Anatomical study of the teres major muscle: description of an additional distal muscle slip

Abstract Background Understanding muscle and tendon anatomy is of tremendous importance to achieve optimal surgical execution and results in tendon transfers around the shoulder. The aim of this study was to introduce and describe an additional distal muscle slip of the teres major (TM). Methods Sixteen fresh-frozen cadaver shoulders were dissected with the deltopectoral approach. The ventral latissimus dorsi (LD) tendon was harvested, and the shoulders were analyzed for the presence/absence of a distal teres major slip (dTMs) and its dimensions and relationship with the TM and LD tendons. Results The dTMs was identified in 12 shoulders (75%). It was always distal to the TM tendon and visible during the deltopectoral approach. There was a clear separation between the TM proximally and dTMs tendon distally. At the humeral insertion, both tendons had a common epimyseal sheet around the teres major and inserted continuously at the humerus. The mean width of the dTMs tendon at the insertion was 13 ± 4 mm (range, 7–22 mm). The total lengths of the dTMs tendon and LD tendon were 40 ± 7 mm (range, 25–57 mm) and 69 ± 7 mm (range, 57–79 mm), respectively (p < 0.001). The dTMs muscle showed direct adhesions in ten shoulders (83%) with the LD muscle. Conclusions This is the first macroscopic description of an additional distal slip of the teres major muscle. The dTMs has a separate (distal) but continuous (mediolateral) insertion at the humerus within a common epimyseal sheet around the TM. The dTMs tendon is visible during the deltopectoral approach and can therefore provide a lead structure, particularly in ventral LD transfers with the deltopectoral approach.

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ANATOMICAL STUDY OF ARCADE OF STRUTHERS

Hand Surgery ◽

10.1142/s0218810410004941 ◽

2010 ◽

Vol 15 (03) ◽

pp. 157-159 ◽

Cited By ~ 3

Author(s):

Piyapong Tiyaworanan ◽

Surut Jianmongkol ◽

Tala Thammaroj

Keyword(s):

Ulnar Nerve ◽

Anatomical Study ◽

Medial Epicondyle ◽

Anatomical Location ◽

Greater Tuberosity ◽

Lateral Epicondyle ◽

Surgical Exploration ◽

Fresh Frozen ◽

The Mean ◽

Proximal Border

The incidence and the anatomical location of the arcade of Struthers as related to the arm length were studied in 62 arms of adult fresh-frozen cadavers. The distance between the greater tuberosity and the lateral epicondyle was designated as the arm length. The arcades of Struthers were identified in 85.4%. The mean arm length was 27.85 ± 1.3 cm. The mean of the distance between proximal border of the arcade of Struthers and the medial humeral epicondyle was 8.24 ± 2.06 cm. The mean ratio between the distance from the proximal border of the arcade to the tip of the medial epicondyle and arm length was 0.29 ± 0.07. We concluded that the anatomical location of the arcade as related to the arm length was 29% proximally, from the tip of the medial epicondyle. This report of the anatomical location of the arcade of Struthers related to the arm length can be useful to identify this structure in the arms which have differences in arm length during the surgical exploration and anterior transposition of the ulnar nerve procedures.

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Redefining Zone II: Anatomy of the Flexor Digitorum Superficialis Insertion

Hand ◽

10.1177/1558944717735940 ◽

2017 ◽

Vol 14 (3) ◽

pp. 377-380

Author(s):

Luke T. Nicholson ◽

Jeffrey R. Hill ◽

Braden McKnight ◽

Nathanael Heckmann ◽

Milan Stevanovic ◽

...

Keyword(s):

Kirschner Wire ◽

Surgical Approaches ◽

Flexor Digitorum Superficialis ◽

Mean Width ◽

Fresh Frozen ◽

Zone Ii ◽

The Mean ◽

Distal Aspect ◽

Middle Ring ◽

Flexor Digitorum

Background: Flexor zone II is defined as the region spanning the proximal aspect of the A1 pulley to the insertion of the flexor digitorum superficialis (FDS) tendon. Descriptions of the FDS insertion are inconsistent in the literature, but zones of injury are frequently determined with reference to superficial landmarks. The purpose of this study was to describe the footprint of the FDS insertion and define its relationship to the proximal interphalangeal (PIP) skin crease. Methods: The FDS insertion on the index, middle, ring, and small fingers was dissected in 6 matched pairs of fresh-frozen cadaveric hands. A Kirschner wire was used to mark the level of the PIP skin crease on bone before measurements of the FDS footprint and its position relative to the PIP skin crease were made using digital calipers. Results: The radial and ulnar FDS slips inserted a mean distance of 3.22 mm from the distal aspect of the PIP skin crease and varied by digit. The mean distal extent of the FDS insertion was 8.29 mm. The mean length of the insertion of each FDS slip was 5.15 mm and the mean width was 1.9 mm. Conclusions: The radial and ulnar FDS slips insert on average 3.22 mm distal to the PIP skin crease and vary by digit. Knowledge of the FDS insertion is clinically relevant when differentiating between flexor zone I and zone II injuries, planning surgical approaches to the finger, and in guiding patient expectations for surgery given the variability in outcome based on zone of injury.

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The Anatomy of the Dorsal Capsulo-Scapholunate Septum: A Cadaveric Study

Journal of Wrist Surgery ◽

10.1055/s-0036-1597922 ◽

2017 ◽

Vol 06 (03) ◽

pp. 244-247 ◽

Cited By ~ 4

Author(s):

Marina Tommasini Carrara de Sambuy ◽

Tanya Burgess ◽

Christophe Mathoulin ◽

Adeline Cambon-Binder

Keyword(s):

Dorsal Surface ◽

Anatomical Study ◽

Biomechanical Properties ◽

Scapholunate Ligament ◽

Maximum Width ◽

Interosseous Ligament ◽

Gothic Architecture ◽

Constant Structure ◽

Fresh Frozen ◽

The Mean

Background Tears of the dorsal radiocarpal capsule at the level of the scapholunate interosseous ligament (SLIL) have recently been described in association with predynamic scapholunate instability. Purpose The aim of this anatomical study of the dorsal capsulo-scapholunate septum (DCSS) was to examine the connection of the dorsal capsule on the SLIL and dorsal intercarpal ligament (DICL). Methods Fourteen fresh frozen wrists from seven adult cadavers were dissected through a dorsal approach. Any dorsal attachment of the DICL on the dorsal surface of the SLIL, that is, the DCSS, was identified and measured (height and width). Results The DCSS was consistently found connecting the DICL, the dorsal radiocarpal capsule, and the dorsal aspect of the SLIL. It was formed by the confluence of three arches like intersecting ribs in gothic architecture. The mean dimensions of the DCSS were 5.8 mm in height and 4.0 mm in maximum width. Conclusion The DCSS that connects the SLIL with the dorsal capsule and DICL could be a constant structure of dorsal wrist. Further investigation is required to study the histology of the DCSS and its biomechanical properties in isolation to know whether the DCSS can be considered a secondary stabilizer of the scapholunate ligament complex. Clinical Relevance A better anatomical knowledge of scapholunate ligament complex could help understand and manage instability of the wrist.

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An Anatomical Study of Morton's Interdigital Neuroma: The Relationship Between the Occurring Site and the Deep Transverse Metatarsal Ligament (DTML)

Foot & Ankle International ◽

10.3113/fai.2007.1007 ◽

2007 ◽

Vol 28 (9) ◽

pp. 1007-1010 ◽

Cited By ~ 35

Author(s):

J-Young Kim ◽

Jae Hyuck Choi ◽

Jungmin Park ◽

Joonho Wang ◽

Inmook Lee

Keyword(s):

Anterior Margin ◽

Metatarsophalangeal Joint ◽

Anatomical Study ◽

Causative Factor ◽

Metatarsal Head ◽

Digital Nerve ◽

Fresh Frozen ◽

The Common ◽

The Mean ◽

The Relationship

Background: Using clinical and cadaver studies, we examined the relationship between the location of Morton interdigital neuromas and the surrounding structures, including the deep transverse metatarsal ligament (DTML), which has been suspected as a major causative factor in neuroma formation. Methods: Seventeen fresh-frozen cadavers were evaluated to determine the relationship between the location of Morton interdigital neuromas and the DTML at two phases of the gait cycle with 60 degrees of metatarsophalangeal dorsiflexion and with 15 degrees of ankle dorsiflexion. We measured the distance from the bifurcation of the common digital nerve in the foot to the anterior margin of the DTML and also measured the length of the DTML itself. Clinically, we checked the location of the Morton interdigital neuroma and its length during surgery in 32 feet. Results: In the second and third webspace, the mean distance from the bifurcation of the common digital nerve of the foot to the anterior margin of the DTML was 16.7 mm, 15.1 mm in the mid-stance position, and 15.9 mm and 14.6 mm in the heel-off position. The length of the second and third DTML averaged 12.8 mm and 10.6 mm. Clinically, all of the cases of Morton interdigital neuroma started at the bifurcation area of the common digital nerve, and the mean neuroma length was 7.5 mm (6 to 11). Conclusions: Morton interdigital neuromas were located more distally than the DTML in both the mid-stance and the heel-off stage during walking. The main lesion was located between the metatarsal head and the metatarsophalangeal joint and more distal than the DTML, questioning previous studies suggesting that the DTML is the major causative factor in development of Morton interdigital neuroma.

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Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0038-1676083 ◽

2018 ◽

Vol 46 (02) ◽

pp. 106-112

Author(s):

Sergi Barrera-Ochoa ◽

David Campillo-Recio ◽

Jorge Knorr ◽

Xavier Mir-Bullo ◽

Alfonso Rodríguez-Baeza ◽

...

Keyword(s):

Anatomical Study ◽

Osteogenic Potential ◽

Fresh Frozen ◽

Pedicle Length ◽

Mean Size ◽

Microsurgical Techniques ◽

The Mean ◽

Radial Axis

Introduction Vascularized periosteal flaps (VPFs) have proven to be a useful technique for the treatment of unfavorable biological situations in children, with excellent results due to their osteogenic potential. The objective of this work is to present a detailed anatomical description of the periosteal vascularization of the radius and ulna, as well as the design of the forearm VPFs. Methods Anatomical study with 10 fresh-frozen specimens with antegrade injection of green colored latex. Periosteal branches of the radius and ulna, septocutaneous branches, and muscular branches were dissected. The size of the pre and postdissection flaps was measured, as well as the length of the vascular pedicles. Results The four vascular axes studied were the anterior interosseous vascular axis (AIA), radial axis (RA), ulnar axis (UA), and posterior interosseous vascular axis (PIA). The AIA (volar-radial VPF): an average of 16.2 periosteal branches were obtained, with a mean distance of 6.6 mm between them. The mean size of the VPF was 41.3 cm2 pre-dissection and 32.4 cm2 post-dissection. The average pedicle length was 16.1 cm. Vascular RA (radial VPF): an average of 20.8 branches was found, with a mean VPF size of 54.8 cm2predissection, and 39.3 cm2 post-dissection. The average pedicle length was 20.2 cm. Vascular PIA (dorsal-ulnar VPF): an average of 12.8 periosteal branches were obtained, with the mean VPF size being 26.2 cm2 pre-dissection and 20.4 cm2 post-dissection. The average pedicle length 12.6 cm. Vascular UA (ulnar VPF): an average of 10.2 periosteal branches were obtained with a mean VPF size of 37.5 cm2 pre-dissection and 28.2 cm2 post-dissection. of the average pedicle length was 14.8 cm. Conclusions We have described four new VPFs, with the most useful and versatile being the dorsal-ulnar VPF, based on the PIA, and the volar-radial, based on the AIA. The main advantages of these flaps with respect to microsurgical techniques are the simplicity and speed of the technique, its elasticity and adaptability to the recipient bed, as well as its versatility.

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Dimensions and morphology of the sinus tympani: an anatomical study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185060 ◽

2018 ◽

Vol 5 (1) ◽

pp. 60

Author(s):

B. Y. Praveen Kumar ◽

Deekshita Venugopal ◽

Rajapur Parashuram ◽

M. K. Veenapani ◽

C. Subhash ◽

...

Keyword(s):

Chronic Otitis Media ◽

Anatomical Study ◽

Classical Type ◽

Type D ◽

Sinus Tympani ◽

Surgical Access ◽

Mean Width ◽

Restricted Type ◽

The Mean ◽

Temporal Bones

Background: The sinus tympani is a deep pocket of varying dimensions and shape situated in the retrotympanum. The sinus tympani lies medial to the facial nerve. Hence surgical access is difficult. This area is frequently involved in chronic otitis media attico antral type. Removal of disease from this area is difficult leading to cholesteatoma recidivism. The anatomy has been well described in literature. Its dimensions and morphology has not been described in the Indian population. Knowledge of the endoscopic anatomy of this area will help to eradicate disease leading to better results.Methods: A canal wall down mastoidectomy was performed on twenty wet temporal bones. A zero degree endoscope was introduced into the middle ear to view the sinus tympani. Using a graduated millimetre scale. The dimensions and morphology of the sinus tympani was studied. Results: Twenty wet bones were dissected. The mean height of the sinus tympani was 3.55 mm. The mean width was 2.22 mm and mean depth was 1.72 mm. The morphology was as follows: 13 bones had a type A morphology (classical type), 6 had a type B morphology (confluent), 1 bone had a type D morphology (restricted type). We did not encounter a type C sinus tympani in our study.Conclusions: The morphology and dimensions of the sinus tympani are variable. The otologist must have a complete knowledge of the anatomy of this area to successfully eradicate disease from this area.

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Anatomic evaluation of the insertional footprints of the iliofemoral and ischiofemoral ligaments: a cadaveric study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03848-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Yasuaki Tamaki ◽

Tomohiro Goto ◽

Keizo Wada ◽

Daisuke Hamada ◽

Yoshihiro Tsuruo ◽

...

Keyword(s):

Femoral Neck ◽

Nerve Tissue ◽

Lesser Trochanter ◽

Femoral Neck Axis ◽

Complex Anatomy ◽

Mean Width ◽

Fresh Frozen ◽

Muscle Fascia ◽

The Mean ◽

Iliofemoral Ligament

Abstract Background An understanding of the insertional footprints of the capsular ligaments of the hip is important for preserving hip function and stability given the increasing number of minimally invasive hip surgeries being performed under a limited surgical view. However, it is difficult to detect these ligaments intraoperatively and many surgeons may not fully appreciate their complex anatomy. The aims of this study were to quantify the proximal and distal footprints of the iliofemoral ligament (ILFL) and ischiofemoral ligament (ISFL) and to estimate the location of the corresponding osseous landmarks on the proximal femur, which can be detected easily during surgery. Methods Twelve hip joints from Japanese fresh frozen cadavers were used. All muscle, fascia, nerve tissue, and vessels were removed to expose the intact capsular ligaments of the hip. The length and width of the proximal and distal footprints of the ILFL and ISFL were measured and their relationship to osseous structures was evaluated, including the intertrochanteric line, femoral neck, and lesser trochanter. Results The mean length of the distal medial arm of the ILFL footprint was 17.9 mm and the mean width was 9.0 mm. The mean length of the distal lateral arm of the ILFL footprint was 23.0 mm and the mean width was 9.7 mm. For the footprint of the medial arm, the insertion was in the distal third of the intertrochanteric line and that of the lateral arm was in the proximal 42% of this line. The mean distance from the lesser trochanter to the footprint of the medial arm was 24.6 mm. The mean length of the distal ISFL footprint was 11.3 mm and the mean width was 6.9 mm. The footprint of the distal ISFL was located forward of the femoral neck axis in all specimens. Conclusions Understanding the size and location of each capsular ligament footprint in relation to an osseous landmark may help surgeons to manage the hip capsule intraoperatively even under a narrow surgical view. The findings of this study underscore the importance of recognizing that the distal ISFL footprint is located relatively forward and very close to the distal lateral arm footprint.

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Ethnic variation in medial orbital wall anatomy and its implications for decompression surgery

BMC Ophthalmology ◽

10.1186/s12886-021-02009-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Minhui Amy Chan ◽

Farah Ibrahim ◽

Arjunan Kumaran ◽

Kailing Yong ◽

Anita Sook Yee Chan ◽

...

Keyword(s):

Relative Position ◽

Ethmoid Sinus ◽

Decompression Surgery ◽

Ethnic Variation ◽

Sinus Wall ◽

Orbital Wall ◽

Mean Width ◽

Significant Difference ◽

The Mean ◽

Medial Orbital Wall

Abstract Background To describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects. Methods Single-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA). Results There were 12 males (60 %) in each group, with no significant difference in age (p = 0.334–0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were − 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively. Conclusions No inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.

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The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

Foot & Ankle International ◽

10.1177/10711007211027262 ◽

2021 ◽

pp. 107110072110272

Author(s):

Kenneth M. Chin ◽

Nicholas S. Richardson ◽

John T. Campbell ◽

Clifford L. Jeng ◽

Matthew W. Christian ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Metatarsal Head ◽

Cadaveric Study ◽

Anatomic Study ◽

Orthopedic Surgeons ◽

Popular Knowledge ◽

Fresh Frozen ◽

The Mean ◽

Anatomic Relationship

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

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Comparative Study of Flexor Hallicus Longus Tendon Length through Single Incision or Accessory Plantar Medial Incision: A Cadaver Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00181 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0018

Author(s):

Caitlin Curtis Crocker ◽

Eildar Abyar ◽

Sean Young ◽

Fatemah Razaghi ◽

Gerald McGwin ◽

...

Keyword(s):

Single Incision ◽

Plantar Flexion ◽

Cadaver Study ◽

Tendon Graft ◽

Interference Screw ◽

Flexor Hallucis Longus ◽

Tunnel Length ◽

Exact Test ◽

Fresh Frozen ◽

The Mean

Category: Ankle; Hindfoot Introduction/Purpose: Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus is a common adjuvant procedure in the treatment of Achilles pathology. The FHL tendon can be harvested using a posterior incision where the tendon is dissected along its course into the fibroosseous tunnel. Alternatively, the FHL may be harvested through a separate plantar medial incision as it crosses the flexor digitorium longus at the Knot of Henry. This study aims to quantify FHL tendon lengths achieved through the two common approaches utilizing pair matched cadavers. Methods: Seven pair matched fresh-frozen cadaver legs without signs of musculoskeletal abnormalities were used for this assessment. One leg in each pairing underwent a single incision harvest while the contralateral leg underwent an accessory medial plantar harvest. After dissecting the tendon, a calcaneus tunnel was prepared from dorsal to plantar in both calcanei in standard fashion. Two measurements were obtained. The first measurement was taken from the distal aspect of the muscle belly to the distal end of the tendon. The tendon was then pulled through the calcaneus, and the foot was held in tension at 20 degrees of plantar flexion. The second measurement was taken from site where tendon entered the calcaneous to the distal end of the tendon graft. The measurements were analyzed using Wilcoxon Signed Ranks Test and Fischer Exact Test. Results: Using a posterior incision, the mean tendon measurement from calcaneous tunnel to the distal end of the tendon was 4.0 cm. Using an accessory plantar medial incision, the mean tendon measurement from the calcaneous tunnel to the distal end of the tendon was 7.2 cm. The average tunnel length obtained using an accessory medial incision was significantly greater than the length obtained using the single incision approach (p= 0.0003, p=0.0022, and p=0.0016). The accessory plantar medial incision obtained an FHL tendon tunnel length that was an average of 2.9 cm greater than the posterior incision. Conclusion: The single incision approach provided sufficient length to safely anchor the FHL into the calcaneus which suggests that the accessory plantar medial approach is not necessary for routine FHL transfers to the calcaneus with interference screw fixation. However, if additional length is needed for other applications such as posterior tibialis tendon dysfunction or peritoneal tendon tears, the accessory incision does provide an average of 2.9 cm of additional length.

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