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SUMMARY: The axillary artery is a continuation of the subclavian artery and transitions into the brachial artery. Variations in the axillary artery are not uncommon. During the upper-limb dissection of a 95-year-old Korean female cadaver, assorted anatomical variations of the axillary artery branches were identified. On the right side, no branches emerged from the first part of the axillary artery. The thoracoacromial artery (excluding the pectoral branch) and the common subscapular trunk arose from the second part, with the common subscapular trunk giving origins to the pectoral branch, lateral thoracic artery, and subscapular artery. The subscapular artery is divided into the thoracodorsal artery, circumflex scapular artery, and accessory posterior circumflex humeral artery. Additionally, the superior thoracic artery arose from the lateral thoracic artery. The third part of the axillary artery gave rise to the anterior and posterior circumflex humeral arteries, accessory acromial branch, and accessory thoracodorsal artery. On the left side, the thoracoacromial artery (excluding the pectoral branch) and the superior thoracic artery arose from the first part. The common subscapular trunk arose from the second part, which included the pectoral branch, lateral thoracic artery, and subscapular artery. The subscapular artery is divided into the thoracodorsal artery, circumflex scapular artery, accessory posterior circumflex humeral artery, and accessory lateral thoracic artery. The third part gave rise to the anterior and posterior circumflex humeral arteries and the accessory acromial branch. This study presents variations of the axillary artery, emphasizing their rarity, considering their embryologic basis, and highlighting their importance not only for educational purposes but also surgical and radiological applications.
La arteria axilar es una continuación de la arteria subclavia y luego esta continua como arteria braquial. Las variaciones en la arteria axilar no son infrecuentes. Durante la disección de los miembros superiores de un cadáver de una mujer coreana de 95 años, se identificaron diversas variaciones anatómicas de las ramas de la arteria axilar. En el lado derecho no se originaban ramas de la primera parte de la arteria axilar. La arteria toracoacromial (excluyendo la rama pectoral) y el tronco subescapular común surgieron de la segunda parte, y el tronco subescapular común dio origen a la rama pectoral, la arteria torácica lateral y la arteria subescapular. La arteria subescapular se dividía en arteria toracodorsal, arteria circunfleja escapular y arteria humeral circunfleja posterior accesoria. Además, la arteria torácica superior se originaba de la arteria torácica lateral. La tercera parte de la arteria axilar dio origen a las arterias circunflejas humerales anterior y posterior, la rama acromial accesoria y la arteria toracodorsal accesoria. En el lado izquierdo, de la primera parte surgían la arteria toracoacromial (excluyendo la rama pectoral) y la arteria torácica superior. De la segunda parte se originaba el tronco subescapular común, que incluía la rama pectoral, la arteria torácica lateral y la arteria subescapular. La arteria subescapular se dividía en arteria toracodorsal, arteria circunfleja escapular, arteria circunfleja humeral posterior accesoria y arteria torácica lateral accesoria. La tercera parte daba origen a las arterias circunflejas humerales anterior y posterior y a la rama acromial accesoria. Este estudio presenta variaciones de la arteria axilar, enfatizando su rareza, considerando su base embriológica y destacando su importancia no sólo para fines educativos sino también para aplicaciones quirúrgicas y radiológicas.
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Artéria Axilar/anatomia & histologia , Variação Anatômica , CadáverRESUMO
BACKGROUND: Previously reported outcomes after tendon transfers to reconstruct the subscapularis are unpredictable and often unsatisfactory, especially in the presence of anterior humeral head subluxation. We studied the anatomic feasibility of the lower trapezius and the rhomboid minor transfer to reconstruct irreparable tendon tears of the subscapularis. The aim of this study was to determine the feasibility of lower trapezius and rhomboid minor transfer to reconstruct irreparable subscapularis tendon tears. MATERIALS AND METHODS: We measured the tendons dimensions, muscles excursions, distances to pedicles, and dissection needed to complete a successful lower trapezius and/or rhomboid minor transfer to the subscapularis footprint in 10 cadaveric shoulders. The transferred muscles were detached distally, augmented with a semitendinosus and gracilis autograft, and passed anteriorly between the scapula and the subscapularis remnant through a small serratus window to reach the lesser tuberosity. The risk of pedicle compression was subjectively assessed in all cases. RESULTS: The trapezius and rhomboid tendons were asymmetric with an average length of 37.6 mm and 21.7 mm, an average width of 63 mm and 33.4 mm, respectively. The mean distances from each distal insertion to the lesser tuberosity were 109 mm for the trapezius and 144 mm for the rhomboid. Mean distances from tendon to pedicle were 57.9 mm and 33.1 mm, respectively. The mean size of the necessary serratus window was 49.4 mm, which was measured at maximal excursion achieved at maximal external rotation 90° representing two digitations. All of the tendon transfers were feasible, and the risk of pedicle compression was 20% for the trapezius and 10% for the rhomboid. Superior migration of the transfer was observed during passive external rotation if the insertion point was too high. CONCLUSIONS: Transfer of the lower trapezius and rhomboid minor to the lesser tuberosity to reconstruct an irreparable subscapularis tear is feasible without extensive dissection and with a low risk of nerve compression. We recommend not to transfer the rhomboid minor routinely, owing to the risk of tendon luxation after external rotation of the shoulder.
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BACKGROUND: The rarity and anatomical complexity of brachial plexus tumors (BPTs) impose many challenges onto surgeons performing surgical resections, especially when these tumors invade the cervicothoracic spine. Treatment choices and surgery outcomes heavily depend on anatomical location and tumor type. METHODS: The authors performed an extensive review of the published literature (PubMed) focusing on "brachial plexus tumors" that identified invasion of the cervicothoracic spine. RESULTS: The search yielded 2774 articles pertaining to "brachial plexus tumors". Articles not in the English language or involving cervicothoracic spinal invasion were excluded. CONCLUSIONS: Recent research has shown that the most common method used to resect tumors of the proximal roots is the dorsal subscapular approach. Despite its association with high morbidity rate, this technique offers excellent exposure to the spinal roots and intraforaminal portion of the spinal nerve. The dorsal approach is used to resect recurrent lower trunk tumors and dumbbell-shaped neurofibromas, yet it is also the least common overall approach used in brachial plexus tumor resections. The ventral or anterior technique is commonly used to resect tumors at the cord to division level, and root to trunk level. Motor complications, transient nerve palsy, and bleeding are among the most common complications of the anterior supraclavicular approach. Further controlled studies are needed to fully determine the optimal surgical approach used to obtain the best outcomes and least complications for each type of brachial plexus tumor.
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Plexo Braquial , Neoplasias do Sistema Nervoso Periférico/patologia , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Raízes Nervosas Espinhais , Vértebras Cervicais , Humanos , Invasividade Neoplásica , Procedimentos Neurocirúrgicos/métodos , Vértebras Torácicas , Resultado do TratamentoRESUMO
La tendinopatía de la porción larga del Bíceps es causa frecuente de dolor en el hombro. Usualmente esta patología se relaciona con tendinopatía y lesiones del manguito rotador comprometiendo con mayor frecuencia el tendón del subescapular. El diagnóstico de esta entidad es difícil tanto clínica como radiológicamente, y la precisión diagnóstica de las lesiones parciales del Bíceps en Resonancia Nuclear Magnética (RMN) es relativamente baja. El objetivo de la nota técnica es presentar una Tenodesis intra-articular de la porción larga del Bíceps utilizando un anclaje óseo sin nudos, el cual sirve a su vez para reinsertar lesiones de tendón subescapular Laffosse tipo I y II con suturas adicionales.
Long head biceps tendinopathy is a common cause of shoulder pain. Usually, this pathology is related to both, tendinopathy and rotator cuff injuries, most frequently involving the subscapularis tendon. The diagnosis of this entity is difficult clinically and radiologically, and the diagnostic sensitivity and specificity of partial biceps injuries in Magnetic Resonance imaging (MRI) is relatively low. The aim of the technical note is to present an intra-articular tenodesis of the long head of the biceps using a knotless bone anchor, which serves once to reinsert type I and II Laffosse subscapular tendon injuries with additional sutures.
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Humanos , Músculos Isquiossurais , Manguito Rotador , Tenodese , Lesões do Manguito RotadorRESUMO
PURPOSE: The suprascapular artery originates in the thyrocervical trunk; however, several variations regarding both the origin and the path have already been described. This article aims to describe a complex and rare variation of the suprascapular artery originating as a branch of the subscapular artery. We described, reviewed the literature, and highlighted the clinical relevance of such variations to the medical practice. METHODS: A routine dissection was performed on a male adult cadaver approximately 60-70 years old, embalmed in formalin 10%. In addition, the diameter of the axillary, subscapular and suprascapular arteries was measured. RESULTS: During the dissection, we identified the suprascapular artery emerging from the medial side of the subscapular artery with a long and tortuous pathway to the supraspinatus fossa, under the superior transverse scapular ligament. Associated with this, three other anatomical variations stand out: the posterior circumflex humeral artery emerging from the subscapular artery, the absence of the anterior circumflex humeral artery, and two pectoral branches emerging from the third part of the axillary artery and from the subscapular artery, respectively. CONCLUSION: Such variations are of great clinical relevance to orthopedists, mastologists, vascular surgeons and other specialties for both surgical approaches and suprascapular neuropathy.
Assuntos
Variação Anatômica , Artérias/anormalidades , Escápula/irrigação sanguínea , Idoso , Cadáver , Humanos , Ligamentos Articulares/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/cirurgia , Articulação do Ombro/irrigação sanguínea , Articulação do Ombro/inervação , Articulação do Ombro/cirurgiaRESUMO
OBJECTIVE: The aim was to establish a correlation between the integrity of a suture made in the subscapular tendon (SST), as assessed by an ultrasound examination, and its functionality, as assessed by clinical tests during the postoperative period following reverse shoulder arthroplasty (RSA). A secondary goal is to evaluate the presence and viability of the sutured SST. METHODS: This is a retrospective study of 18 RSA patients in whom the SST was repositioned to the anterior face of the humeral osteotomy. The median time of the postoperative evaluation was 31 months. The clinical evaluation consisted of the Gerber lift-off test, the internal rotation (IR) lag sign test, and the abdominal compression test, as well as forward flexion (FF), external rotation (ER), and IR. All patients underwent shoulder ultrasounds to evaluate the SST presence and viability. RESULTS: The SST was visualized in 13 patients (72.2%; 95% confidence interval [CI], 51.5-92.9). Of these 13 patients, the SST presented an altered fibrillar pattern in 5 patients (38.4%; 95% CI, 12.0-64.9) and was considered nonviable. There were no associations between SST viability and a positive Gerber's lift-off test (P = .480), a positive IR lag sign test (P = .480), or a positive abdominal compression test (P = .618). There were no significant differences in FF (P = .104), ER (P = .196), or IR (P = .374) mobility between patients with viable SSTs and those without viable SSTs. CONCLUSION: It was not possible to demonstrate a correlation between the integrity of the SST repair based on the ultrasound and its functionality as assessed by clinical tests in the postoperative period following an RSA. The SST repair has a high failure rate, as demonstrated by the high incidence of nonviable or absent tendons.
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A large range of variability marks the branching pattern of the axillary artery. The knowledge of the anatomical variations and this pattern is essential to diagnostic and therapeutic approaches, including surgery, of the axillary region. The aim of this study was to observe the different possible origins of circumflex humeral arteries and to measure the length and diameter of each vessel. In our study, 24 armpits from adult cadavers (fixed in tamponed formalin 10%) were dissected. The data were analyzed with a digital caliper and the results expressed as Mean ± SD. In majority of specimens, posterior circumflex humeral artery (PCHA) arose from subscapular artery (SSA) (54.16%) and had an average diameter of 3.92±0.41 mm. The anterior circumflex humeral artery was a branch from axillary artery (AA) in the majority of the specimens (62.5%) with an average diameter of 1.83±0.68 mm. Circumflex humeral arteries can arise from SSA, deep brachial artery and AA. The result of this study is an interesting data for origin, length and diameter of these vessels, contributing to the knowledge of these variations occurrence.
Una amplia gama de variabilidad marca el patrón de ramificación de la arteria axilar. El conocimiento de las variaciones anatómicas de este patrón es esencial para enfoques de diagnóstico y terapéuticos, incluyendo la cirugía de la región axilar. El objetivo fue observar los diferentes orígenes posibles de arterias circunflejas humerales y medir la longitud y el diámetro de cada vaso. En el estudio se disecaron 24 axilas de cadáveres adultos (fijados en formalina tamponada al 10%). Los datos se analizaron con un calibrador digital y los resultados se expresaron como Media ± DS. En la mayoría de los especímenes, la arteria circunfleja humeral posterior surgió de la arteria subescapular (ASE) (54,16%) con un diámetro medio de 0,41±3,92 mm. En la mayoría de los especímenes (62,5%), la arteria circunfleja humeral anterior era una rama de la arteria axilar (AA) con un diámetro medio de 0,68±1,83 mm. Las arterias circunflejas humerales pueden surgir de la ASE, de la arteria braquial profunda y AA. El resultado de este estudio es un dato interesante para el origen, la longitud y el diámetro de los vasos, lo que contribuye al conocimiento de la ocurrencia de estas variaciones.
Assuntos
Humanos , Adulto , Variação Anatômica , Artérias/anatomia & histologia , Úmero/irrigação sanguínea , Artéria Axilar/anatomia & histologia , CadáverRESUMO
Very few large studies in Latin America have evaluated the association between waist:height ratio (W-HtR) and cardiometabolic risk in children and adolescents. Further, multivariable analyses verifying the independence of located subcutaneous fat have not been conducted so far. The aim of this study was to evaluate the associations of W-HtR and waist circumference (WC) with metabolic syndrome abnormalities and high LDL-cholesterol levels in schooled adolescents before and after adjusting for trunk skinfolds and BMI. The sample consisted of 831 boys and 841 girls aged 10-17 years. Biochemical, blood pressure and anthropometrical variables were measured. Age- and sex-specific quartiles of W-HtR and WC were used in Poisson regression models to evaluate the associations. High WC values (highest quartile v. quartiles 1-3) were associated with high TAG levels in both sexes (prevalence ratio, boys: 2·57 (95 % CI 1·91, 3·44); girls: 1·92 (95 % CI 1·49, 2·47); P0·05). High W-HtR (highest quartile v. quartiles 1-3) was only independently associated with high TAG in female adolescents (1·99 (95 % CI 1·55, 2·56); P<0·05). In conclusion, WC showed better association with cardiometabolic risk than W-HtR in the children of this study. This observation does not support W-HtR as a relevant adiposity marker for cardiovascular and metabolic risk in adolescence.
Assuntos
Adiposidade , Doenças Cardiovasculares/etiologia , Síndrome Metabólica/patologia , Obesidade Abdominal/complicações , Circunferência da Cintura , Razão Cintura-Estatura , Adolescente , Estatura , Índice de Massa Corporal , Peso Corporal , Doenças Cardiovasculares/sangue , Criança , LDL-Colesterol/sangue , Colômbia , Feminino , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/complicações , Análise Multivariada , Obesidade Abdominal/sangue , Fatores de Risco , Triglicerídeos/sangueRESUMO
Introduction: Painful shoulder on hemiplegic patients has been associated to subscapular muscle spasticity.An alternative for treatment is based on subscapular nerve block using phenol. However, there is lack ofinformation on anatomical references for subscapular nerves blockage technique. The aim of this study wasto determine mean values and confidence intervals for maximum penetration points in order to facilitateblockage during anesthetic procedure of subscapular nerves. Material and methods: Using 30 dissected adultcadaver limbs, the medial edge of scapula and a horizontal plan to the lower edge of the bone spine wereidentified. The maximal and minimal angles of the penetration points of the subscapular nerve both above andbelow the horizontal plan were measured, as well as the minimal and maximal distances from the medial edgeof scapula. Superior and inferior bisector angles and the mean horizontal distance (in mm) were calculatedfor descriptive analysis. Kolmogorov-Smirnov normality test indicated the normal distribution of the data(p > 0.05). Results: Mean superior angle was 6.63° (confidence interval 4.52-8.75), mean inferior angle was11.30° (confidence interval 8.73-13.86) and mean horizontal distance was 72.53 mm (confidence interval69.25-75.80). Conclusions: According to this data, for maximum points blocking after solution injection, theneedle should be introduced horizontally at the scapula spine level under its medial edge to a mean depth of72.53 mm. Then, the needle must be driven upwards in a 6.63° angle and later, driven downwards to form a11.30° angle with the horizontal plan. Those mean values represent 95% of the distribution.
Assuntos
Humanos , Masculino , Feminino , Adulto , Ombro/cirurgia , Ombro/fisiopatologia , Ombro/inervação , Anestesia , Dissecação , Escápula/anatomia & histologia , Ombro/anatomia & histologia , FenóisRESUMO
Background: In obstetric palsy, limitation in the external abduction and rotation of the shoulder is the most frequent sequelae. Glenohumeral deformity is the result of muscular imbalance between the external and internal rotators. Releasing the contracted muscles and transferring the latissimus dorsi are the most common surgeries in this case. Patients and methods: We operated on 24 children between 4 and 8 years of age with obstetric palsy sequelae to elevate the subscapularis muscle off the anterior surface of the scapula posteriorly and transfer the latissimus dorsi. The patients received a minimum of 2 years of follow up. They were evaluated based on Mallets and Gilberts classifications. Results: All of the patients recovered within the above mentioned classifications. Out of 22 children evaluated via Mallets classification, all improved from 3 to 4 on that scale. With respect to Gilberts classification, 16 children improved one degree and 8 improved 2 degrees. All of the patients parents were satisfied with the results. Discussion: The benefit from releasing contracted muscles and muscle transfer to improve shoulder abduction in the sequelae of obstetric palsy has been amply reported in the literature. The results we had from elevating the subscapularis muscle off the anterior surface of the scapula and transferring the latissimus dorsi were good. Children who were difficult to classify based on the described scale were taken note of and some sub-classifications for Gilberts descriptions were proposed. Patients must be selected carefully. To transfer the latissimus dorsi, it is necessary to have good passive mobility in abduction, a minimum of 20º of external rotation and no joint deformities. When negative external rotation is found, the subscapularis muscle should be released. When there is glenohumeral joint deformity in older children, other methods are recommended, such as rotational humeral osteotomy.
Introducción: Las limitaciones en la abducción y la rotación externa del hombro son las secuelas más frecuentes en la parálisis obstétrica. Se encuentra deformidad de la articulación glenohumeral como resultado del desequilibrio que existe entre los músculos rotadores externos e internos. Dentro de las cirugías más usadas para corregir las deformidades del hombro están las liberaciones musculares y la transposición del músculo dorsal ancho. Materiales y métodos: El autor operó 24 niños entre los 4 y 8 años de edad, con secuelas de parálisis braquial obstétrica, a quienes se les practicó liberación del subescapular por vía posterior y transferencia del músculo dorsal ancho. Se evaluaron según la escala de Mallet y la de Gilbert, con un seguimiento mínimo de dos años. Resultados: Todos los niños se recuperaron según las escalas mencionadas. En 22 evaluados según Mallet, todos mejoraron del nivel 3 al 4. Según la clasificación de Gilbert, 16 niños mejoraron un grado y 8 niños mejoraron dos grados. Todos los padres estuvieron satisfechos con los resultados. Discusión: Existen muchos informes en la literatura médica sobre los beneficios de liberar los músculos contracturados y de las transferencias musculares en el hombro en las secuelas de parálisis braquial obstétrica. Se obtuvieron buenos resultados en todos los niños. Algunos casos fueron difíciles de clasificar en las escalas usadas, para lo cual se propone una sub-clasificación. Se requiere tener una buena movilidad pasiva, que no haya deformidad articular en el hombro y mínimo 20º de rotación externa, para realizar la transferencia muscular del dorsal ancho. Cuando no se encuentra la rotación externa, se debe hacer la liberación del subescapular. Si hay deformidad de la articulación glenohumeral, no se recomiendan las transferencias musculares y entonces se recurre a osteotomías.
Assuntos
Ombro/anatomia & histologia , Ombro/cirurgia , Músculos/cirurgia , Ortopedia/métodos , Articulação do Ombro/anatomia & histologia , Articulação do Ombro/cirurgia , Plexo Braquial/anatomia & histologia , Plexo Braquial/cirurgiaRESUMO
An unusual unilateral variation in the branching pattern of axillary artery was observed in a 60 year old female embalmed cadaver. The axillary artery had only two branches arising from its proximal (first) part and no branches from its remaining distal (second & third) parts. The branches are superior thoracic (usual) and another large collateral (unusual) branch. This collateral branch is the origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. We propose to name this artery as common subscapular trunk. The course of this collateral artery (common subscapular trunk) and its branches and also clinical significance of this variation are discussed in the paper.
Una inusual variación unilateral en el patrón de ramificación de la arteria axilar se observó en un cadáver embalsamado de 60 años de edad. La arteria axilar tuvo sólo dos ramas derivadas de su parte proximal (primera) y no otorgó ramas de su parte distal (segunda y tercera). Las ramas son superiores torácica (habitual) y otra gran rama colateral (inusual). Esta rama colateral es el origen de varias arterias importantes como la circunfleja escapular, toracodorsal, circunfleja humeral posterior, taraco-acromial y torácica lateral. Proponemos el nombre variación arterial como tronco común subescapular. El curso de este tronco común subescapular y sus ramas y también el significado clínico de esta variación son discutidas en este trabajo.