Anatomy and Correlation of the Coracoid Process and Coracoclavicular Ligament Based on Three-Dimensional Computed Tomography Reconstruction and Magnetic Resonance Imaging.

BACKGROUND The anatomy of the coracoid process and coracoclavicular (CC) ligament have been described and the correlation between them has been assessed based on 3-dimensional computed tomography (CT) reconstruction and magnetic resonance imaging (MRI), which provide a guide for coracoclavicular ligament reconstruction. MATERIAL AND METHODS Data were collected from 300 patients who underwent both CT and MRI of the shoulder joint from January 2017 to January 2019 at the Jiang'an Hospital of Traditional Chinese Medicine. The coracoid process was observed and classified and parameters of the CC ligament were measured according to different corneal types. All of the statistics were collected and classified by 2 radiologists, and average values were determined.Measurements of segments were taken as follows: ab - In the coronal plane, the length of the CC ligament from the central point of the CC ligament at the clavicular attachment to the CC ligament at the center of the CC attachment); ac - The distance from the center point of the CC ligament at the supraclavicular attachment to the acromioclavicular joint; de - In the sagittal plane, the length of the CC ligament from the center of the clavicular attachment to the coracoid attachment point; fg - The maximum diameter of the CC ligament at the anterior and posterior margins of the clavicle attachment; hi - The largest diameter of the CC ligament at the anterior and posterior edge of the coracoid process attachment; dj - The distance of the coracoclavicular ligament from the center point of the coracoid process attachment to the coracoid process tip; kl - The distance in the supraclavicular plane from the coracoclavicular ligament to the subcoracoid process. RESULTS The analysis showed that there are 5 types of coracoid process: gourd (31%), short rod (20%), long rod (22.3%), wedge (10.3%), and water drop (6.3%). There were statistically significant differences between the lengths of the ac and hi segments in the among the wedge and gourd-type and the short rod and water drop-type coracoid processes. There were statistically significant differences between the lengths of the ab, de, and fg segments in the short rod, gourd, and long rod-type coracoid processes. There were statistically significant differences between the lengths of the ac, fg, hi, dj, and kl segments in the water drop, gourd, and long rod-type coracoid processes. CONCLUSIONS The present study indicated that measurement of the CC ligament and the different shapes of the coracoid process provide an anatomical basis for the diagnosis and treatment of shoulder diseases and the data can be used to improve the safety of CC ligament reconstruction.

Descriptive anatomy of the interscalene triangle and the costoclavicular space and their relationship to thoracic outlet syndrome: a study of 60 cadavers.

OBJECTIVE: Thoracic outlet syndrome classically results from constrictions in 1 or more of 3 specific anatomical locations: the interscalene triangle, costoclavicular space, and coracopectoral tunnel. Magnetic resonance and computed tomographic imaging studies suggest that, of the 3 potential locations for constriction, the costoclavicular space is the most susceptible to compression. This study of human cadavers aims to expand on the descriptive anatomy of the interscalene triangle and associated costoclavicular space. METHODS: The interscalene angle, interscalene triangle base, and costoclavicular space were measured on 120 sides of embalmed human cadavers. Linear distances and angles were measured using a caliper and protractor, respectively. The data were analyzed by calculating the mean, range, and standard deviation. RESULTS: The range for the interscalene base was 0 to 21.0 mm with a mean of 10.7 mm. For the interscalene angle, the range was 4° to 22° with a mean of 11.3°. Measurements for the costoclavicular space ranged from 6 to 30.9 mm with a mean of 13.5 mm. CONCLUSIONS: No significant differences were observed between left and right interscalene triangles or costoclavicular spaces; furthermore, there were no differences between the sexes concerning these 2 locations.

Population continuity, demic diffusion and Neolithic origins in central-southern Germany: the evidence from body proportions.

The transition to agro-pastoralism in central Europe has been framed within a dichotomy of "regional continuity" versus exogenous "demic diffusion". While substantial genetic support exists for a model of demographic diffusion from an ancestral source in the Near East, archaeological data furnish weak support for the "wave of advance" model. Nevertheless, archaeological evidence attests the widespread introduction of an exogenous "package" comprising ceramics, cereals, pulses and domesticated animals to central Europe at 5600calBCE. Body proportions are under strong climatic selection and evince remarkable stability within regional lineages. As such, they offer a viable and robust alternative to cranio-facial data in assessing hypothesised continuity and replacement with the transition to agro-pastoralism in central Europe. Humero-clavicular, brachial and crural indices in a large sample (n=75) of Linienbandkeramik (LBK), Late Neolithic and Early Bronze Age specimens from the middle Elbe-Saale-Werra valley (MESV) were compared with Eurasian and African terminal Pleistocene, European Mesolithic and geographically disparate recent human specimens. Mesolithic Europeans display considerable variation in humero-clavicular and brachial indices yet none approach the extreme "hyper-polar" morphology of LBK humans from the MESV. In contrast, Late Neolithic and Early Bronze Age peoples display elongated brachial and crural indices reminiscent of terminal Pleistocene and "tropically adapted" recent humans. These marked morphological changes likely reflect exogenous immigration during the terminal Fourth millennium cal BC. Population expansion and diffusion is a function of increased mobility and settlement dispersal concomitant with significant technological and subsistence changes in later Neolithic societies during the late fourth millennium cal BCE.

A safer technique of internal jugular venipuncture: experience with 320 cases.

Placement of central venous catheters for monitoring or long-term access has become an indispensable surgical procedure. Various routes to establish central venous access have previously been described. The internal jugular vein can be cannulated percutaneously from several access points, using the clavicle and the sternocleidomastoid muscle as reference landmarks. An alternate method of internal jugular venipuncture using a previously undescribed point of entry is described. Experience with this modified technique in 320 cases where it was used for various purposes is reviewed. The incidence of complication was less than 1% and the improved safety of the procedure is attributed to the vertical direct method of venipuncture through the new access point.

[Further studies on serum calcium and inorganic phosphorus in postmenopause (author's transl)].

The author previously reported that the serum calcium (Ca) and inorganic phosphorus (P) levels were gradually decreased with advance in age in regularly menstruating women, but that they were rapidly increased soon after the menopause. In this experiment the changes of the serum Ca and P levels in postmenopausal women were studied more precisely in 410 peri- or post-menopausal subjects and 534 controls with regular menses. They were classified into 12 groups according to age or period since last menses. The clavicular cortical thickness was also measured as an index of bone resorption. Blood samples were taken between 9-11 A.M. after an overnight fast and the separated sera were applied to a Technicon Autoanalyzer SMA 12/60 and analyzed. The mean levels of Ca and P in serum were both increased following the menopause and reached a plateau in Groups F-3 (12-24 months since last menses) and G (2-5 years since last menses). In Group G (5-10 years since last menses) both the levels were slightly declined. Then a dissociation was observed in Groups I-1 and I-2. This was a successive decrease of Ca and a re-increase of P. This dissociation might be explained partly by the physiologic fall of parathyroid function. Furthermore the clavicular cortical thickness was measured with a micrometer in the middle of the clavicle on the chest X-ray film of the same subjects and the clavicular score was computed as Cortical width X 100/Whole width. The score was gradually but steadily reduced with the lapse of time after the menopause and in Group I-2 it was lowered to approximately 45% of that in the premenopausal groups. From these results it is certain that the decline of estrogen secretion led to the elevation of the serum Ca and P levels and subsequently to the reduction in the clavicular score.