Arora J

Unilateral intercordal neural communication coexistent with variant branching pattern of posterior cord of brachial plexus.

Variant branching pattern of the cords of brachial plexus coupled with erroneous communications has been an area of concern for surgeons opting to explore this region. Anaesthetic blocks and surgical approaches are the highlights of these interventions, where a keen familiarization of the anatomy of this region is mandatory. The present case description reports a unilateral variant branching pattern of the posterior cord coexistent with a neural communication between lateral and medial cords in an adult male cadaver. This intercordal neural communication between lateral and medial cords was oriented obliquely and measured 2.2 cm in length. Furthermore, the posterior cord revealed a variant branching pattern. It branched into three upper subscapular nerves and a common trunk for the thoracodorsal and lower subscapular nerves. The lowest of the three upper subscapular nerves gave a communicating twig to the thoracodorsal nerve. Inspite of uncountable reports on variations ofbrachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anesthetists and surgeons, besides being of academic interest for the anatomists.

Unilateral Double Axillary and Double Brachial Arteries: Embryological Basis and Clinical Implications

Este reporte describe la presencia de las arterias axilar y braquial duplicadas en el lado derecho de un cadaver adulto de sexo masculino. La arteria axilar derecha se bifurco en arterias axilares I y II, localizadas posteriormente al musculo pectoral menor. Ambas arterias, con sus respectivas ramas atravesaron bajo el musculo redondo mayor y continuaron como arterias braquiales I y II, respectivamente. La arteria axilar I, que se continuo como arteria braquial I, tuvo un trayecto superficial y tortuoso, mientras que la arteria axilar II fue de poco calibre y de localizacion profunda. Las arterias toracoacromial, toracica lateral y subescapular se originaron de la arteria axilar I. La arteria toracica superior se origino de la arteria toracoacromial. Las arterias circunflejas humerales anterior y posterior se originaron desde la arteria axilar II. La arteria braquial profundase origino de la arteria braquial II, mientras que a nivel de la linea intercondilea, la arteria ulnar se origino de la arteria braquial I. En la fosa cubital, la arteria braquial I se dividio en arterias radial e interosea comun, mientras que la arteria braquial II termino anastomosandose con la arteria braquial I. Las arterias ulnar, radial e interoseas comun continuaron como arterias independientes y tuvieron un trayecto y distribucion normales en el antebrazo. La persistencia de arterias axilar y braquial dobles tiene una base embriologica, pudiendo ser de interes para la embriologia experimental. El conocimiento de estas variaciones arteriales multiples, como el presente caso, es de importancia fundamental durante la medicion de flujo en los vasos sanguineos a traves de Doppler, para el diagnostico clinico y manejo quirurgico de enfermedades que afectan al miembro superior

A rare bimuscular conglomeration gluteopiriformis case report.

The present paper reports a rare anomalous muscle in the gluteal region, which appears to be a conglomeration of gluteus maximus and piriformis muscles. The muscle was proximally attached to the gluteus maximus and distally merged with the piriformis muscle. The innervation of the anomalous muscle was derived from the inferior gluteal nerve. Recognition of such a muscle variant may facilitate early clinical diagnosis and treatment of patients with symptoms of piriformis syndrome or sciatica of unexplained etiology. Contraction of such an anomalous muscle could lead to altered biomechanics of the piriformis and the gluteus maximus. Such a rare muscle, which morphologically resembles the piriformis and developmentally appears to be a part of gluteus maximus could be a challenging puzzle for the present day surgeon and radiologist.

Unusual Topography of Posterior Antebrachial Musculature in the First Osseofibrous Compartment of Wrist: Clinicomorphological Appraisal

Las variaciones anatomicas de los musculos abductor largo del pulgar y extensor corto del pulgar son importantes en la evaluacion clinica de la mano enferma y traumatizada. El presente caso informa una inusual fusion de los vientres musculares de los Mm. abductor largo del pulgar y extensor corto del pulgar con dos tendones de insercion separados, el tendon medial se inserto en la base del primer metacarpiano y el tendon lateral en el musculo abductor corto del pulgar. El conocimiento de estas variaciones anatomicas es de importancia en el manejo de la enfermedad de De Quervain y cirugia reconstructiva de la mano.

Pronator teres accessorius: A new variant in flexor antebrachial musculature

Muscles of flexor compartment of forearm have a common origin from medial epicondyle of humerus. Additional bellies of flexor muscles are commonly reported but presence of supernumerary muscles is an infrequent phenomenon. The present study describes an unusual muscle mass in flexor compartment of forearm simulating pronator teres. During routine dissection the upper limb of a 50 years old male cadaver, a supernumerary muscle was found on left side of the upper limb in the flexor compartment. The origin of the muscle was 2cm wide and aponeurotic in nature and attached to an oblique line extending from the inferior surface of the medial epicondyle and the medial surface of the trochlea. It was inserted on an oblique line 2.5cm wide on the radius in area between supinator superiorly and flexor digitorum profundus inferiorly. Existence of accessory muscles, which connect flexor muscles, could be explained embryologically by incomplete cleavage of flexor mass during development. The flexor muscles of the forearm develop from the flexor mass which subsequently divides into two layers: superficial and deep. The deep layer gives rise to flexor digitorum superficialis, flexor digitorum profundus and flexor pollicis longus. These supernumerary muscles are extremely rare entities and probably represent deranged embryological development or the process of atavism in which the anomalous part persist for a longer time in the tree of evolution.

Unusual branching pattern of brachial artery - Embryological basis and clinicoanatomical insight.

Variations in the arterial pattern of upper limb are of colossal importance to the surgeons as they are liable to iatrogenic injuries. During routine dissection for undergraduate medical students, an anomaly of brachial artery was discovered. The brachial artery terminated at higher level into ulnar and radial artery. The common interosseus artery took origin arising from radial artery. The ulnar artery did not give any branches in the forearm. Both radial and ulnar artery displayed a superficial course in the forearm. The anatomical knowledge of these variations may be of great help for the clinicians in planning and conducting flap harvesting during reconstructive surgeries and in arteriography.

Adductor accessorius - an unusual supernumerary adductor muscle of thigh.

The knowledge of variant anatomy of medial compartment of thigh is extremely important in surgical procedures requiring obturator nerve block. The nerve block is also recommended for providing additional analgesia following major knee surgeries and for relieving painful adductor muscle spasm. The interfascial injection technique is commonly followed in ultrasound guided obturator nerve block. For this procedure it is imperative to identify the adductor muscles on sonography to inject the anesthetic solution in the intermuscular fascial planes. The presence of an additional muscle can prove useful in myocutaneous flap surgeries for reconstruction especially of perineum. We hereby report a case of such an anomalous supernumerary adductor muscle present between adductor brevis and proximal part of adductor magnus, in an adult Indian male cadaver, recorded during routine dissection in Department of Anatomy, Vardhman Mahavir Medical College and Safdarjung Hospital. The muscle was innervated by the posterior division of obturator nerve. The morphology, embryological basis and clinical aspects are also discussed.

Rare atypical vascular pattern of subscapular artery: Anatomico-clinical insight.

BACKGROUND AND OBJECTIVE The use of muscles of scapular region in transposition and reparative surgery has made the anatomical knowledge of axillary artery and its branches imperative. The subscapular arterial tree is frequently used as a source of microvascular grafts to replace damaged or diseased portion of arteries especially in upper and lower limbs. This investigation is aimed to study the variation in branching pattern of the third part of axillary artery. MATERIALS AND METHODS Routine educational cadaveric dissection of a young adult Indian male cadaver. RESULTS The present article highlights a rare variation of the subscapular artery and its branches. The subscapular artery displayed a unique pattern of trifurcation. Its branches were seen supplying serratus anterior, subscapularis, latissimus dorsi and teres major muscles. CONCLUSIONS The study focuses on a new variation of the subscapular artery which could prove useful for interventional radiologists and surgeons in reconstructive surgeries.

Multifaceted profile of an unusual paramedian occipital condyle-anatomical and computerised tomographic evaluation.

During extensive osteological study of 150 dry skulls in the Department of Anatomy, Vardhman Mahavir Medical college, an unusual Paramedian Occipital (POC) condyle was detected in the occipital bone of a cadaveric skull. The anatomical details of this unusual occipital condyle were carefully studied and its morphometric measurements taken. A coronal multiplanner reformatted image and a volume rendered image were taken to study radiological details and establish significant clinical correlation. Precise understanding of anatomy of craniovertebral junction and its anomalies have become immensely important for the present day surgeon during orthopaedic and neurosurgical procedures of this region . Technical advancements in imaging modalities such as CT and MRI scans further signify the importance of these anatomical variations ,which are often missed in routine examination. Osteological study combined with radiological details of the paramedian occipital condyle in the present case aims to emphasize the importance of bony anomalies in the craniovertebral region and their role in diagnosis and appropriate treatment of neurovascular compression syndromes of craniovertebral junction. The present study highlights anatomical details, clinical relevance and embryological basis of such a rare unusual paramedian occipital condyle.

Unusual architecture of extensor digitorum muscle of hand in conjunction with accessory belly of extensor carpi radialis brevis: a clinico-anatomical insight.

The present article highlights an unusual combination of variations of the extensor digitorum and extensor carpi radialis brevis muscles in the dorsum of forearm and hand. The extensor carpi radialis brevis exhibited an accessory musculotendinous belly which inserted into the dorsal digital expansion of index finger. The extensor digitorum showed trifurcation into three distinct parts. Resultant multiple extensor tendon insertion pattern is reported upon highlighting the embryological basis and clinical importance. Knowledge of such anatomical variations adds upon the already existing information in literature and is also of profound interest to the clinician. Anatomical awareness of accessory multiple extensor tendons in the dorsum of hand is essential for successful management of extensor tendon injuries and graft transfer operations.