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PubMed1987

Exposure to formaldehyde in anatomy: an occupational health hazard?

The adverse effects of formaldehyde have been discussed very emotionally in public. Anatomists, technicians in histology and embalming laboratories, as well as medical students during their dissection course are all exposed to formaldehyde, which in many situations crosses the threshold for irritation of the eyes and upper respiratory tract. There is no doubt about the acute toxic effects and the occurrence of contact dermatitis caused by formaldehyde. Studies in rats and mice using high concentrations over an extremely long period (which would not be tolerated by humans) resulted in squamous carcinoma of the nose. Epidemiologic studies on the mortality of medical personnel exposed to formaldehyde do not provide sufficient evidence of cancerogenicity. A number of recommendations will be given for defining the exact concentration in a dissecting room or laboratory and for ways of reducing formaldehyde concentrations and thus minimizing adverse health hazards. These data could initiate a discussion among anatomists, and with technicians and students, based on a sound scientific background rather than on emotion.

Anatomy↗
PubMed1988

Human abductor pollicis brevis muscle "divisions" and the nerve hila.

The interpretation of neuromuscular impairment may be aided by an analysis of functional anatomic factors. The anatomy of the abductor pollicis brevis (APB), a muscle used for skilled movements, was investigated in 19 embalmed hands, and the muscular divisions joining the common tendon at different sites were reproduced on clear vinyl sheets. The median nerve pathway to thenar muscles was followed to where it divides to the APB nerve and to the sites of the main terminal hila. Transverse (x) and longitudinal (y) muscle axes were established with the aid of landmarks to reproduce the nerve pathway on the skin surface. In the rather thick APB, three groups of six muscular heterogeneous divisions were regularly present. The dorsal aponeurotic expansion of the thumb receives the first group. The second group forms a continuous vertical line from the base to the body of the first phalanx. The outside site of its lateral tubercle takes the central tendon from the penniform third group. Hence, a reverse figure-seven distal insertion can be observed. The deepest medial (V2) and the most superficial lateral (V3) divisions had the highest mean diameters. The APB nerve fell between V2 and V2' and its line of projection supplied a guideline to establish an x axis at the proximal one-third of the muscle. The nerve hila plotted in relation to the x-y axes revealed a mode of location. The classical description of a thin APB muscle, made up of two bellies of parallel fibers seems incorrect. The APB nerve is not found on the deep aspect of the muscle as stated earlier, but within the muscle. The well-innervated muscular divisions point to the possibility of their individual use. The APB neuromuscular projection to the skin should allow more accurate fundamental EMG studies of the thumb and therefore provide a basis for more effective treatment in cases of impaired APB.

Humans↗
PubMed2002

Anatomic relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region.

There are inconsistencies between the descriptions of the physical connections between the spinal cervical dura and the surrounding tissues. This study was undertaken to clarify the relationship between the spinal dura, the nuchal ligament and the suboccipital muscles. Dissections were performed on embalmed cadavers: in nine the relevant structures were removed en bloc, whereas in one a sagittal section was prepared. In all specimens it was possible to demonstrate continuity in the midline between the nuchal ligament and the posterior spinal dura at the atlanto-occipital and atlanto-axial intervals. No such attachments were found caudal to the arch of the axis. In addition, there was a connective tissue bridge between the deep aspect of the rectus capitis posterior minor muscle to the transverse fibers of the posterior atlanto-occipital membrane that extended laterally to blend with the perivascular tissue of the vertebral arteries. The present study is, we believe, the first to describe continuity between the nuchal ligament and the dura at the atlanto-occipital interspace, and confirms previous descriptions of similar connections at the atlanto-axial level. Knowledge of the exact attachments of the dura may contribute to understanding the biomechanics of the cervical spine and of the possible etiology of some types of cervicogenic headaches.

Aged↗
PubMed2002

Insertion of the tendon of the tibialis anterior muscle in feet with and without hallux valgus.

The insertion of the tendon of the tibialis anterior muscle may be related to pathologic changes of the foot and, in particular, hallux valgus. Morphologic data should enable evaluation of such a relationship and perhaps offer a basis for improved therapy. One hundred fifty-six embalmed feet, including 27 with hallux valgus, were examined. The tendon of the tibialis anterior muscle was dissected and measurements were made, including the width of the insertion on the first metatarsal and medial cuneiform. Distal-superficial and proximal-deep slips of the tendon twisted around each other. Two specimens presented with an insertion only on the medial cuneiform; in two other cases the insertion was limited to the first metatarsal; in one case the tendon inserted into the navicular and the medial cuneiform; in all other cases, the tendon inserted into the medial cuneiform and first metatarsal. The insertion was mainly located along the plantar margin of the medial side of the foot; some of the proximal-deep fibers also passed onto the plantar surface. Fibers inserting on the first metatarsal bone can outwardly rotate the first ray, which is opposite to the inward rotation of the first ray in hallux valgus. In all feet with hallux valgus these fibers were present. Therefore, it is unlikely that this deformity develops because of a specific type of insertion of the tendon of the tibialis anterior muscle, and any therapeutic approach altering the attachment of the tibialis anterior tendon would cause no biomechanical improvement.

Adult↗
PubMed2003

Anatomical study of the "trochanteric bursa".

To resolve ambiguity in the literature about the anatomy of the "trochanteric bursa" or trochanteric subgluteus maximus bursa, this study examines the constancy, structure, and relationships of this bursa in a series of anatomical dissections of the hip. Sixteen embalmed hip specimens, from subjects aged 63-91 years, were examined. Subgluteus maximus bursae were demonstrated in 13 hips. In each of these a bursa, the deep bursa, was seen immediately superficial to the common attachment of the gluteus medius, minimus, and vastus lateralis muscles onto the greater trochanter. In five hips a smaller second bursa, the superficial bursa, was reflected with the gluteus maximus muscle. In two hips, four bursae were identified. The additional bursae were associated with either the deep or the superficial bursa. Examination of histological samples from the bursal walls confirmed the presence of a synovial lining in varying stages of development in seven of the eight bursae examined. Branches of the inferior gluteal nerve were seen to supply deep and superficial bursae in two dissections. The study data indicate that subgluteus maximus bursae at the level of the greater trochanter are an expected finding in the older age group and that they vary in number, position, and histological appearance. These features give rise to the hypothesis that these bursae are acquired as a consequence of excessive friction between the greater trochanter and the gluteus maximus as it inserts into the fascia lata.

Aged↗
PubMed2003

Anatomy of the arcus tendineus fasciae pelvis in females.

Because of its proximity to the urethra, the anterior part of the arcus tendineus fasciae pelvis (ATFP) may be used in urethrosuspension procedures for urinary stress incontinence. In this study, 10 embalmed female cadaver hemipelves were dissected and their gross anatomy described. In females, the ATFP is a condensation of the endopelvic fascia. The anterior attachment of the ATFP is to the caudal inner surface of the body of the pubic bone at a site averaging 4 mm lateral to the pubic symphysis and covering an average area of 53 mm(2). Posteriorly, it attaches to the medial surface of the ischial spine. In nine of the 10 hemipelves the first anterior centimeters of the ATFP have a clear lateral fixation either to the lateral part of the levator ani muscle (n = 1), to the fascia covering the obturator internus muscle (n = 7), or to the obturator membrane (n = 1). Medially from the ATFP derives a 2-3-cm long flat fibrous attachment to the posterolateral aspect of the urethra. In eight unembalmed cadavers, the ATFP gave way at a pulling force of 8.2 kg (range = 3.5-11.5 kg). The ATFP resists caudal movement of the proximal anterior vaginal wall and the urethra in the upright posture and, therefore, may be suitable for urethrosuspension procedures.

Adult↗
PubMed2003

Clinical anatomy of ligamentum nuchae.

In view of the disparities in the anatomical, clinical, and biomechanical literature this study was undertaken to reappraise the gross anatomy of ligamentum nuchae with the objective of providing an accurate anatomical basis for biomechanical studies and for clinical theories and practices. Ligamentum nuchae was studied by gross dissection in ten embalmed human adult cadavers and was found to be comprised of two structures: a dorsal raphe and a midline fascial septum. The dorsal raphe was formed by the interweaving of the right and left upper trapezius, splenius capitis, and rhomboid minor. It spanned the cervical spine and was firmly attached to the external occipital protuberance and to the spinous process of C7. The fascial septum consisted of dense connective tissue and ran ventrally from the midline raphe to be confluent with the interspinous ligaments and atlanto-axial and atlanto-occipital membranes. These findings agree with those anatomical descriptions that portray ligamentum nuchae as a two-part structure but not with those studies in which it is characterized as a strong ligament attaching to all cervical spinous processes. Importantly, the findings of this study emphasize the need for clinical and biomechanical literature to portray the gross anatomy of ligamentum nuchae accurately.

Adult↗
PubMed2004

Radial nerve in the radial tunnel: anatomic sites of entrapment neuropathy.

Common anatomical structures that can lead to radial nerve entrapment in the radial tunnel (radial tunnel syndrome) were studied in 46 embalmed cadaveric upper limbs. After dissecting the radial tunnel, we investigated: the radial nerve and its division into superficial and deep (DBRN) branches; the course of the DBRN in relation to the extensor carpi radialis brevis (ECRB) muscle; the presence of fat; fibrous adhesions between the anterior radiohumeral joint capsule and the DBRN; the nature of the superomedial margin of the ECRB; vascular arcades of the radial recurrent vessels; and the superior and inferior borders of the superficial layer of the supinator muscle. The locations of some of these structures were measured in reference to two fixed points: the radiohumeral joint line and a line joining the tips of medial and lateral epicondyles of humerus. Near the radiohumeral joint, fibrous adhesions were observed between the DBRN and underlying capsule in 23/46 (50%) cases; vascular arcades of the radial recurrent vessels were found in 33/46 (72%) cases; the superomedial margin of the ECRB was tendinous in 36/46 (78%) instances; the superior border of the superficial layer of the supinator muscle was noted to be tendinous (arcade of Frohse) in 40/46 (87%) specimens, and the inferior border of the superficial layer of the supinator muscle was tendinous in 30/46 (65%) cases. These anatomical features in the radial tunnel are significant enough to lead to entrapment neuropathy of the radial nerve.

Adult↗
PubMed2004

Skin ligaments: regional distribution and variation in morphology.

Skin ligaments (SL) (L. retinacula cutis) are present extensively in the face, hands, feet, and in breast tissue, but have seldom been reported elsewhere in the body. The traditional histological view of the subcutaneous region is that it comprises a matrix of loose connective tissue devoid of fibrous specializations. The purpose of this study was to determine the structure and distribution of skin ligaments. Eight embalmed cadavers (3 males, 5 females, 69-90 years of age) were used in this study. Tissue was prepared using the E12 plastination technique. Macroscopic and microscopic examination demonstrated the widespread presence in the limbs and most of the rest of the body of fibrous strands linking the base of the dermis and the superficial fibers of the underlying deep fascia. The morphology and distribution of these skin ligaments were similar in the individuals examined. Variations in the structure of the skin ligaments depended on the presence of underlying muscle, neurovascular bundles, intermuscular septa and adipose tissue. We conclude that skin ligaments are complex fibrous structures that are present over most of the body. They form an extensive peripheral network in the subcutaneous fat. These 'ligaments' seem to provide an anchorage of skin to deep fascia that is flexible and yet resistant to mechanical loading from multi-directional forces. The use of the E12 plastination technique coupled with fluorescent confocal microscopy has been of benefit in visualizing and delineating SLs from other soft tissue structures in three planes.

Aged↗
PubMed2001

Two bellies of the coracobrachialis muscle associated with a third head of the biceps brachii muscle.

Reports that describe the abnormalities and complexities of the anatomy of the arm are important with regard to surgical approaches. This case study reports a combined abnormal form of the coracobrachialis and biceps brachii muscles of the left arm of an adult male cadaver that was detected during the educational gross anatomy dissections of embalmed cadavers. The coracobrachialis muscle demonstrated two bellies which formed shortly inferior to its origin from the coracoid process of the scapula. One belly inserted into the middle of the antero-medial surface of the humerus, whereas the other belly inserted into the medial head of the triceps brachii muscle. The musculocutaneous nerve passed between the two bellies, giving a separate branch to each. We suggest that the two bellies of the coracobrachialis muscle may represent the incompletely fused short heads of the ancestral muscle. The biceps brachii muscle showed a third head, which originated mainly from the antero-medial surface of the humerus and partially from an aponeurosis belonging to the medial head of the triceps brachii muscle. These observations were confined to the left upper limb and were not accompanied by any other abnormality.

Anatomy↗
PubMed2002

Teaching gross anatomy using living tissue.

Embalmed cadaver tissues and organs that are dissected in gross anatomy laboratories lack many characteristics of fresh or living tissues. The purpose of this study was to assess the educational value of allowing first-year medical students to experience first-hand the color, texture, delicacy and other qualities of living porcine tissues and organs that are similar to those of human tissues. Guided by a laboratory protocol, medical students palpated and inspected organs of the opened thorax, abdomen and pelvis of anesthetized pigs on pulmonary ventilators. The learning experience was rated highly by the students as well as by the participating faculty. A further review of the medical students' later experiences at autopsies and in surgical clerkships showed that the living-tissue experience in their gross anatomy course represented a large part of their medical school exposure to unembalmed tissues.

Abdomen↗
PubMed2004

Anatomic survey of the common fibular nerve and its branching pattern with regard to the intermuscular septa of the leg.

Compression syndromes of the common fibular nerve and its branches frequently occur primarily as well as secondarily to trauma and surgery. A keen knowledge of the course and the relationship of the deep fibular nerve to adjacent anatomical structures in the proximal leg is mandatory. Previous literature often lacks detailed information on the course of the deep fibular nerve and is based on a limited number of observations. The aim of this study was to investigate the common fibular nerve and its branching pattern with special regard to the relationship between the deep fibular nerve and the anterior intermuscular septum of the leg. Variations in the course of the fibular nerve were demonstrated. The fibular compartments of the leg (n = 111) were dissected in 57 embalmed cadavers and included: 1) investigation of the number of muscular branches; 2) entering passages to the respective compartments of the leg; and 3) the relationship between the fibularis longus muscle and the deep fibular nerve. The most proximal muscular branch of the deep fibular nerve directly "pierced" the anterior intermuscular septum of the leg. Narrow passages within the fibular compartment and, in consequence, areas of possible higher incidence of nerve compression were suggested at the level of the intermuscular septa of the leg, between the two distinct portions of the fibularis longus muscle and the crossing of the supplying vessels. There were hardly ever statistically significant differences between the two sides or male and female gender. According to our results, the anterior intermuscular septum of the leg may be regarded as an important landmark for the surgeon when dissecting the muscular branches of the deep fibular nerve. The variable branching pattern of the deep fibular nerve within the fibular compartment of the leg should be taken into account.

Aged↗
PubMed2004

Prevalence of accessory head of flexor pollicis longus muscle and its relation to anterior interosseous nerve in Thai population.

A detailed description of the accessory head of flexor pollicis longus muscle (AHFPL) in the Thai population has not been reported. Because it is one of the causes of anterior interosseous nerve syndrome (AINS), a study was carried out on 120 Thai cadavers (70 embalmed, 50 fresh; 78 male, 42 female) to elucidate the prevalence of AHFPL, its morphology and relationship with the anterior interosseous nerve (AIN). The prevalence of AHFPL was 62.1% (149/240) with 74.5% (111/149) of its origin on medial epicondyle, 23.5% (35/149) on coronoid process and 2% (3/149) on flexor digitorum superficialis muscle. One hundred percent of its insertion was on the ulnar border of flexor pollicis longus tendon, and it was 98% (146/149) fusiform-shaped and 2% (3/149) slender shaped, with a diameter between 0.8-16.0 mm (average 6.7 mm), averaging 6.5 mm on the right and 4.2 mm on the left. The right was significantly statistically larger than the left (P < 0.05). The average distance from the mid-point of the distal wrist crease to the insertion point of AHFPL was 12.8 cm. Four patterns of relationship with AIN were noted including: 1) I AIN passed anterior to AHFPL, 13.4% (20/149); 2) AIN passed lateral to AHFPL, 65.8% (98/149); 3) AIN passed posterior to AHFPL, 8.1% (12/149); and 4) AIN passed both lateral and posterior to AHFPL, 12.8% (19/149). We believe that the latter two patterns (3 and 4) with AIN passing posteriorly would be more likely to be associated with AINS due to anatomic considerations.

Adult↗
PubMed2005

Anatomical variations as potential risk factors for ulnar tunnel syndrome: a cadaveric study.

The aim of this study was to assess the anatomical variations, especially the anomalous muscles passing through Guyon's canal and the fibrous arch forming the piso-hamate hiatus, which may play a role in ulnar tunnel syndrome. We have also focused on the relation of these structures with specific concern to the ulnar nerve. Nineteen embalmed cadavers (37 hands and forearms) were dissected. A fibrous arch extending between the pisiform and the hook of the hamate was observed in 21 hands. In majority of the cases flexor digiti minimi muscle was found to originate only from this arch. An anomalous muscle was disclosed in six hands with four of them passing through the piso-hamate hiatus with the deep branch of the ulnar nerve. In two of four cases, the superficial branch of the ulnar nerve was also accompanying the deep branch of the ulnar nerve beneath the anomalous muscle and through the piso-hamate hiatus. Because these anomalous muscles were generally found to course through the piso-hamate hiatus with the branches of the ulnar nerve, we conclude that the distal portion of the Guyon's canal has a relatively higher risk for ulnar nerve entrapment. We believe that surgeons operating on this region should take into account these various anatomic structures.

Cadaver↗
PubMed2006

Innervation patterns of the inferior glenohumeral ligament: anatomical and biomechanical relevance.

Although the Inferior Glenohumeral Ligament (IGHL) has a well known mechanical and proprioceptive relevance in shoulder stability, the interrelation of the ligament's anatomical disposition/innervation has not actually been described previously. The purpose of the study was to determine the IGHL innervation patterns and relate them to dislocation. Forty-five embalmed and 16 fresh-frozen human cadaveric shoulders were studied. Masson's Trichrome staining detailed the intraligamentous nerve fiber arrangements. The effect on the articular nerves of an anteroinferior dislocation of the shoulder joint and the position of 60 degrees abduction and 45 degrees external rotation was studied dynamically. The axillary nerve provided IGHL innervation in 95.08% of the cases. We saw two distinct innervation patterns originating from the axillary nerve. In Type 1, one or two collaterals diverged later from the main trunk to enter the ligament. Type 2 showed innervation to the ligament provided by the posterior branch for three to four neural branches. In both cases, these branches enter the ligament near the glenoid rim and at the 7 o'clock position (right shoulder). The radial nerve (Type 3 innervation pattern) provided IGHL innervation in 3.28% of the cases. Microscopic analysis revealed wavy intraligamentous neural branches. The articular branches relaxed and separated from the capsule at the apprehension position and stayed intact after dislocation. These results showed a special predisposition to avoid possible denervation and suggested that the neural arch probably remains unaffected after most dislocations. Knowledge of the neural anatomy of the shoulder will clearly help in avoiding its injury in surgical procedures.

Aged↗
PubMed2005

Nerve supply of the brachioradialis muscle: surgically relevant variations of the extramuscular branches of the radial nerve.

The brachioradialis muscle is utilized in tendon-transfer operations, carried out for a variety of purposes. The extramuscular branches of the radial nerve to the brachioradialis were dissected and studied in 43 embalmed cadaveric specimens. The number of primary and secondary branches and the spatial locations of their origins and muscle-entry points was determined for each specimen. All distances were measured relative to the lateral epicondyle. A wide anatomic variation was observed in both the nerve branching pattern as well as the number and locations of muscle-entry points. A single primary nerve branch was found in 20 specimens, or 46.5% of the cases. On an average, single primary nerve branches arose from the radial nerve 30 mm proximal to the lateral epicondyle. In 16 of these cases, the primary branch splits into two to four secondary branches, and in four cases there was only one branch entering the muscle. Seventeen specimens had two primary branches whose origin points were separated by 5 to 40 mm with an average of 15 mm. In seven of these seventeen cases one or both of the primary branches split into secondary branches. Six specimens had three primary branches; the origin points of the most proximal and the most distal branch were separated by up to 30 mm with an average of 13 mm. Excluding the four cases with extensive fanning into multiple thin branches, the number of muscle-entry points ranged from 1 to 4 (mean 2.7). The locations of the muscle-entry points for all specimens were widespread ranging from 50 mm proximal and 40 mm distal to the lateral epicondyle with an average at 6 mm proximal to the lateral epicondyle. The greatest distance between muscle-entry points was 50 mm in a single specimen. In surgical procedures involving dissection of the brachioradialis muscle more proximal than 50 mm distal to the elbow, the extramuscular branch(es) of the radial nerve branches to the brachioradialis may be at risk.

Cadaver↗
PubMed2006

Correlation of magnetic resonance imaging with histopathology in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an asymptomatic cardiac disease characterized by fatty infiltration of the right ventricular myocardium and often results in sudden cardiac death. ARVD/C diagnosis includes the assessment of fatty infiltration, which can be achieved noninvasively with cardiovascular magnetic resonance (CMR). The standard CMR protocol places the signal-generating coil directly on the anterior chest wall and produces a nonspecific high intensity signal that obscures the high signal from fatty infiltration. The aim of this study was to determine whether increasing the coil-to-chest distance would improve identification of fatty infiltration. Thoraces from seven embalmed cadavers were imaged on a conventional 1.5 Tesla CMR scanner using the control protocol and an experimental protocol, with a 6 cm coil-to-chest distance. A representative axial MR image and corresponding gross section of the heart were analyzed in each case. Fatty infiltration was graded in a blinded fashion on the MR images with independent histopathologic assessment. In five of the seven cases, the experimental protocol provided a correlation between CMR and histopathology that was as good as or better than the control protocol. The experimental protocol was also better in preventing false positive diagnosis in cases of minimal infiltration. Thus, the experimental protocol showed a stronger correlation with histopathology than did the control protocol. Increasing the distance between the anterior surface coil and chest wall may improve classification of presence or absence of fatty infiltration in the right ventricular myocardium, potentially improving the noninvasive detection of ARVD/C with CMR.

Adipose Tissue↗
PubMed2006

A cadaveric investigation into the links between macroscopic and microscopic osteoarthritic changes at the hip.

Our objective was to investigate the frequency and distribution of osteoarthritic changes at the hip, including the relationship between osteoarthritic lesions on the femoral head surface and histological changes in articular cartilage, in 12 cadavers. Twelve embalmed cadavers (five males and seven females) were dissected, and the femoral head was removed from both sides (24 femoral heads). Any gross osteoarthritic changes were noted and graded (on a scale of 1-3). A circular disc was then removed from the equator of the femoral head and divided into nine regions. Out of 192 segments, 54 underwent sectioning and staining with haematoxylin and eosin to assess histological changes in cartilage. Osteoarthritis of the hip was present in all cadavers, with all males having bilateral OA and 50% having grade 2 or higher lesions (50% were grade 1), and four of the seven female specimens having bilateral OA and only 7% with grade 2 lesions (with 71% grade 1 and 21% normal). Chondrocyte clustering was most commonly observed in the deep layer of cartilage followed by the intermediate and superficial layers respectively, as the grade of the macroscopic lesion increased. Cartilage injury at the histological level precedes any visible denudation of the femoral head articular cartilage. This study supports the hypothesis that early osteoarthritic changes occur in the deep layer of cartilage near the tide mark and progress superficially concomitant with an overall increase in the osteoarthritic lesion size on the femoral head surface.

Aged↗