Reappraisal of the morphological and morphometric study of the psoas minor muscle with clinical and developmental insights: cadaveric study.

BACKGROUND: The Psoas Minor (PMi) is the most unstable muscle of the psoas group of the posterior abdominal muscle. This muscle has a fusiform shape and consists of a short fusiform belly continuing distally as a long tendon inserted on the pecten pubis and the iliopectineal arch. The present study was conducted to obtain more detailed information about the muscle and to expand knowledge about its morphology and morphometry. MATERIALS AND METHODS: The posterior abdominal wall of 30 adult cadavers was dissected. Anatomical variabilities in origin, insertion, length, width, and muscle-to-cone ratio were measured when PMi was found. The data collected was interpreted descriptively. RESULTS: PMi was found in 12 cases, ten bilateral and two unilateral. The origin was constant in all cases and, except for three cases, extended into the iliac fascia and the iliopubic eminence. Morphometric analysis revealed that the average length of the proximal muscle belly and distal tendons was 4.52 ± 1.35 cm and 13.05 ± 0.90 cm, respectively. The mean width of the muscle belly was 1.71 ± 0.17 cm, and that of the tendon was 0.47 ± 0.10 cm. On average, the muscle belly occupied the proximal 33.71 ± 6.15% of the total musculotendinous unit. CONCLUSIONS: Findings confirm the inconsistency of PMi in the study population. Morphological variations became more evident as the tendon approached the insertion level. The muscle's distal attachment to the iliac fascia may partially control the position, mechanical stability of the underlying iliopsoas and this circumstantial function may be clinically related to iliopsoas inflammation and pathology. However, further studies recommended to determine biomechanical validity and clinical applicability of this vestigial muscle in human.

Thoracolumbar fascia in the lumbar region: anatomical description and topographical relationships to the cutaneous nerves: a preliminary study.

BACKGROUND: The study aims to determine principal topographical relations between thoracolumbar fascia (TLF) and lateral branches derived from the dorsal (posterior) rami of lumbar spinal nerves and elucidate their potential link to lumbar region pain. The research protocol involves basic TLF morphological description, evaluating its relation to the nerves, and examining general histology. MATERIALS AND METHODS: The research was conducted on four male cadavers fixed in 10% neutral buffered formalin. RESULTS: The dorsal rami of the spinal nerves branched into medial and lateral divisions. The lateral divisions were about 1 mm thick and mainly visible in the subcutaneous tissue during stratigraphic dissection. They pierced the TLF superficial layer. They descended sidewards and downwards within the superficial fascia (laterally to the erector spinae muscle) to provide sensory innervation to the skin. CONCLUSIONS: Anatomical relationships between TLF, deep (intrinsic or true) back muscles, and dorsal rami of the spinal nerves are complex and may be clinically involved in low back pain etiopathogenesis.

The occipital artery: a meta-analysis of its anatomy with clinical correlations.

The occipital artery arises as one of the main branches of the external carotid artery. The goal of the present meta-analysis was to provide a detailed analysis of the complete anatomy of the occipital artery using the available data in the literature. The main online medical databases such as PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were used to gather all studies on anatomical variations, course, branches, and the close anatomical area of the occipital artery. A total of 65 studies were indicated, evaluated, and included in this meta-analysis. The occipital artery was found to run in the groove with a prevalence of 83.93% (95% confidence intervals: 50.53-100.00%). The occipital artery forming a common trunk with another artery had a prevalence of 13.91% (95% confidence intervals: 9.15-19.47%). The mean maximal diameter of the occipital artery was set to 2.26 mm (standard error = 0.15). The mean maximal diameter of the occipital segment of the occipital artery was found to be 1.24 mm (standard error = 0.15). The mean occipital artery length was set to 131.93 mm (standard error = 3.02). In conclusion, the authors of the present study believe that this is the most accurate and up-to-date meta-analysis regarding the anatomy of the occipital artery. Knowledge about this structure can be of great use when performing revascularization procedures, such as the occipital artery-posterior inferior cerebellar artery bypass, or reconstructive procedures, such as the occipital artery fascial flap.

Pelvic cavity and its spaces - anatomical overview.

Anatomical nomenclature commonly does not follow changes in the clinical language and demands. Therefore we tried to explain the pelvic relationships based on the changes that occur in the pelvis as well as to compare different nomenclatural strategies used in every day language. Courses of fasciae in the male and female pelvis are also considered.

Treatment Options for Tennis Elbow - An Umbrella Review.

INTRODUCTION: The main goal of the present umbrella review was to provide the most up-to- date and evidence-based results regarding the various treatment options for tennis elbow (TE), which hopefully will significantly decrease the confusions existing in the literature. Furthermore, our study differs from past analytical studies because, as to the best of the authors' knowledge, is the first to provide independent (not in comparison to other treatment) statistical results regarding the effectiveness of each TE treatment. MATERIALS AND METHODS: Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO were searched. The overall search process was conducted in 3 stages. RESULTS: A total of 40 studies met the inclusion criteria and were included in this study. Out of those 40 meta-analyses, a total of 160 primary studies were screened in order to extract the data and perform a statistical analysis. CONCLUSION: The present umbrella review underlines the efficiency of injection therapies, especially autologous blood, and platelet-rich plasma, while simultaneously proving the ineffectiveness of acupuncture and shock wave therapy as treatments for TE. Furthermore, the value of other known conservative treatment modalities, such as physical therapy, has been demonstrated.

Arthrofibrosis - a myth or true joint disorder?

Authors, mostly specialists on rehabilitation and orthopedic surgery prove that arthrofibrosis is a commonly overlooked phenomenon, which may lead to serious limitation in the range of movement, leading to limitation in patients quality of functioning. The main goal of this article is to emphasize the importance of understanding a such complex condition. Non typical patomechanism, lack of biomarkers dedicated to this dysfunction and general lack of understanding in this pathology causes that risk factors and the most effective strategies remain vastly unknown. Pathophysiology of the arthrofibrosis in the joints is definitely multifactorial, but intense production of collagen seems to be the main factor. Most modern pharmacological methods concentrate on the regulation of collagen fiber production and reducing the inflammation. Inflammation from joint contractures stimulates the proliferation of activated cells that results in the production of extracellular matrix macromolecules to form fibrotic tissue that is deposited into the capsule, thereby resulting in fibrosis. Lack of unified classification scale is caused by relatively high variation of the functions fulfilled by particular joints and each treatment plan should be constructed individually. Quality of surgical treatment and physical therapy play a major role in both prevention and treatment of such complex condition as arthrofibrosis. Both iatrogenic mistakes and overly aggressive manual therapy are some of main factors increasing the risk of this pathological condition. Introducing properly conducted physical therapy treatment in the early stage is crucial to main the range of movement and preventing this significant problem.

The costocervical trunk: A detailed review.

The number of studies on the anatomy of the costocervical trunk (CCT) is scarce, and the actual prevalence of this structure is unknown. Therefore, the authors of the present study would like to propose a set of four types of CCT, which were created based on observations of computed tomography angiographies (75 CCTs). A retrospective study was conducted to establish variations and the morphometric properties of the CCT. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography (CTA) were analyzed in March 2022. The analysis was performed on a total of 75 CCTs. Of these, 32 were from women (42.7%) and 43 were from men (57.3%). Branching variations of each CCT were thoroughly analyzed. A classification of the branching pattern of the CCTs was made and consisted of four types. In the present study, the variety of branching and morphology of CCT was analyzed, proposing its novel classification based on the four most frequently observed types. Type 1 was the most prevalent (76.1%), having a similar origin and branching pattern as described in the major anatomical books. CCT was found to be absent in 23.94% of the cases, making it a somewhat less consistent branch of the SA. Understanding the variability of the anatomy of the CCT can be a great tool for physicians performing endovascular procedures in the cervical region.

The deep brachial artery-A meta-analysis of its origin and diameter with a review of the literature.

The deep brachial artery (DBA) is the first and largest branch of the brachial artery. Multiple variations of the DBA's origin, termination, and diameter have been reported in the literature. Major online medical databases such as PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched in order to find all studies considering origin variations and the diameter of the DBA. The prevalence of the DBA originating directly from the axillary or brachial artery was shown to be 92.87%. DBA originating indirectly from the axillary or brachial artery, as a common trunk with other arteries, was found to be 7.13%. The mean diameter of the DBA was shown to be 2.05 mm. The authors of the present study believe that this is the most accurate and up-to-date meta-analysis considering origin patterns and the diameter of the DBA. Additionally, this study contains a comprehensive literature review in which current detailed anatomical knowledge concerning the DBA was gathered. The results of this study could provide a helpful tool for physicians, especially surgeons, dealing with an upper limb in their daily practice.

Anatomy of the deep brachial artery - general overview (cadaveric study) - discussion on terminology.

There are only very few studies on the anatomy of the deep brachial artery - DBA (arteria profunda brachii), both regarding its course, branching pattern and contribution to the cubital rete. Most of the textbooks are based on data which remain unchanged for years. The aim of this article was to summarize the current knowledge on this vessel, based on the anatomical and clinical studies and other sources available including also own cadaveric study. We tried to present also some controversies regarded to the nomenclature of the branches of the DBA.

The course of the main septum in the sphenoid sinuses - evaluation before the FESS.

The purpose of this study was to determine the course of the main septum (MS) in the sphenoid sinuses in the adult population. Materials and Methods: 296 patients (147 females, 149 males), who did not present any pathology in the paranasal sinuses, were included in this retrospective analysis of the computed tomography (CT) scans. Spiral CT scanner (Siemens Somatom Sensation 16) was used in order to glean the images of the paranasal sinuses, using standard procedure, in the option Siemens CARE Dose 4D, without using any contrast medium. Secondary reconstructions of the sagittal and frontal planes were obtained using multi- plans reconstruction (MPR) tool after obtaining transverse planes in the first instance. R e s u l t s: The course of the MS changed the most often from the anterior to the posterior part of the sphenoid sinuses. Such situation took place in 83.78% of the patients, in 32.43% of whom a clear shift to the lateral side was noticed only in the posterior part of the MS: in 18.24% of the patients to the right side, and in 14.19% of the patients to the left side. In 17.57% of the patients the lateral shift was visible in both anterior and posterior parts of the septum, where in 9.46% of the patients it was from the left side to the right, whereas in 8.11% of the patients the shift took place from the right side to the left. The MS had the shape of the letter 'C' in 22.29% of the cases, and 11.82% had the typical shape of the letter 'C,' and in 10.47% of the patients it paralleled the inverted letter 'C' (upside down). Amongst the types of the MS shifting directions the rarest was the MS that resembled the letter 'S' - 11.48% of the patients. In 5.74% of the cases it looked like the typical letter 'S,' and in 5.74% of the cases it was similar to the inverted letter 'S.' Only 16.22% of the cases had the MS that did not change its course nor its shape and ran medially in the sagittal plane from the anterior to the posterior part of the sinuses. Conclusions: In furtherance of reducing the risk of problems occurring during a surgery in the paranasal sinuses, it is prudent to have a CT scan done in all the patients beforehand, due to the high prevalence of the anatomical variations in the sinuses.

Sphenoid bone and its sinus - anatomo-clinical review of the literature including application to FESS.

Authors paid attention to anatomy and clinical implications which are associated with the variations of the sphenoid sinus. We discuss also anatomical structure of the sphenoid bone implementing clinical application of this bone to different invasive and miniinvasive procedures (i.e. FESS).