Clinical Anatomy最新文献

Optimizing analgesia after hip surgery enables more rapid recovery. However, peripheral nerve blocks (PNBs) often fail to provide adequate pain relief in the posterolateral hip as they typically target the lateral cutaneous nerve of the thigh (LCNT). This study aimed to map the nerves innervating the posterolateral hip through analysis of anatomy textbooks (n = 5) and cadaveric dissections (n = 13). The subcostal (SCN), iliohypogastric (IHN), and ilioinguinal (IIN) nerves were identified as key contributors to innervating the posterolateral hip. The optimal site for ultrasound-guided PNBs to target these three nerves was identified at the "75/25" landmark: 75% horizontally along the 12th rib and 25% vertically down to the iliac crest. Ultrasound-guided dye injections in cadavers (n = 6) showed that while the "75/25" landmark effectively stained the SCN (6/6) and IHN (4/6), it inconsistently stained the IIN (2/6). A second injection in the posterolateral hip stained branches of the IHN (4/6) and IIN (4/6) but not the SCN (1/6), suggesting the IHN and IIN are the dominant nerves in the posterolateral hip. These findings recommend a more distal injection at the "100/75" landmark to consistently block the IHN and IIN, thereby optimizing postoperative analgesia after hip surgery.

The title of this issue's editorial is taken from a quote from Dr. James Jealous and, in its entirety, reads,

“Anatomy is a living wholeness of function and should be seen as a mystery of form, not static academic structure.”

Taken together, these quotes support the endeavor of this issue of Clinical Anatomy, which includes papers that support our trajectory as educators and scientists in the anatomical sciences.

Hunter W. Two introductory lectures, delivered by Dr. William Hunter; to his last course of anatomical lectures, at his theatre in Windmill Street: as they were left corrected for the press by himself. To which are added, some papers relating to Dr. Hunter's intended plan, for establishing a museum in London, for the improvement of anatomy, surgery, and physic. London: Printed by order of the Trustees, for J. Johnson 1784:64–65.

Recent advances in small-joint arthroscopy and cutting-edge magnetic resonance imaging systems have enabled orthopedic surgeons to perform more complex repairs of the wrist. Such repairs can include those of the triangular fibrocartilage complex (TFCC) of the wrist that necessitates a reappraisal of its morphometry with special emphasis on the relationship between its articular disc (AD) and surrounding tissues. The TFCC AD is a fibrocartilaginous, biconcave structure located between the ulnar styloid process and the carpal bones of the wrist. We carefully dissected and measured the ADs of 58 wrists from 34 embalmed cadavers (20 females, 14 males) and fabricated three-dimensional biofidelic plastic models of them. Precise measurements of the ADs were taken that included length, width, and thickness at five standardized points. For the entire sample, the mean length and width of left ADs were 18.09 and 9.60 mm, respectively, while right ADs averaged 18.63 mm in length and 9.93 mm in width. Significant differences were found between male and female ADs on the right and left sides (p < 0.05). After the data were further analyzed and casts fabricated, a medical illustrator created novel anatomical illustrations to clarify structures that form the TFCC and help illuminate its complex anatomy. Our study provides valuable morphometric data of the AD and detailed novel medical illustrations of the entire TFCC, enhancing our understanding of its morphology for both educational and clinical applications.

The hallmark of evidence-based anatomy (EBA) is the anatomical meta-analysis (AMA). The Critical Appraisal Tool for Anatomical Meta-Analysis (CATAM) was recently published to enable users to appraise AMAs quickly and effectively. The tool is valuable for students and clinicians who need to judge the quality of AMAs, which informs clinical decision making and results in better patient care. Subjective measures of the tool's face and content validity have been established, but establishing its reliability provides a more objective measure of the instrument's dependability. This study investigated the interrater reliability (IRR) of the CATAM between novice and expert raters. Three graduate students and three professors (two anatomists and one pharmacist) read the original CATAM paper, and then had a post hoc meeting to discuss scoring with the tool. Three recent AMAs (published between 2017 and 2022) were randomly chosen from PubMed, and all six raters scored the papers blindly. The intraclass correlation coefficient (ICC) statistic was used to calculate the interrater reliability (IRR) between all scores, and then the ICCs between novice and expert scores were compared. Cronbach's alpha (internal consistency) of the CATAM was also calculated (SPSS 25, Armonk, NY). ICC for AMA-1 was 0.999 (95% CI, 0.997-0.999), p = 0.000, and alpha was 0.999. ICC for AMA-2 was 0.994 (95% CI, 0.988-0.998), p = 0.000, and alpha was 0.994. ICC for AMA-3 was 0.998 (95% CI, 0.995-0.999), p = 0.000, and alpha was 0.998. ANOVA showed no significant differences (p > 0.05) in mean ICCs between raters. The CATAM is a robust tool with excellent IRR (ICC > 0.990) and internal consistency (alpha > 0.990). No significant difference in ICC scores between novices and experts suggests the tool does not require prior expert knowledge to be effective. Now that the reliability of the CATAM is established, it can be more widely adopted by students and physicians worldwide to evaluate the quality of AMAs. The CATAM offers widespread applicability, and can be adopted in medical education, journal clubs, and clinical seminars to critically evaluate AMAs.

In the third year of pre-clinical medicine (known as Part II of the Natural Sciences Tripos at the University of Cambridge), students have the opportunity to lead a primary research project on clinically relevant anatomy, often involving donor dissection. This descriptive study used a cross-sectional survey to explore the effects of undertaking an anatomical research project on students' attitudes, interests, and a variety of academic and professional skills. Of 45 students who were invited to participate in this study, 40 responded. Of these, 30 students (75%) had performed cadaveric dissection. Projects increased students' interests in academic careers (36% or 90% agreed/strongly agreed) and scientific inquiry, with 30 students (75%) undertaking subsequent research. Many students (30/40; 75%) strongly agreed their projects highlighted the importance of considering the scientific literature when providing patient care. Most (39/40; 97.5%) felt that there was scope for further anatomical research to appreciate and explore anatomical variation. Many students (32/40; 80%) strongly agreed that projects improved their self-directed learning skills. Inductive thematic analysis of free-text answers identified themes of improved academic, practical, and professional skills such as negotiation, responding to questions, presenting at conferences, and liaising with experts and non-experts. These results suggest that anatomical primary research through this program effectively fosters academic aptitude and interest, as well as the practical and professional skills necessary to thrive in academia and clinical medicine. Aspirations for a surgical career were strengthened and valuable anatomical context was provided.

Shoulder pain often involves the tendon of the long head of the biceps brachii (LHBT) and the transverse humeral ligament (THL). Traditionally, the THL is considered a ligament that prevents the LHBT from dislocating, but recent studies suggest that it may be part of the subscapularis tendon. This review evaluates the nature of the THL and its overlying structures. We reviewed the literature from PubMed and Scopus through April 2024 and selected seven studies. Four described the THL as a ligament, and three did not. THL measurements ranged from 14 to 21 mm in length and 14 to 17 mm in width. Histology was inconsistent, with some studies suggesting it is more tendon-like. Clinically, LHBT injuries are associated with rotator cuff injuries. Biomechanical studies, such as those by Kwon et al. (2009), associate the LHBT with subscapularis tendon tears. Accurate diagnosis and treatment of shoulder pain should consider these anatomical variations. The structure covering LHBT in the intertubercular sulcus is most likely the subscapularis tendon, rather than a ligament. Understanding these variations is critical to improving the management of shoulder pain.

Bunny lines are vertical and diagonal wrinkles attributed to contractions of the nasalis muscle. Common management involves botulinum toxin (BoNT) injections into wrinkles immediately below the nasal bridge. Here, we investigated the anatomical structures underneath bunny lines and their relationships with adjacent muscular structures. The area between the medial canthus and nasal dorsum was examined by ultrasonography in 13 adult volunteers (mean age, 29.4 years) and dissected in 39 cadavers. The findings consistently showed a non-muscular area (bunny triangle) between the borders of the procerus, nasalis, orbicularis oculi (OOc), and levator labii superioris alaeque nasi (LLSAN) muscles. The size and shape of the bunny triangle vary according to the width of the procerus and nasalis muscles. The muscles neighboring the bunny lines affect the thinning of the thin skin between the medial canthus and nasal dorsum. Our results indicate that conventional BoNT injection into bunny line wrinkles is likely to target connective tissue rather than a muscle, potentially producing suboptimal results. Therefore, the BoNT injection points probably need to target the borders of the procerus, nasalis, OOc, and LLSAN muscles to be most efficient.

Pathology found during cadaveric dissection has been used to model integrative teaching methods for medical students at several institutions. Recent evidence has shown that pathology found during dissection can be used in the design of self-directed learning (SDL) activities with standards that are difficult to meet. This study presents a novel method for providing formative feedback, one of the most challenging aspects for LCME accreditation of SDL activities. Three practitioners (two board certified pathologists and one board certified family physician) reviewed and rated pathological findings during routine dissection by first year medical students in the gross anatomy laboratory in New Orleans, Louisiana. The students also rated the findings, and a comparative score was given that provided quick, individualized formative feedback with no additional faculty time burden. The inter-rater reliability (IRR) among the clinical expert panel (n = 3) was adequate (IRR = 0.85). The students' percentage agreement with the expert panel was just under 57%. There was no significant correlation between the score on the Gift formative feedback instrument (FFI) and the students' performances in their gross anatomy course (p > 0.05). This study describes a FFI that allows for the variety of clinical presentations in cadavers dissected in the gross anatomy laboratory, while protecting faculty time that would otherwise be used for scoring individuals in large cohorts of medical students. This instrument can be used to integrate pathology and gross anatomy and provide a practical way of implementing self-directed learning.