Structural Anatomy
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21669
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Browsing Structural Anatomy by Author "Liu, Howe"
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Item Surface projection of the posterior interosseous nerve and artery as they exit the supinator and interosseous foramen respectively : A cadaver study(2018-03-14) Hart, Keaton; Mincy, Missy; Liu, Howe; Arguello, Eric; Tran, HuyPurpose: The purpose of this study was to develop a method for locating surface projections of the posterior interosseous nerve (PIN) and posterior interosseous artery (PIA) as they exit the supinator muscle and interosseous foramen respectively. Methods: Distances from the vertical and transverse planes through the lateral epicondyle of the humerus to the exit point of the PIN through the supinator and the PIA through the interosseous foramen were measured on 10 upper extremities from 5 cadavers. Average distances were used to find coefficients in terms of the thumb interphalangeal joint widths. Results: The mean transverse plane distance from the lateral epicondyle to the exit points of the PIN and PIA were 79.38 mm (~4.0 IPJ widths) and 90.62 mm (~4.5 IPJ widths) respectively. The mean vertical plane distance from the radius to the exit points of the PIN and PIA were 9.45 mm (~0.5 IPJ widths) and 10.86 mm (~0.5 IPJ widths) respectively. Conclusions: The results of this study present a method to assist clinicians in avoidance of iatrogenic outcomes with the application of various treatments such as dry needling and acupuncture.Item Variation of Median Nerve Pathway Around the Elbow Joint(2018-03-14) Reyes, Aubrie; Francis, Alex; Liu, Howe; Wohleb, EvanIntroduction The median nerve is one of the large terminal branches originating from the brachial plexus. It provides the motor innervations to both the forearm and palmar hand, as well as most of the sensory innervation for the palmar hand. On the way to its targeted areas, the median nerve pathway from the upper arm to the hand may pass through some muscles and other accessory structures that may not be considered normal, particularly around the elbow area. The purpose of this study was to trace and observe how this nerve travels in terms of the relationship with surrounding structures proximally and distally to the elbow. Methods Twelve upper extremities from six cadavers (3 males and 3 females) were dissected to trace and observe how the median nerve travels in these specimens. The focused area was from the middle upper arm to the proximal 1/3 of the forearm. Results All twelve identified median nerves passed between the biceps brachii and brachialis muscles. In ten out of the twelve specimens, about two to three fingers width proximal to the elbow joint line between the medial and lateral epicondyles of the humerus, it was found that the median nerve surfaced from the inferomedial edge of the biceps muscle and continued traveling down under a tight bicep aponeurosis and then pierced into the pronator teres muscle - common impingement areas for the median nerve. After we reflected the biceps muscle laterally from the remaining two of the twelve left forearms to expose the median nerve, it was observed that the nerve pierced through the brachialis muscle at its superior border (three to four fingers width proximal to the joint line), which was a very interesting finding. The nerve exited from the inferior border of the muscle, continued to pass down for one to two fingers width, and pierced the pronator teres as did the other ten median nerves. Conclusion Observing two of twelve specimens, the median nerve showed a different pathway around the elbow joint, which is abnormal from others’. Namely, the nerve pierces through the brachialis muscle before descending and passing through the pronator teres muscle. Clinical Implication Such a variation of the median nerve pathway has not been reported before. This finding may offer clinicians an additional explanation of the median nerve impingement-related clinical symptoms that are very similar to the pronator teres syndrome.