Morphology of Piriformis- its clinical implications in Piriformis syndrome

Background and Aim: Anatomical variations of neuromuscular structures of gluteal region are common. Each and every anatomical variation reflects a different and case specific clinical presentation. Piriformis is the key muscle to this region. This work was done to re-investigate the morphology of this muscle and structures related to it, in sufficient number of specimens to correlate with clinical syndrome. Materials and Methods: 60-lower extremities with gluteal region belonging to 30 embalmed adult human cadavers named as specimens comprised the material for this study. Gluteal region was dissected to see the variations in the origin, insertion and accessory slips of piriformis muscle. Results and Conclusion: Out of 60 specimens, piriformis consisted of one belly in 55 specimens (91.67%) and two bellies were observed in 5 specimens (8.33%). In two specimens belonging to one male cadaver, the piriformis was found being pierced by common trunk for inferior gluteal and common peroneal nerves whereas in three specimens piriformis was also being pierced by one root of posterior cutaneous nerve of thigh An accessory muscle was observed bilaterally in one cadaver. This accessory muscle was present below the piriformis on right side& it was related with the emergence of tibial nerve in between the piriformis and accessory muscle which is a rare pattern. On left side this accessory muscle was present above the piriformis & was associated with presence of superficial branch of superior gluteal artery between the upper border of piriformis and this accessory muscle. All these variations should be kept in mind during physical examination or evaluating radiological images of patients with low back pain. KEY WORDS: Anatomical variation, Piriformis, Pirifomis syndrome, extraspinal sciatic.

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Variations in branching pattern of the axillary artery: a study in 40 human cadavers

Jornal Vascular Brasileiro ◽

10.1590/s1677-54492012000100003 ◽

2012 ◽

Vol 11 (1) ◽

pp. 12-17 ◽

Cited By ~ 7

Author(s):

Rajesh Astik ◽

Urvi Dave

Keyword(s):

Axillary Artery ◽

Artery Bypass ◽

Clinical Signs ◽

Coronary Bypass ◽

Signs And Symptoms ◽

Anatomical Variations ◽

Common Trunk ◽

Branching Pattern ◽

Lateral Thoracic Artery ◽

Human Cadavers

BACKGROUND: Variations in the branching pattern of the axillary artery are a rule rather than an exception. The knowledge of these variations is of anatomical, radiological, and surgical interest to explain unexpected clinical signs and symptoms. OBJECTIVE: The large percentage of variations in branching pattern of axillary artery is making it worthwhile to take any anomaly into consideration. The type and frequency of these vascular variations should be well understood and documented, as increasing performance of coronary artery bypass surgery and other cardiovascular surgical procedures. The objective of this study is to observe variations in axillary artery branches in human cadavers. METHODS: We dissected 80 limbs of 40 human adult embalmed cadavers of Asian origin and we have studied the branching patterns of the axillary artery. RESULTS: We found variations in branching pattern of axillary artery in 62.5% of the limbs. Anatomical variations included: origin of lateral thoracic artery from the subscapular artery; absent thoracoacromial trunk and all its branches arose directly from the second part of the axillary artery; division of thoracoacromial trunk into deltoacromial and clavipectoral trunks, which were divided into all branches of thoracoacromial trunk; origin of subscapular, anterior circumflex humeral, posterior circumflex humeral and profunda brachii arteries from a common trunk from the third part of the axillary artery; and origin of posterior circumflex humeral artery from brachial artery in addition to third part of the axillary artery. CONCLUSIONS: The study was carried out to show important variations in the branching pattern of axillary artery, in order to orient the surgeons performing angiography, coronary bypass, and flaps in reconstructive surgeries.

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Anatomic variation of the thoracic duct and absence of accessory hemiazygos and hemiazygos veins: case report

Journal of Morphological Sciences ◽

10.4322/jms.061614 ◽

2015 ◽

Vol 32 (03) ◽

pp. 209-211

Author(s):

D. Rodrigues ◽

F. Leão ◽

S. Siqueira ◽

L. Carim ◽

G. Lacerda ◽

...

Keyword(s):

Thoracic Duct ◽

Anatomic Variation ◽

Anatomical Variation ◽

Circulatory System ◽

Azygos Vein ◽

Anatomical Variations ◽

Lymph Vessel ◽

Aortic Hiatus ◽

Male Cadaver ◽

Anatomy Laboratory

AbstractThe thoracic duct is a lymph vessel extending from the abdomen to the base of the neck where it drains to one of the large veins in the region. Many cases are described in the scientific literature, regarding anatomical variations of the thoracic duct, from its origin, path, until its end, and the vast majority intended to relate variations in the last part of the duct. The reports related to variations of its path are very scarce. In a male cadaver dissection in the anatomy laboratory of the Faculdade de Ciências Médicas of Minas Gerais (FCMMG), an anatomical variation of the position of the thoracic duct was found. The thoracic duct was presented to the left of the aorta and spine, from its entry in the aortic hiatus of the diaphragm and chest throughout its length. There were also anatomical variations of interest in the venous circulatory system, such as the absence of the veins: hemiazygos and accessory hemiazygos, and the different location of the azygos vein, which was located to the left of the aorta. These variations have no relation to each other. The study of this variation is important because the knowledge of variations in the thoracic duct path allows lower rates of trauma and iatrogenic lesions in thoracic surgery, with possible serious complications, such as a chylothorax.

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Repensar a Ciatalgia Perante Variação Anatómica Bilateral do Nervo Isquiático, com Origem Baixa e Divisão Alta: Importância Histórica, Anatómica e Clínica

Acta Médica Portuguesa ◽

10.20344/amp.10567 ◽

2018 ◽

Vol 31 (10) ◽

pp. 568 ◽

Cited By ~ 2

Author(s):

Fernando Silva Ribeiro ◽

Maria Alexandre Bettencourt-Pires ◽

Edivaldo Xavier da Silva Junior ◽

Diogo Casal ◽

Daniel Casanova-Martinez ◽

...

Keyword(s):

Sciatic Nerve ◽

Undergraduate Students ◽

Anatomical Variation ◽

Anatomical Variations ◽

Leonardo Da Vinci ◽

Gluteal Region ◽

Lower Margin ◽

Anatomical Dissection ◽

Hind Limbs ◽

The Common

Introduction: The aim of the present study is to report an original, unusual, case of bilateral anatomical variation of the sciatic nerve, with low origin and high division.Material and Methods: Anatomical dissection was performed on a 66 year-old female cadaver. The corpse was embalmed and conserved through our original embalming techniques.Results: The particular anatomical variation was first detected during routine dissection classes for undergraduate students. The study was completed with contralateral dissection to unveil bilateral variation. In both hind limbs, the sciatic nerve had a low origin, deep below the mid-gluteal region, and suffered high division, near the lower margin of the gluteal region, after a short length of circa 8 cm, to divide into the common fibular and tibial nerves.Discussion: We detect several cases of sciatic nerve high division, in the reports of the earliest anatomists, such as Leonardo da Vinci, Vesalius, Da Cortona, or Eustachius. Such ancestral interest for these anatomical variations demonstrates the importance of their knowledge for health professionals of different areas.Conclusion: The accurate study of sciatic nerve anatomical variations bears evident surgical, anaesthesiology and clinical applications. As more meticulous as our anatomical studies may get, one will never reach the state of perfection to consider such studies as definitive.

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Anatomical Variations of ProfundaFemoris Artery in Indian Population

Annals of International medical and Dental Research ◽

10.53339/aimdr.2022.8.1.24 ◽

2022 ◽

Vol 8 (1) ◽

pp. 180-184

Author(s):

SadiqaliAbbasali Syed

Keyword(s):

Femoral Artery ◽

Anatomical Variations ◽

Common Trunk ◽

Lateral Circumflex Femoral Artery ◽

Circumflex Femoral Artery ◽

Medial Circumflex Femoral Artery ◽

Significant Difference ◽

Human Cadavers ◽

Lateral Circumflex Femoral ◽

Age Range

Background: Aim: To assess anatomical variations of profundafemoris artery in Indian population.Methods:45 embalmed lower extremities adult human cadavers age range of 30–65 years were recruited for the study. The femoral triangles were dissected with proper care to identify the profundafemoris and circumflex femoral arteries. Their source of origin, position, and distance were noted with the mid-inguinal point (MIP) as a reference point.Results:Side of profundafemoris artery (PFA) was postero- lateral in 60%, posterior in 30%, lateral in 5% and absent in 5%. Medial circumflex femoral artery (MCFA) had 65%, 15%, 12% and 8% and lateral circumflex femoral artery (LCFA) had 80%, 15%, 5% and 0% respectively. Origin of profundafemoris artery (PFA) was FA in 90% and common trunk with medial circumflex femoral artery in 10%. Origin of Medial circumflex femoral artery (MCFA) was FA in 55%, PFA in 40% and FA with common trunk with MCFA in 5%. Origin of lateral circumflex femoral artery (LCFA) was femoral artery in 70%, PFA in 20% and FA with common trunk with PFA in 10%. A significant difference was observed (P< 0.05).Conclusions:A thorough knowledge of variation of profunda femoral artery is of great importance and to avoid complications.

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Clinical importance of a star shaped branch of internal iliac artery and unusual branches of an abnormal obturator artery: rare vascular variations

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.000116 ◽

2016 ◽

Vol 15 (2) ◽

pp. 168-172

Author(s):

Satheesha Badagabettu Nayak ◽

Anitha Guru ◽

Deepthinath Reghunathan ◽

Prasad Alathadi Maloor ◽

Abhinitha Padavinangadi ◽

...

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Clinical Importance ◽

Gluteal Region ◽

Common Trunk ◽

Branching Pattern ◽

Undergraduate Medical Students ◽

Superior Gluteal Artery ◽

Obturator Artery ◽

Internal Iliac

Abstract The internal iliac artery (IIA) is one of the branches of the common iliac artery and supplies the pelvic viscera, the musculoskeletal part of the pelvis, the gluteal region, the medial thigh region and the perineum. During routine cadaveric dissection of a male cadaver for undergraduate Medical students, we observed variation in the course and branching pattern of the left IIA. The artery gave rise to two common trunks and then to the middle rectal artery, inferior vesicle artery and superior vesicle artery. The first, slightly larger, common trunk gave rise to an unnamed artery, the lateral sacral artery and the superior gluteal artery. The second, smaller, common trunk entered the gluteal region through the greater sciatic foramen, below the piriformis muscle and presented a stellate branching pattern deep to the gluteus maximus muscle. Two of the arteries forming the stellate pattern were the internal pudendal artery and the inferior gluteal artery. The other two were muscular branches.

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Anatomical study on sciatic nerve variations in Andhra Pradesh, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193399 ◽

2019 ◽

Vol 7 (8) ◽

pp. 3085

Author(s):

K. Lakshmi Kumari ◽

M. Sushma ◽

A. Raja ◽

D. Asha Latha

Keyword(s):

Sciatic Nerve ◽

Anatomical Study ◽

Anatomical Variations ◽

Ischial Tuberosity ◽

Popliteal Fossa ◽

The Body ◽

Lower Limbs ◽

Gluteal Region ◽

Pelvic Cavity ◽

Human Cadavers

Background: The sciatic nerve is the largest and widest nerve in the body and is derived from ventral rami of spinal nerves L2 to S3. Sciatic nerve appears in the Gluteal region below Piriformis from Pelvic cavity by passing through Greater Sciatic foramen. In between the Ischial tuberosity and greater trochanter of Femur, it reaches the back of the thigh. At the superior angle of Popliteal fossa, it divides into Tibial and common Peroneal (fibular) nerves. The division varies, and it may occur within the pelvis, Gluteal, upper, mid and lower part of thigh. The anatomical variations of the level at which the Sciatic nerve divides is considered important by Neurosurgeons, Anaesthetists, Orthopaedicians and Surgeons.Methods: This study was conducted on 52 lower limbs to determine the level of sciatic nerve bifurcation and its variations on 26 embalmed human cadavers. The data was analyzed manually using numbers, frequencies and percentages.Results: The findings of this study states that in 2 limbs (3.84%) the nerve divided in the gluteal region; in 4 limbs (7.69%) in the pelvic region; in 10 limbs (19.23%) at the junction between upper and middle thigh. The highest incidence of division occurs in 36 limbs (69.23%) at the superior angle of the popliteal fossa.Conclusions: The findings of this study revealed that the majority of sciatic nerve divisions occur at the superior angle of popliteal fossa while some divided into other regions such as Pelvis, Gluteal and thigh regions.

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An Anatomical Variation of Terminal Branches of the Thoracoacromial Artery – Case Report

Journal of Interdisciplinary Medicine ◽

10.2478/jim-2020-0018 ◽

2020 ◽

Vol 5 (3) ◽

pp. 110-113

Author(s):

Loránd Kocsis ◽

Mihai-Iuliu Harșa ◽

Lóránd Dénes ◽

Zsuzsánna Pap

Keyword(s):

Axillary Artery ◽

Anatomical Variation ◽

Practical Importance ◽

Anatomical Variations ◽

Common Trunk ◽

Anatomical Variant ◽

Case Presentation ◽

Thoracoacromial Artery ◽

Lateral Thoracic Artery ◽

Shoulder Region

AbstractIntroduction: Mapping the branching patterns of the thoracoacromial artery has a particular practical importance. Familiarity with the different anatomical variations is essential for successful surgical procedures in the anterior shoulder region.Case presentation: We present an unusual anatomical variant observed during the dissection of a cadaver at the Department of Anatomy and Embryology of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania. According to the classical description, the thoracoacromial artery originates from the second part of the axillary artery, but we observed an unusual branching variation: the thoracoacromial artery provided a subscapular branch right after its origin, then it split into a pectoral branch, the lateral thoracic artery, and a common trunk that gave a second pectoral branch and a deltoid-acromial branch. The clavicular branch was missing.Conclusions: The case we presented demonstrates that there are anatomical variations of the axillary artery system that are partially or entirely different from the classical descriptions. Our study describes a variation of the thoracoacromial artery that has not been reported so far.

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Anatomical Variation of the Azygos System of Veins - Case Report

Journal of Morphological Sciences ◽

10.1055/s-0039-1688976 ◽

2019 ◽

Vol 36 (03) ◽

pp. 207-209

Author(s):

Josikwylkson Costa Brito ◽

Vlademir Lourenço Falcão ◽

Ana Luisa Castelo Branco Gomes ◽

Deyvsom Felipe de Sousa Queiroga ◽

Luciana Karla Viana Barroso

Keyword(s):

Case Report ◽

Superior Vena ◽

Anatomical Variation ◽

Vena Cava ◽

Variable Structure ◽

Azygos Vein ◽

Anatomical Variations ◽

Surgical Approaches ◽

Common Trunk ◽

Hemiazygos Vein

Introduction The azygos system of veins (ASV) is a very variable structure characterized as a communication between the inferior and superior vena cava, having the azygos vein (AV), the hemiazygos vein (HV), and the accessory hemiazygos vein (HAV) as its main components, which are responsible for the mediastinal viscera and for the thoracoabdominal wall drainage. The aim of the present study is to report an anatomical variation found in a male cadaver at the Laboratory of Anatomy of the University Center of UNIFACISA, Campina Grande, PB, Brazil. Case Report In the posterior mediastinum, the union of the HV, of the HAV, and of the 8th left posterior intercostal vein formed a common trunk at the level of the left 8th intercostal space, crossing the mediastinum posterior to the aorta artery, ending up in the AV, in the right hemithorax. Conclusion The study of the anatomical variations of the ASV is important and will provide knowledge for physicians not to confuse them with pathological processes in imaging exams. Moreover, it can provide safety in surgical approaches of the thorax.

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Multiple variations of superficial and deep veins in the neck region of a cadaver: a case report

Anatomy (International Journal of Experimental and Clinical Anatomy) ◽

10.2399/ana.20.753013 ◽

2020 ◽

Vol 14 (2) ◽

pp. 150-155

Author(s):

Nilgün Tuncel Çini ◽

Nazan Güner Sak ◽

Senem Turan Özdemir ◽

İlknur Arı

Keyword(s):

Jugular Vein ◽

Anatomical Variation ◽

Neck Region ◽

External Jugular Vein ◽

Brachiocephalic Vein ◽

Facial Trauma ◽

Common Trunk ◽

Communicating Branch ◽

Male Cadaver ◽

The Right

Multiple variations on the right side of the neck of a 65-year-old male cadaver were observed during a routine dissection. The cadaver had no sign of facial trauma or previous surgery. The facial vein had a communicating branch with the internal jugular vein and distally drained into the jugulo-subclavian confluence via a common trunk with external jugular vein. Other superficial veins of the neck drained into the brachiocephalic vein separately. On the contrary, no anatomical variation was observed on the left side. Even if the variations of the head and neck are common, more than one variation in a single cadaver unilaterally is remarkable. We suggest that it is important for surgeons to examine the patients with ultrasound before any clinical interventions on the neck to determine the possible variations beforehand.

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Anatomical Variation of a Communicating Branch between the Musculocutaneous and the Median Nerve: A Case Report

Acta Medica Academica ◽

10.5644/ama2006-124.286 ◽

2020 ◽

Vol 49 (1) ◽

pp. 71

Author(s):

Dimosthenis Chrysikos ◽

Andreas Athanasopoulos ◽

Panagiotis Georgakopoulos ◽

Ioannis Antonopoulos ◽

Alexandros Samolis ◽

...

Keyword(s):

Case Report ◽

Brachial Plexus ◽

Clinical Significance ◽

Anatomical Variation ◽

Anatomical Variations ◽

Clinical Findings ◽

Minimal Invasive ◽

Musculocutaneous Nerve ◽

Communicating Branch ◽

Male Cadaver

Objective. The aim of our paper is to depict an anatomical variation of the brachial plexus, concerning a communicating branch between the median and the musculocutaneous nerve and its clinical significance. Anatomical variations of the brachial plexus and especially those of the musculocutaneous nerve are quite common. Awareness of these variations is of paramount importance in clinical practice, mainly in achieving best results in minimal invasive or surgical procedures.Case Report. After dissection in upper extremities in a 89-year-old male cadaver, a communicating branch between the median and the musculocutaneous nerve was found. This communicating branch was formed before the musculocutaneous nerve perforated the coracobrachialis muscle. It also derived from the level of the ansa medianis and its course was of an approximately 2cm length.Conclusion. The clinical significance of our study is the entrapment of the musculocutaneous nerve that may cause clinical findings similar to those of the carpal tunnel syndrome.

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