Clinical anatomy : official journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists
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The aim of this study was to analyze the arterial supply of the sesamoid bones of the hallux. Twenty-two feet from adult cadavers were injected with epoxide resin or an acrylic polymer in methyl methacrylate (Acrifix) and subsequently processed by two slice plastination methods and the enzyme maceration technique. Afterwards, the arterial supply of the sesamoid bones was studied. ⋯ The supplying arteries penetrated the sesamoid bones on the proximal, plantar, and distal sides. The analysis and cataloging of the microvascular anatomy of the sesamoids revealed the first plantar metatarsal artery as the main arterial source to the medial and lateral sesamoid bones. In addition, the first plantar metatarsal artery ran along the lateral plantar side of the lateral sesamoid bone, suggesting that this artery is at increased risk during soft-tissue procedures such as hallux valgus surgery.
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The knowledge of sacral hiatus anatomy is imperative in clinical situations requiring caudal epidural block for various diagnostic and therapeutic procedures of the lumbosacral spine to avoid failure and dural injury. In this study, a detailed anatomic study of the sacral region was carried out on 49 male adult Indian cadavers. Dorsal surface of sacral region was dissected to study sacral cornua, sacral hiatus, and the dimensions of triangle formed by the right and left posterosuperior iliac spines with apex of the hiatus. ⋯ The dural sac was found to terminate at S2 in 41 (83.6%). The mean (SD) angle of depression of the needle was 65.7 (5.5) (range 58-78). The measurements described for the identification of the sacral hiatus, optimal angle of depression, and depth of the needle may improve the safety and reliability of a caudal epidural block.
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The majority of clinical tests used to diagnose superior labral anterior to posterior (SLAP) lesions of the shoulder have poor diagnostic accuracy, possibly related to a lack of anatomical validity for test procedures. The resisted supination external rotation (RSER) test is suggested to reproduce symptoms associated with a SLAP lesion by placing stress on the labrum through increasing tension in biceps brachii long head. The test requires supination of the forearm against resistance, while the shoulder is externally rotated passively. ⋯ Brachialis was minimally active throughout the test. The results provide support for the anatomical basis of the RSER test, with the resisted forearm supination component of the test recruiting moderately strong levels of activity in biceps brachii long head throughout the test. Although the evidence of anatomical validity provides support for the RSER test as a clinical test for SLAP lesions of the shoulder, further tests of diagnostic accuracy are required.
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The percutaneous placement of lateral distal humeral pins risks injury to the radial nerve. We aimed to provide a reliable and safe parameter for the insertion of lateral distal humeral pins. A secondary aim of this study was to investigate the effect of pin/screw placement in the intended zone of fixation at the lateral distal humerus. ⋯ The Pearson correlation coefficient between the lateral nerve height and the trans-epicondylar distance was r = 0.95. A relative dimension, the trans-epicondylar distance is both reliable and easily accessible to the operating surgeon. The absolute safe zone for pin entry into the lateral distal humerus is that area lying within the caudad 70% of a line, equivalent in length to the patient's own trans-epicondylar distance, when projected proximally from the lateral epicondyle.