Clinical anatomy : official journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists
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Hypertrophy of the ligamentum flavum (LF) can reduce the diameter of the spinal canal posteriorly. Such stenosis may significantly compress the dural sac and nerve roots, resulting in symptoms, even without a bulging anulus fibrosus or herniated nucleus pulposus. We conducted an anatomical study to determine the influence of age and gender on the thickness of the LF at the lower lumbar levels using magnetic resonance imaging (MRI). ⋯ Furthermore, the LF thicknesses at L5-S1 bilaterally were significantly greater than on the corresponding sides at L4-L5 (P < 0.05). The LF is an important anatomical structure, which might cause low back or leg pain. Therefore, the thickness of the LF should be measured and evaluated carefully in the case of spinal stenosis.
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Case Reports
An unusual anatomical explanation for contralateral upper extremity weakness after frontal craniotomy.
Contralateral upper extremity weakness following resection of a frontal tumor is not unusual to neurosurgeons. The differential diagnosis is broad and includes postoperative brachial plexopathy, which is usually secondary to malpositioning. We report the first known case of postoperative brachial plexopathy secondary to sialadenitis. ⋯ The cause of the neck edema was found to be sialadenitis of the submandibular gland. With medical treatment, the edema slowly resolved and the patient regained full function of her left upper extremity within weeks. This unusual case represents a new etiology of postoperative brachial plexopathy, illustrates the clinical relevance of the anatomy of the neck fasciae, and broadens the differential diagnosis of contralateral weakness following craniotomy for resection of a brain tumor.
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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.