Clinical Examination of the Extensor Pollicis Brevis: Anatomical Study and Description of a Novel Clinical Sign

2018 ◽  
Vol 23 (03) ◽  
pp. 330-335 ◽  
Author(s):  
Michael Lonne ◽  
David S. Sparks ◽  
Carl Stephan ◽  
Michael Wagels ◽  
Anthony Berger
Keyword(s):  
Clinical Examination ◽  
Anatomical Variation ◽  
Proximal Phalanx ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Clinical Test ◽  
Main Function ◽  
Extensor Pollicis Longus ◽  
Extensor Pollicis Brevis ◽  
Significant Difference

Background: The Extensor Pollicis Brevis (EPB) is an extrinsic thumb muscle whose main function is extension of the first metacarpophalangeal joint (MCPJ). It is subject to significant anatomical variation and may be absent, vestigial or have an anomalous distal attachment. Clinical examination of EPB is notoriously difficult and no reliable test has yet been described. We propose a novel test for the accurate examination of EPB. We sought to clarify the anatomical variations of EPB and to validate our clinical test using human cadaveric anatomical tests. Methods: A structured literature review of all human cadaveric anatomical studies describing the attachments of EPB was performed using MEDLINE and Embase with the key words “Extensor Pollicis Brevis”. A cadaveric anatomical study was performed using 18 unembalmed upper limbs. Positive and negative tests were simulated by manipulating the tendons of EPB, Extensor Pollicis Longus (EPL) and Flexor Pollicis Longus (FPL). Changes in tendon tension and joint position were measured and recorded. The EPB anatomy was then determined by dissection. Results: Anatomical variations were present in the majority of wrists, with only 35% of EPB tendons having a distal attachment to the proximal phalanx alone. EPB was absent in 5% of specimens. There was a significant difference between the change in MCPJ position between a positive (36 degrees; 95% CI 25 to 47 degrees) and negative (19 degrees; 95% CI 14 to 25 degrees) clinical test (p = 0.002). Conclusions: The functional importance of EPB depends on its congenital architecture in addition to the functional demands of the patient. We report a novel clinical test which is effective in demonstrating the integrity of the EPB. A positive test result is observed when a change in MCPJ position that occurs while the interphalangeal joint is brought into flexion from full thumb extension is 25 degrees or more.

scholarly journals Arterial diameter of the celiac trunk and its branches: anatomical study

2009 ◽  
Vol 24 (1) ◽  
pp. 43-47 ◽  
Author(s):  
Luís Augusto da Silveira ◽  
Fernando Braga Cassiano Silveira ◽  
Valéria Paula Sassoli Fazan
Keyword(s):  
Hepatic Artery ◽  
Celiac Trunk ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Left Gastric Artery ◽  
Gastric Artery ◽  
Arterial Diameter ◽  
Significant Difference ◽  
Diameter Reduction ◽  
Formalin Fixed

PURPOSE: Despite the fact that anatomical variations of the celiac trunk are well explored in the literature, information on these vessels diameters is scanty. The aims of the present study were to describe the arterial diameters of the celiac trunk and its main branches, and to investigate if these diameters are altered in those cases presenting anatomical variations of these vessels. METHODS: Twenty-one formalin fixed adult male cadavers were appropriately dissected for the celiac trunk identification and arterial diameter measurements. Arteries measured included the celiac trunk and its main branches (splenic artery, left gastric artery and common hepatic artery), as the proper hepatic artery, right gastric artery, the left and right hepatic arteries and the gastroduodenal artery. RESULTS: From the 21 cadavers, 6 presented anatomical variations of, at least, one of the above mentioned branches. The average arterial diameter comparisons between groups (normal and variable) clearly showed smaller diameters for variable vessels, but with no significant difference. CONCLUSION: Our data indicates the possibility of a diameter reduction of the celiac trunk main branches in the presence of anatomical variations. This should be taken into account on the selection for the liver transplantation donors.

scholarly journals Anatomical Study of the Ulnar Nerve Variations at High Humeral Level and Their Possible Clinical and Diagnostic Implications

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Anitha Guru ◽  
Naveen Kumar ◽  
Swamy Ravindra Shanthakumar ◽  
Jyothsna Patil ◽  
Satheesha Nayak Badagabettu ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Upper Limb ◽  
Nerve Palsy ◽  
Motor Behavior ◽  
Anatomical Variation ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Clinical Implications ◽  
Surgical Practice ◽  
Careful Observation

Background. Descriptive evaluation of nerve variations plays a pivotal role in the usefulness of clinical or surgical practice, as an anatomical variation often sets a risk of nerve palsy syndrome. Ulnar nerve (UN) is one amongst the major nerves involved in neuropathy. In the present anatomical study, variations related to ulnar nerve have been identified and its potential clinical implications discussed. Materials and Method. We examined 50 upper limb dissected specimens for possible ulnar nerve variations. Careful observation for any aberrant formation and/or communication in relation to UN has been carried out. Results. Four out of 50 limbs (8%) presented with variations related to ulnar nerve. Amongst them, in two cases abnormal communication with neighboring nerve was identified and variation in the formation of UN was noted in remaining two limbs. Conclusion. An unusual relation of UN with its neighboring nerves, thus muscles, and its aberrant formation might jeopardize the normal sensori-motor behavior. Knowledge about anatomical variations of the UN is therefore important for the clinicians in understanding the severity of ulnar nerve neuropathy related complications.

scholarly journals Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy

2014 ◽  
Vol 41 (6) ◽  
pp. 440-444 ◽  
Author(s):  
Berliet Assad Gomes ◽  
Max Rogério Freitas Ramos ◽  
Rossano Kepler Alvim Fiorelli ◽  
Camila Rodrigues de Almeida ◽  
Stênio Karlos Alvim Fiorelli
Keyword(s):  
Sciatic Nerve ◽  
Hip Arthroscopy ◽  
Average Distance ◽  
Anatomical Variation ◽  
Anatomical Study ◽  
Access Point ◽  
Type A ◽  
Anatomical Variations ◽  
Type B ◽  
Surgical Access

Objective: To evaluate the anatomic topographic relation between the sciatic nerve in relation to the piriform muscle and the posterior portal for the establishment of hip arthroscopy.Methods: We dissected 40 hips of 20 corpses of adult Brazilians, 17 male and three female, six black, six brown and eight white. We studied the anatomical relationship between the sciatic nerve and the piriform muscle with their variations and the distance between the lateral edge of the sciatic nerve and the posterior portal used in hip arthroscopy. We then classified the anatomical alterations found in the path of the sciatic nerve on the piriform muscle.Results: Seventeen corpses had bilateral relationship between the sciatic nerve and the piriform muscle, i.e., type A. We found the following anatomical variations: 12.5% of variant type B; and an average distance between the sciatic nerve and the portal for arthroscopy of 2.98cm. One body had type B anatomical variation on the left hip and type A on the right.Conclusion: the making of the posterior arthroscopic portal to the hip joint must be done with careful marking of the trochanter massive; should there be difficult to find it, a small surgical access is recommended. The access point to the portal should not exceed two centimeters towards the posterior superior aspect of the greater trochanter, and must be made with the limb in internal rotation of 15 degrees.

scholarly journals Evaluation of Extensor Pollicis Brevis as a Recipient of Tendon Transfer for Thumb Extension

2019 ◽  
Vol 52 (02) ◽  
pp. 171-177 ◽  
Author(s):  
Praveen Bhardwaj ◽  
Poonacha Puchimada Muddappa ◽  
Dadi Bindesh ◽  
Shanmuganathan Raja Sabapathy
Keyword(s):  
Tendon Transfer ◽  
Anatomical Variation ◽  
Excellent Result ◽  
Extensor Tendon ◽  
Interphalangeal Joint ◽  
Radial Nerve Palsy ◽  
Brachial Plexus Palsy ◽  
Extensor Pollicis Longus ◽  
Extensor Pollicis Brevis ◽  
Flexor Carpi Ulnaris

Abstract Introduction Rerouting of the extensor pollicis longus (EPL) is the standard part of tendon transfer surgery for thumb extension. It is done to overcome the ulnar vector of the EPL action. Extensor pollicis brevis (EPB), however, produces better thumb abduction and extension by virtue of its radial vector. The described anatomical variation of EPB extending the thumb interphalangeal joint (IPJ), therefore, gives the “best combination” of movements by a single-thumb extensor tendon. Materials and Methods We performed this transfer in six patients in whom the EPB was found to be extending the IPJ while checked intraoperatively. Three of these six patients were cases of radial nerve palsy and the other three presented with brachial plexus palsy. The outcome was assessed by measuring palmar and radial abduction of the thumb, Kapandji’s score, and Bincaz’s scale. Results We found satisfactory results in all the six patients. In our series, patients had an average radial extension of the thumb of 29.2 degrees and an average palmar abduction of the thumb of 65.7 degrees. On evaluation with the Bincaz score; one patient had excellent result, three patients had good results, and two patients had fair results. Conclusion In situations where EPL rerouting is not possible (as in cases where the donor tendon needs to reach the thumb from the ulnar side, for example, flexor carpi ulnaris), transfer to the EPB, provided it is extending the thumb IPJ, would produce better extension and abduction of the thumb than the transfer to the EPL.

scholarly journals 643 How the Straight Leg Raise and Crossed Straight Leg Raise Sign Influence Patient Reported Outcome Measures in Patients with a Lumbar Disc Herniation

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Stanley ◽  
T Jones ◽  
M McCarthy
Keyword(s):  
Lumbar Disc Herniation ◽  
Clinical Examination ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Patient Reported Outcome ◽  
Clinical Test ◽  
Lumbar Radiculopathy ◽  
Significant Difference ◽  
Patient Reported ◽  
Straight Leg Raise

Abstract Aim Low back pain (LBP) with associated lumbar radiculopathy is common. Clinical assessment utilises the straight leg raise (SLR) test and the more specific crossed straight leg raise (XSLR) test. Patient reported outcome measure (PROMs) scores can assess the contributary biopsychosocial factors to pain. Evidence shows links between radiculopathy and psychosocial issues, but little has assessed them in relation to clinical examination. The aim of this study was to assess the significance of the SLR and XSLR sign on PROMs in patients with an MRI-confirmed lumbar disc herniation. Method Patients with an MRI-confirmed lumbar disc herniation who presented with LBP and lumbar radiculopathy were identified. Collected data included the clinical examination outcome, level and side of disc prolapse, interventions and PROMs scores (VAS, ODI, EQ5D, GAD7, PHQ9). Statistical analysis was performed using SPSS. Results 216 patients were included in this study (mean age 50.4, 41% female, 59% male), 102 had negative straight leg raise (NSLR), 94 had positive SLR and 20 had both a positive SLR and positive XSLR. Patients with a positive clinical test on examination had ‘worse’ PROMs scores, with a positive XSLR sign associated with the ‘worst’ PROMs scores. For each PROM, t-test analysis reported a significant difference between the NSLR and SLR groups and NSLR and XSLR groups (P < .01). Conclusions PROMs scores indicating a lower health-related quality-of-life, increased levels of disability, pain, anxiety and depression and greater expectations are associated with a positive SLR or XSLR test.

scholarly journals Computed tomographyand magnetic resonance image-based analysis of the anatomical variations of the Sylvian fissure and characteristics of the middle cerebral artery

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Homajoun Maslehaty ◽  
Cornelius Deuschl ◽  
Bernadette Kleist ◽  
Sophia Göricke ◽  
Ulrich Sure ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Normal Population ◽  
Preoperative Evaluation ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Sylvian Fissure ◽  
Cross Sectional ◽  
Significant Difference ◽  
Ct And Mri

The aim of this cross sectional anatomical study is to determine the distribution of the defined anatomical variations of the Sylvian fissure (SF) in a normal population and to analyze its bilateral superposable presentation. Furthermore, we examined the course of the middle cerebral artery (MCA) and the division of the MCA branches in relation to the SF types. A total of 300 cranial CT scans - 100 CT angiography datasets and 86 MRIs of patients without intracranial pathologies - were reviewed. The SF was categorized in five types based on Yasargils description and our previous publication. The length, diameter and branches of the MCA were measured and compared to the SF types. SPSS 23.0 for Windows® was used for statistical analysis. We analyzed data of 300 patients (171 male, 129 female; mean age 51.6years). Symmetric and mirror-imaged coherence of the SF was found in 266 patients (88.7%, χ2(8)=3.04, p=0.932). The distribution of the SF types showed significant differences in patients younger than 60 years compared to older patients. A bifurcation was observed in 72.0%. A trifurcation was observed in 12.0% and a <em>false bifurcation</em> in 16.0% of patients. There was no significant difference of the measured diameters or length of the M1 segments according to the SF types. In this CT and MRI based anatomical study we could show that a twisted and narrow SF occurred more frequently in patients younger than 60 years of age. The SF has a high congruence intra-individually. The anatomical condition might influence the size and configuration of the proximal MCA, which in turn might influence the surgeon’s choice of the approach to the SF. Preoperative evaluation on the basis of the presented data, may help to decide for an appropriate approach to the SF.

Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma

2019 ◽  
Vol 11 (12) ◽  
pp. 1273-1276 ◽  
Author(s):  
Corey Area ◽  
Christopher J Yen ◽  
Patricia Chevez-Barrios ◽  
Cynthia Herzog ◽  
Peter Kan ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Anatomical Variation ◽  
Interventional Neuroradiology ◽  
Anatomical Variations ◽  
Fluoroscopy Time ◽  
P Value ◽  
Factors Affecting ◽  
Dose Area Product ◽  
Significant Difference ◽  
Intraocular Retinoblastoma

BackgroundIntra-arterial chemotherapy has an increasingly prominent role in the management of retinoblastoma. One concern regarding this technique is procedural radiation exposure.ObjectivesTo examine the effects of our institution’s procedural technique on fluoroscopy parameters for patients undergoing intra-arterial chemotherapy infusions for intraocular retinoblastoma. Secondary goals included describing the effect of anatomical variations of the carotid siphon and ophthalmic artery on radiation dose.MethodsA retrospective review of pediatric patients with retinoblastoma referred to interventional neuroradiology for chemosurgery was performed. Techniques were classified as: A (1.2 Fr or 1.5 Fr microcatheter with continuous verapamil flush, advanced without guide through a 2 Fr sheath) or B (1.5 Fr or 1.7 Fr microcatheter advanced within a 4 Fr base catheter, through a 4 Fr sheath). Statistical analysis was performed to determine if there was a significant difference in fluoroscopy parameters based on technique or due to anatomical variation.Results26 patients were treated with 94 intra-arterial chemotherapy infusions. 34 procedures were performed using technique A and 60 using technique B. Mean fluoroscopy time (4.75 min), fluoroscopy dose (23.3 mGy), and dose–area product (DAP; 85.2 μGy.m2) for technique A were significantly lower (p value <0.05) than for technique B, 14.0 min., 191 mGy, and 586 μGy.cm2, respectively.ConclusionsMicrocatheter-only technique with continuous verapamil infusion resulted in decreased fluoroscopy times, DAP, and radiation doses at our institution for the treatment of intraocular retinoblastoma. Furthermore, our fluoroscopy times using this technique are the lowest reported in the current literature. Additionally, our anatomical analysis has demonstrated a positive correlation between increasing vessel tortuosity and fluoroscopy times.

scholarly journals Anatomical variation of the liver with elongated left lobe may be a trap forthe ultrasound detection of focal liver lesion.

2015 ◽  
Vol 17 (1) ◽  
pp. 12 ◽  
Author(s):  
Size Wu ◽  
Rong Tu ◽  
Guangqing Liu ◽  
Ruixia Nan ◽  
Ying Guan ◽  
...  
Keyword(s):  
Anatomical Variation ◽  
Anatomical Variations ◽  
Distal Region ◽  
Left Lobe ◽  
Focal Liver Lesion ◽  
Focal Liver Lesions ◽  
Focal Lesions ◽  
Normal Length ◽  
Significant Difference ◽  
The Impact

Aims: The aim of this study was to evaluate the impact of anatomical variations of the elongated left lobe of the liver on the ultrasound detection of focal liver lesions. Materials and methods: We evaluated, by ultrasonography (US), 296 patients with elongated left lobe of the liver and 30 patients with focal lesions in the normal length left lobe of the liver. Those patients had undergone prior computed tomography (CT) evaluation. Results: Of the 296 patients evaluated, 34 patients had focal lesions (the size range 11- 20 mm) in the distal region of the elongated left lobe of the liver, and none of the lesions was visualized at US examination (p<0.001). All the focal lesions in the normal length left lobe of the liver of the 30 patients were visualized by US without significant difference between the dimensions established by CT and US (p=0.136). Conclusion: Focal lesions in the distal region of elongated left lobe of the liver are difficult to be detected by conventional US examination and the main reason is the impact of anatomical localization on the examination protocol.

Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽  
2011 ◽  
Vol 40 (5) ◽  
pp. 404-407
Author(s):  
Maras ◽  
Tzormpatzoglou ◽  
Papas ◽  
Papanas ◽  
Kotsikoris ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Local Anaesthesia ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Circle Of Willis ◽  
Variable Degree ◽  
Operative Complications ◽  
The Right ◽  
Ica Stenosis ◽  
Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

Anatomical variations of clivus: a descriptive anatomical study

2021 ◽  
Author(s):  
Bhavana Murjani ◽  
Rohini Bhosale ◽  
Easwaran Ramaswami ◽  
Sonali Kadam ◽  
Amit Ramchandani
Keyword(s):  
Anatomical Study ◽  
Anatomical Variations
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