), type II (23.3 %), type III (13.7 %), type IV (20.5 %), type V (2.7 %), type VI (5.5 %)and absence (5.5 %). Acromion type were type I (45.5 %), type II (7.5 %) and type III (47.0 %), acromion tilt type I (15.2 %), and type II (84.8 %). An understanding of the association between the anatomical structures of the scapula and morphometric measurements is clinically important.

En este trabajo se evaluó la incidencia de diferentes tipos de incisura supraescapular, dimensiones de acromion y los ángulos escapulares superior e inferior. La incisura supraescapular y las variaciones del acromion son clínicamente importantes en la compresión del nervio supraescapular y el pinzamiento subacromial. Las mediciones se tomaron de 73 escápulas secas de Anatolia, de edad y sexo desconocidos. La incisura supraescapular se clasificó según Rengachary et al. (1979). Se determinaron también el ancho y la profundidad, la distancia entre el tubérculo supraglenoide y el punto más profundo de la incisura, así como los ángulos escapulares superior e inferior. El tipo de acromion se evaluó de acuerdo con la forma [tipo I (cobra), tipo II (cuadrado), tipo III (intermedio)] y la inclinación [tipo I (plano), tipo II (curvo)]. También se midieron la longitud del elemento y la distancia entre el acromion, como así también el proceso coracoide. La frecuencia de los diferentes tipos de incisura supraescapular fueron: tipo I (28,8 %), tipo II (23,3 %), tipo III (13,7 %), tipo IV (20,5 %), tipo V (2,7 %), tipo VI (5,5 %) y ausencia (5,5 %). Los tipos de acromion fueron: tipo I (45,5 %), tipo II (7,5 %) y tipo III (47,0 %), tipo de inclinación de acromion I (15,2 %) y tipo II (84,8 %). En conclusión, el conocimiento de la asociación entre las estructuras anatómicas de la escápula y las mediciones morfométricas es clínicamente importante.

Anatomy and clinical importance of the extracranial clivus and surrounding structures / Anatomía e importancia clínica del clivus extracraneal y las estructuras circundantes

The aim of this study was to reveal the clinical importance of measurements taken from the pharyngeal tubercle (PT) to various anatomical structures around the extracranial clivus. Twenty-six adult dry Anatolian skulls were examined. The extracranial clivus and PT were used as landmarks from which various distances were measured using a digital caliper accurate to 0.01 mm. The following mean distances from the PT were observed; foramen lacerum (FL) (L: 17.15 mm, R: 17.4 mm) ; medial external margin of the carotid canal (CC) (L: 26.7 mm, R: 27.5 mm); anterior tip of occipital condyle (OC) (L: 16.4 mm, R: 16.3 mm); anterior margin of foramen magnum (FM) (10.8 mm); foramen ovale (FO) (L: 25.9 mm, R: 29.1); medial margin of the jugular fossa (JF) (L: 25.4 mm, R: 25.7 mm); medial external margin of the hypoglossal canal (HC) (L: 20.0 mm, R: 19.9 mm). Mean bilateral distances were: LFO-RFO: 45.34 mm; LFL-RFL: 20.1 mm; LCC-RCC: 52.1 mm; LOC-ROC: 17.6 mm; LJF-RJF: 45.2 mm; LHC-RHC: 33.5 mm. The following mean distances were observed from the FM: FM-OC (L: 8.3 mm, R: 9.3 mm); FM-HC (L: 17.8 mm, R: 17.4 mm). Also the mean distance of OC-HC were observed (L: 11.7 mm, R: 11.4 mm). Present measurements suggest that the PT can be used as an anatomical landmark during surgery involving clival pathology. However, the anatomy and variations of the extracranial clivus and surrounding structures must be taken into consideration.

El objetivo de este estudio fue revelar la importancia clínica de las mediciones tomadas desde el tubérculo faríngeo (TF) a diversas estructuras anatómicas alrededor del clivus extracraneal. Veintiséis cráneos, secos adultos, de Anatolia, fueron examinados. El clivus extracraneal y TF se utilizaron como puntos de referencia a partir de los cuales se midieron varias distancias con un calibrador digital con una precisión de 0,01 mm. Se observaron las siguientes distancias medias del TF: foramen lacerum (FL) (L: 17.15 mm, R: 17,4 mm); margen externo medial del canal carotídeo (CC) (L: 26,7 mm, R: 27,5 mm); parte anterior del cóndilo occipital (OC) (L: 16,4 mm, R: 16,3 mm); margen anterior del foramen magnum (FM) (10,8 mm); foramen oval (FO) (L: 25,9 mm, R: 29,1); margen medial de la fosa yugular (FY) (L: 25,4 mm, R: 25,7 mm); margen medial del canal hipogloso (CH) (L: 20,0 mm, R: 19,9 mm). Las distancias bilaterales medias fueron: LFO-RFO: 45,34 mm; LFLRFL: 20,1 mm; LCC-RCC: 52,1 mm; LOC-ROC: 17,6 mm; LJFRJF: 45,2 mm; LHC-RHC: 33,5 mm. Se observaron las siguientes distancias medias de la FM: FM-OC (L: 8,3 mm, R: 9,3 mm); FMCH (L: 17,8 mm, R: 17,4 mm). También se observó la distancia media de OC-CH (L: 11,7 mm, R: 11,4 mm). Las mediciones actuales sugieren que el TF puede ser utilizado como un hito anatómico durante la cirugía que involucra la patología clival. Sin embargo, se deben tener en cuenta la anatomía y las variaciones del clivus extracraneal y las estructuras circundantes.

Origin of the long head of biceps brachii from the supraglenoid tubercle and glenoid labrum

The long head of the biceps tendon (LHBT) provides stability to the glenohumeral joint. Although it has been observed to arise from the supraglenoid tubercle and glenoid labrum, its mode of attachment to the glenoid labrum is variable. This study therefore aimed to (I) identify the origin of the LHBT, and (II) investigate if there are differences in attachment related to age, gender and side. A total of 140 shoulders from 30 male and 40 female cadavers were examined: the glenoid fossa with the glenoid labrum and LHBT attached were exposed. The classification of Vangsness et al. (1994) was adopted to determine the mode of attachment of the LHBT. Gender, age, side and type of attachment were double-entered into the Statistical Package for Social Sciences. Chi square tests were conducted to determine statistical significance, which was set at P<0.05. Type I was the most common attachment (47.7%) of the LHBT, then Type II (31.5%), Type III (16.2%) and Type IV (4.6%). No significant difference was observed between the type of attachment of the LHBT and sex, side or age. The LHBT consistently arose from the glenoid labrum and supraglenoid tubercle in all the specimens, with the majority of tendons having a posterior orientation. Involvement of the glenoid labrum can be associated with injury to the LHBT: this may explain the existence of a combined injury in shoulder joint instability. Further study is needed to investigate the association between variations of the LHBT attachment to the glenoid labrum and shoulder joint stability

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Histology, vascularity and innervation of the glenoid labrum.

BACKGROUND: Although the glenoid labrum has an important role in shoulder stability, little is known about its composition, vascularity and innervation. The aims of this study were therefore to evaluate the histology, vascularity and innervation of the glenoid labrum. MATERIALS AND METHODS: Ten glenoid labrum specimens (three male, two female: mean age 81.2 years, range 76-90 years) were detached at the glenoid neck. Following decalcification, sections were cut through the whole thickness of each specimen perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid fossa. Then they were stained using haematoxylin and eosin, a silver nitrate protocol or subjected to immunohistochemistry using anti-protein gene protein 9.5 to demonstrate neuronal processes. RESULTS: The labrum was fibrocartilaginous, being more fibrous in its free margin. There was a variable distribution of blood vessels, being more vascular in its periphery, with many originating from the fibrous capsule and piercing the glenoid labrum. Immunohistochemistry revealed positive staining of nerve fibres within the glenoid labrum. CONCLUSION: The glenoid labrum is fibrocartilaginous, being more fibrous in its periphery, and is vascularized, with the anterosuperior aspect having a rich blood supply. Free sensory nerve fibres were also present; no encapsulated mechanoreceptors were observed. The presence of sensory nerve fibres in the glenoid labrum could explain why tears induce pain. It is postulated that these sensory fibres could play a role in glenohumeral joint proprioception.

Blood supply and vascularity of the glenoid labrum: Its clinical implications.

BACKGROUND: Tears of the glenoid labrum are common after dislocation of the glenohumeral joint. The outcome for healing or surgical reconstruction of the glenoid labrum relies on the extent of its vascularization. This study aims to evaluate the glenoid labrum blood supply and to determine its regional vascularity. MATERIALS AND METHODS: A total of 140 shoulders (30 male and 40 female cadavers) were examined: mean age 81.5 years, range 53-101 years. All blood vessels around the glenohumeral joint were dissected and recorded. Ten specimens with the glenoid labrum and fibrous capsule attached were randomly selected and detached at the glenoid neck and subjected to decalcification. Sections (10-20 µm) were cut through the whole thickness of each specimen from the centre of the glenoid fossa perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid. Sections were stained using haematoxylin and eosin and then examined. RESULTS: The blood supply to the glenoid labrum is by direct branches from the second part of the axillary artery, subscapular, circumflex scapular and anterior circumflex humeral and posterior circumflex humeral arteries, as well as branches of muscular arteries supplying the surrounding muscles. CONCLUSION: This study shows that the glenoid labrum has a rich blood supply suggesting that, regardless of the types of the glenoid labrum lesions or their management, an excellent outcome for glenoid labrum healing and joint stability is possible. The observations also suggest that the blood supply to the glenoid labrum is sufficient, enabling its reattachment.

Variability in attachment of the coracoacromial ligament in relation with its morphology.

PURPOSE: The coracoacromial ligament (CAL) presents with variable morphology and plays a significant role in the development of subacromial impingement syndrome. Sectioning the CAL has been suggested to relieve impingement of the rotator cuff. The aim of the current study was to investigate the CAL attachment in relation with ligament morphology. MATERIALS AND METHODS: The CAL was investigated in 220 cadaveric shoulders from 58 males and 59 females, with a median age of 82 years (range 53-102 years). CALs were classified according to three factors: (1) number of bands present; (2) shape; and (3) attachment to the acromial and coracoid processes. RESULTS: 35 (16%) CALs had a single band, 84 (38%) two bands, and 101 (46%) three or more bands. CAL shape was either broadband (14: 6%), quadrangular (21: 10%), Y-shaped (84: 38%), or multiple-banded (101: 46%). More ligaments were attached to the medial aspect of the acromion (60%) and medial end of the coracoid (75%) than those restricted to the anterior edge of the acromion (40%) and posterior aspect of the coracoid (25%). Multiple-banded ligaments attached significantly more medially at the acromion and coracoid processes, while single band ligament attachments were restricted to the anterior edge of the acromion and posterior aspect of the coracoid process. CONCLUSION: The CAL has variable morphology and attachments with interconnections to different structures around the shoulder. CALs with a medial acromial attachment may narrow the subacromial space leading to further shoulder impingement.

Surface anatomy of major anatomical landmarks of the neck in an adult population: A Ct Evaluation of Vertebral Level.

To compare the projectional surface anatomy of healthy individuals in an adult population with those with a thyroid mass, using computed tomography (CT). Sixteen slice CT images of 101 individuals were analyzed using a 32-bit Radiant DICOM viewer to establish the relationships among major anatomical landmarks in the neck and their vertebral levels. The structures investigated included: hard palate (HP), hyoid bone (HB) including body and lesser horns, soft palate (SP), thyroid gland (TG) (both superior and inferior poles), thyroid gland anteroposterior (APD) and superoinferior (SID) diameters, thyroid isthmus (TI) superoinferior dimension, epiglottis, vertebral arteries (right and left), and both right and left parotid glands (superior and inferior extents). The vertebral levels noted most frequently were: body of hyoid bone (C4, 42.71%); lesser horns of hyoid bone (C3, 36.46%); thyroid gland superior pole (C6, 31.25%); and thyroid gland inferior pole (T2, 30.2%). TG-ID, TG-APD, and TG-SID were not significantly different between males and females in the healthy group; however, there was a significant gender difference in thyroid gland inferior diameter in the pathology group [males 2.16(±1.16) vs. females 3.37(±1.30), P = 0.01, paired sample t-test]. Further studies are needed to determine whether neck pathology in those with a thyroid mass affects the dimensions of the thyroid gland. Moreover, the surface anatomy of the neck should be revisited using modern imaging techniques to address inconsistencies in anatomy and clinical reference texts. Clin. Anat. 30:781-787, 2017. © 2017Wiley Periodicals, Inc.

The effect of alendronate sodium on trabecular bone structure in an osteoporotic rat model.

OBJECTIVES: TObjectives: This study aims to investigate the effect of alendronate sodium on trabecular bone structure in an osteoporotic rat model. MATERIALS AND METHODS: Between May 2006 and July 2006, 60 female Wistar Albino rats aged three months were randomly allocated to three groups: sham operated receiving no treatment (Shm); ovariectomized-alendronate receiving 1 mg/kg/day alendronate sodium (Ovx-A), and ovariectomized-vehicle receiving 1 mL/kg/day physiological saline (Ovx-PS). Both Ovx groups received treatment through gastric gavage for 56 days. RESULTS: Densitometric measurements showed that bone mineral density decreased in the Ovx-PS and increased in Ovx-A groups (p<0.05). Biomechanical measurements showed a decrease in the breaking force in the Ovx-PS group and an increase in the Ovx-A group (p<0.05). Histomorphometric measurements showed that the Shm group had normal trabecular structure, while the Ovx-PS group had a less well- formed trabecular structure with a loss in the trabecular number and thickness and a corresponding increase in the trabecular spacing (p<0.05). In the Ovx-A group, there was an improvement in the trabecular structure with an increase in the trabecular number and thickness and a loss in the trabecular space (p<0.05). CONCLUSION: Our study results suggest that alendronate sodium is a valuable treatment agent for osteoporosis in postmenopausal women.

Bare spot and tubercle of Assaki.

BACKGROUND: The definition of the bare spot and tubercle of Assaki is controversial, with studies reporting different incidences, locations, and clinical significance. The aims of this study were to evaluate the incidence of the bare spot, to determine the length and width of the bare spot, and to assess the relationship between the bare spot and tubercle of Assaki. MATERIALS AND METHODS: A total of 140 shoulders from 30 men and 40 women were dissected and examined. After exposure of the glenoid fossa with the glenoid labrum attached, direct measurement of the length and width of the bare spot was undertaken using digital calipers. The repeatability and reliability of the measurements was assessed using Kruskal-Wallis one way analysis of variance on ranks, with statistical significance set at P < .05. RESULTS: A bare spot was observed in 80.7% (n = 113) of shoulders, being more common in men than in women, with an overall mean length and width of 7.2 mm and 6.2 mm. It was significantly longer (P = .002) and wider (P = .018) in men. CONCLUSION: A bare spot exists within the glenoid fossa and differs from the tubercle of Assaki. It is a characteristic round to oval lesion in the central or eccentric cartilage. It should not be misdiagnosed as a pathologic lesion.

Revisiting thoracic surface anatomy in an adult population: A computed tomography evaluation of vertebral level.

To compare key thoracic anatomical surface landmarks between healthy and patient adult populations using Computed Tomography (CT). Sixteen slice CT images of 250 age and gender matched healthy individuals and 99 patients with lung parenchymal disease were analyzed to determine the relationship of 17 thoracic structures and their vertebral levels using a 32-bit Radiant DICOM viewer. The structures studied were: aortic hiatus, azygos vein, brachiocephalic artery, gastroesophageal junction (GEJ), left and right common carotid arteries, left and right subclavian arteries, pulmonary trunk bifurcation, superior vena cava junction with the right atrium, carina, cardiac apex, manubriosternal junction, xiphisternal joint, inferior vena cava (IVC) crossing the diaphragm, aortic arch and junction of brachiocephalic veins. The surface anatomy of all structures varied among individuals with no significant effect of age. Binary logistic regression analysis showed a significant association between individual health status and vertebral level for brachiocephalic artery (P = 0.049), GEJ (P = 0.020), right common carotid (P = 0.009) and subclavian arteries (P = 0.009), pulmonary trunk bifurcation (P = 0.049), carina (P = 0.004), and IVC crossing the diaphragm (P = 0.025). These observations differ from those reported in a healthy white Caucasian population and from the vertebral levels of the IVC, esophagus, and aorta crossing the diaphragm in an Iranian population. The differences observed in this study provide insight into the effect of lung pathology on specific thoracic structures and their vertebral levels. Further studies are needed to determine whether these are general changes or pathology-specific. Clin. Anat. 30:227-236, 2017. © 2017 Wiley Periodicals, Inc.