Contribution to the anatomical nomenclature concerning upper limb anatomy

Towards a Terminologia Anatomica Humana

Unfortunately, the long-awaited revision of the official anatomical nomenclature, the Terminologia Anatomica 2 (TA2), which was issued in 2019 and after a referendum among the Member Societies officially approved by the General Assembly of the International Federation of Associations of Anatomists in 2020, is built on a new version of the Regular Anatomical Terminology (RAT) rules. This breaks with many traditional views of terminology. These changes in the Terminologia Anatomica of 1998 (TA98) met great resistance within many European Anatomical Societies and their members are not willing to use terms following the RAT rules. European anatomy teachers and scientists using traditional Latin in their teaching, textbooks and atlases will keep using the TA98. The German Anatomical Society (Anatomische Gesellschaft) recently announced the usage of the TA2023AG in curricular anatomical media such as textbooks and atlases, based on the TA98 and the Terminologia Neuroanatomica (TNA). We are preparing a more extensive improvement of the TA98, called Terminologia Anatomica Humana (TAH). This project is fully based on the noncontroversial terms of TA98, incorporating the recent digital version (2022) of the TNA from 2017. Further, it is completed with many new terms, including those in TA2, along with their definitions and relevant references, clinical terms, and correcting inconsistencies in the TA98. The TAH is still in process, but many chapters are already freely available at the IFAA Website in Fribourg ( https://ifaa.unifr.ch ) as is the digital version of the TNA.

Axillary arch (of Langer): A large-scale dissection and simulation study based on unembalmed cadavers of body donors

Connective or muscular tissue crossing the axilla is named axillary arch (of Langer). It is known to complicate axillary surgery and to compress nerves and vessels transiting from the axilla to the arm. Our study aims at systematically researching the frequency, insertions, tissue composition and dimension of axillary arches in a large cohort of individuals with regard to gender and bilaterality. In addition, it aims at evaluating the ability of axillary arches to cause compression of the axillary neurovascular bundle. Four hundred axillae from 200 unembalmed and previously unharmed cadavers were investigated by careful anatomical dissection. Identified axillary arches were examined for tissue composition and insertion. Length, width and thickness were measured. The relation of the axillary arch and the neurovascular axillary bundle was recorded after passive arm movements. Twenty-seven axillae of 18 cadavers featured axillary arches. Macroscopically, 15 solely comprised muscular tissue, six connective tissue and six both. Their average length was 79.56 mm, width 7.44 mm and thickness 2.30 mm. One to three distinct insertions were observed. After passive abduction and external rotation of the arm, 17 arches (63%) touched the neurovascular axillary bundle. According to our results, 9% of the Central European population feature an axillary arch. Approximately 50% of it bilaterally. A total of 40.74% of the arches have a thickness of 3 mm or more and 63% bear the potential of touching or compressing the neuromuscular axillary bundle upon arm movement.

Exploring the uncharted: Missing anatomical names in the Terminologia Anatomica

Effective communication and precise navigation within the intricacies of the human body rely on robust anatomical terminology. Since its creation by the Federative Committee on Anatomical Terminology (FCAT), the Terminologia Anatomica (TA 1998) has consistently served as the benchmark in the field. However, the constant advancement of anatomical knowledge requires regular revisions, updates, and enhancements of anatomical nomenclature to accommodate the latest scientific discoveries. The recent adoption of the second edition of Terminologia Anatomica (TA 2019) by the International Federation of Associations of Anatomists (IFAA) has drawn attention to certain notable omissions. Despite over a century of dedicated work establishing standard anatomical terminology, specific widely recognized gross anatomical structures are still absent from the official listing in the Terminologia Anatomica. There is, however, a consensus that the inclusion of names for trivial or variably present structures should be avoided. Accordingly, this article focuses on a thoughtfully selected group of anatomical structures, which are so important that they are routinely discussed during anatomy courses, despite their exclusion from the official lists of anatomical terms. These basic structures hold fundamental importance for both anatomy education and clinical practice. Consequently, their appropriate nomenclature warrants consideration for inclusion in future editions of TA.

Clinical anatomy of the paranasal sinuses and its terminology

Since its inception, the International Anatomical Terminology has been an indispensable and widely embraced resource for authors, anatomists, researchers, and medical professionals, ensuring standardized anatomical terminology across various disciplines. Nonetheless, it is widely acknowledged that periodic updates and enhancements are necessary to incorporate the latest scientific knowledge and advancements in imaging techniques. The current version of Terminologia Anatomica includes a section dedicated to the paranasal sinuses, encompassing ethmoidal cells and three sinuses: frontal, sphenoidal, and maxillary. However, the anatomical lexicon pertaining to the paranasal sinuses is more extensive. In clinical practice, multiple terms related to clinically significant structures are commonly employed. This article focuses on the clinical terminology associated with the paranasal sinuses, proposing significant extensions to the existing Terminologia Anatomica. These extensions aim to enrich the anatomical nomenclature and facilitate a harmonious convergence between the language of clinicians and the anatomical lexicon. Further endeavors should bridge the gap in anatomical nomenclature and improve communication between anatomists, researchers, and clinicians, thereby enhancing diagnostic accuracy and improving interdisciplinary research collaboration.

The communication patterns between the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve

INTRODUCTION

The superficial branch of the radial nerve (SBRN) and the lateral antebrachial cutaneous nerve (LACN) are sensory nerves coursing within the forearm in a close relationship. This high degree of overlap and eventual communication between the nerves is of great surgical importance. The aim of our study is to identify the communication pattern and overlap of the nerves, to localize the position of this communication in relation to a bony landmark, and to specify the most common communication patterns.

MATERIALS

and methods: One hundred and two adult formalin-fixed cadaveric forearms from 51 cadavers of Central European origin were meticulously dissected. The SBRN, as well as the LACN, were identified. The morphometric parameters concerning these nerves, as well as their branches and connections, were measured with a digital caliper.

RESULTS

We have described the primary (PCB) and secondary communications (SCB) between the SBRN and the LACN and their overlap patterns. One hundred and nine PCBs were found in 75 (73.53%) forearms of 44 (86.27%) cadavers and fourteen SCBs in eleven hands (10.78%) of eight cadavers (15.69%). Anatomical and surgical classifications were created. Anatomically, the PCBs were classified in three different ways concerning: (1) the role of the branch of the SBRN within the connection; (2) the position of the communicating branch to the SBRN; and (3) the position of the LACN branch involved in the communication to the cephalic vein (CV). The mean length and width of the PCBs were 17.12mm (ranged from 2.33-82.96mm) and 0.73mm (ranged from 0.14-2.01mm), respectively. The PCB was located proximally to the styloid process of the radius at an average distance of 29.91mm (ranged from 4.15-97.61mm). Surgical classification is based on the localization of the PCBs to a triangular zone of the SBRN branching. The most frequent branch of the SBRN involved in the communication was the third (66.97%). Due to the frequency and position of the PCB with the third branch of the SBRN, the danger zone was predicted. According to the overlap between the SBRN and the LACN, we have divided 102 forearms into four types: (1) no overlap; (2) present overlap; (3) pseudo-overlap; and (4) both present and pseudo-overlap. Type 4 was the most common.

CONCLUSION

The patterns of communicating branch arrangements appeared to be not just a rare phenomenon or variation, but rather a common situation highlighting clinical importance. Due to the close relationship and connection of these nerves, there is a high probability of simultaneous lesion.

Prevalence and anatomy of the anomalous subclavius posticus muscle and its clinical implications with emphasis in neurogenic thoracic outlet syndrome: Scoping review and meta-analysis

BACKGROUND

The subclavius muscle runs underneath the clavicle. However, there have been a few reports of a duplicated subclavius muscle which is commonly referred to as subclavius posticus muscle due to its orientation being posterior to the proper subclavius muscle. Its occurrence seems to potentially create a narrowing interval at the superior thoracic aperture as it crosses over the brachial plexus. It might also have functional influence on the shoulder girdle.

PURPOSE

To provide comprehensive gross anatomy description of the variant "subclavius posticus muscle" and to investigate its reported clinical implications with emphasis on its involvement in causing brachial plexus compression.

BASIC PROCEDURES

A scoping review with meta-analysis of the gross anatomy of the subclavius posticus muscle was conducted along with investigating its correlation to the thoracic outlet syndrome. Forty-seven articles were pooled through two rounds of the selection process. The relevant information was extracted and meta-analyzed.

MAIN FINDINGS

The scoping review and meta-analysis of the 47 articles revealed a total prevalence of 11/2069 (4.9%); 10/1369 (5.1%) in cadaveric studies, and 1/700 (5.0%) in MRI studies. The subclavius posticus muscle is a short triangular muscle with an average length of 12 cm and an average width of 1 cm. It originates from the sternal end of the first rib in most cases with reported variants of one case originating from the costoclavicular ligament and one case where it was fused with the proper subclavius muscle. Its insertion is more variable: on the superior border of the scapula with variable length in 71.35%, on the coracoid process of the scapula in 25.42%, and on the clavicle in 0.90%. The subclavian nerve seems to be the dominant nerve supply with a 57.6% prevalence, while 25.8% are innervated by the suprascapular nerve. Other reported nerves were the nerve to the myolohyoid (4.5%), accessory phrenic nerve (4.5%), and a direct branch from the brachial plexus (2.0%). The blood supply was reported (only once) to be from the suprascapular artery. However, the venous drainage was not established at all.

PRINCIPAL CONCLUSIONS

The subclavius posticus muscle is a variant muscle occurring with a reported overall prevalence of 4.9%. It can compress the brachial plexus as it runs across at the space of the superior thoracic aperture with exquisite contact, and this can lead to a neurogenic thoracic outlet syndrome. It also can be involved in the vascular thoracic outlet syndrome. Lastly, it is important not to omit its potential influence in shoulder joint instability to some extent.

An accessory muscle belly or an accessory muscle head? An unusual arrangement of muscles in the anterior compartment of the forearm

PURPOSE

Knowledge of the unusual arrangement of the flexor pollicis longus (FPL) muscle is important as the variable tendon may be a rare cause of carpal tunnel syndrome.

METHODS

During a routine dissection at the Department of Anatomy, an unusual formation of the FPL muscle was observed in a formalin embalmed Central European cadaver.

RESULTS

This report presents a variation of the FPL muscle, where the muscle split and formed a separate accessory head inserting into the first lumbrical muscle. Moreover, a tendinous interconnection was present between the FPL muscle tendon and the tendon of the aberrant muscle head.

CONCLUSION

The cases described by previous literature, concerning the Linburg-Comstock variation or the accessory head of the first lumbrical muscle originating from the FPL muscle, are closest to the present case. Such variation has a clinical significance ranging from the functional limitation of the thumb and index finger movement to the potential median nerve compression.

VARIATIONS OF THE STRUCTURE, TOPOGRAPHY, BLOOD SUPPLY AND INNERVATION OF THE BRACHIORADIALIS IN HUMAN FETUS

OBJECTIVE

The aim of the research was to establish the features of age-related and individual anatomical variability of the brachioradialis, its blood supply, and innervation options.

PATIENTS AND METHODS

Materials and methods: The study of the variant anatomy of the brachioradialis and its vascular and nervous structures was carried out on 25 preparations of human fetuses of 4-7 months, 81.0-270.0 mm parietal-coccygeal length (PCL) using macromicroscopic preparation, injection vessels, and morphometry.

RESULTS

Results: Spindle-like (56%) and round (24%) shapes of the brachioradialis were found in most of the studied fetuses; its elongated flat (12%) and triangular (8%) forms occur less often. In a fetus of 185.0 mm TKD, the right brachioradialis consisted of two separate parts: upper and lower, which were connected at the level of the middle of the forearm into a common short muscle belly. In another human fetus of 220.0 mm TKD, the right brachioradialis also consisted of two separate parts - upper and lower, triangular in shape, but separated by a pronounced horizontal gap.

CONCLUSION

Conclusions: The features of the fetal anatomy of the brachioradialis are established: its variability and bilateral asymmetry of shape and size, variability of the places of origin and attachment, etc. In individual human fetuses, the brachioradialis consists of two separate parts that have special topographical relationships. The area of the greatest concentration of both extra- and intramuscular nerves and arteries is the upper and middle third of the brachioradialis. In the area of the forearm, the course of radial vascular-nerve formations is determined by the brachioradialis.

Scapula revisited: new features identified and denoted by terms using consensus method of Delphi and taxonomy panel to be implemented in radiologic and surgical practice

BACKGROUND

The scapular structures that have not yet been assigned anatomic terms generate a challenge in clinical diagnostics and surgical application, as well as in scientific observation. The aim of this study was to solve the lack in terminology concerning the scapula and the scapular region.

METHODS

Observation and description of 29 structures were carried out on both dry scapulae and radiographs of the shoulder joint. In addition, several terms commonly encountered throughout the literature concerning the scapula were revised. A degree of consensus was reached by using the Delphi method surveying the opinions of 21 invited experts in the field. Taxonomy panels and etymology of anatomic terminology were considered in the generation of the proposed terms.

RESULTS

The scapula was redefined as a lamina with projecting processes, and several landmarks demarcating certain newly defined topographic spaces were highlighted via 2 rounds of Delphi systematic voting and discussion. The overall level of the peer nominees' consensus was high. Few terms received a neutral opinion.

CONCLUSIONS

This study communicates a proposal of 16 new terms defining grossly visible structures on the scapula that have not yet been described by officially recognized terms, including a call to unify 13 previously contributed terms that have not been codified and are often used interchangeably within different surgical and scientific fields. Incorporating these terms into the anatomic nomenclature would facilitate communication accuracy and eliminate ambiguity among clinicians, surgeons, and anatomists.

Three-Dimensional Comparative Study of Human Bipartite Scaphoids and the Os Centrale of the Wrist in Neandertals and Non-Human Anthropoid Primates

In humans, bipartite scaphoid still does not differentiate clearly from traumatic non-union of the scaphoid. To aid diagnosis, we sought to analyze the main geometrical similarities among bipartite scaphoids from primate species with fused and unfused scaphoid centrales. Four human embryos, four cases of adult humans with bipartite scaphoid, twelve adult specimens of other extant anthropoid primates, and two Neandertal scaphoid specimens were included in this study. Three-dimensional polygon models of the scaphoid and os centrale were generated from CT scan, micro-CT scan, or histological sections. A 3D comparative study of the morphological and morphometrical parameters was performed using the MSC Patran software. The os centrale was smaller than the scaphoid in all specimens and its shape was elongated in the anteroposterior scaphoid direction. The position of the os centrale centroid compared to the scaphoid using direction vectors had a strong orientation along the proximodistal axis in all species. The main morphological feature of bipartite scaphoid was the continuity of the scaphoid from its proximal pole to its tubercule along the anteroposterior axis. In all specimens, if the os centrale was removed, the scaphoid still appeared normal and whole. The bipartite scaphoid in adult humans shares geometrical analogies with monkeys and orangutans, human embryos, and Neandertals. Morphological and morphometrical features identified in this study are useful to differentiate bipartite scaphoid from scaphoid pseudarthrosis. All other criteria suggested in the past lead to misdiagnosis.

Median-to-Ulnar Nerve Communication in Carpal Tunnel Syndrome: An Electrophysiological Study

The median-to-ulnar communicating branch (MUC) is an asymptomatic variant of the upper limb innervation that can lead to interpretation errors in routine nerve conduction studies. The diagnosis of carpal tunnel syndrome (CTS) or ulnar nerve lesions can be complicated by the presence of MUC. In this study, we describe electrophysiological features of MUC in CTS patients presenting to our clinic. We enrolled MUB cases from consecutive CTS patients referred to our laboratory between the years 2014 and 2019. MUC was present in 53 limbs (36 patients) from the studied population. MUC was bilateral in 53% of patients. MUC type II was the most common subtype (74%), followed by types III and I; more coexisting MUC types were found in the majority of tested limbs. A positive correlation was demonstrated between the severity of CTS and the presence of positive onset, faster CV, or a double component of the compound muscle action potentials. We emphasize the importance of suspecting the presence of MUC in CTS in the presence of a positive onset or a double component in routine motor conduction studies.

The morphological stenosis pattern of the suprascapular notch is revealed yielding higher incidence in the discrete type and elucidating the inevitability of osteoplasty in horizontally oriented stenosis

PURPOSE

To identify the morphological patterns of suprascapular notch stenosis.

METHODS

Suprascapular notch space capacity was assessed by morphometric analysis of 333 dry scapulae. Suprascapular notch parameters-superior transverse distance, middle width, depth, medial border length and lateral border length-were measured. The probable suprascapular notch stenosis was referenced by (1) comparing each obtained parameter measurement to the range of the suprascapular nerve diameter, and (2) quantifying the reduced parameters. Finally, the morphological pattern was determined based on the collective reduction of the parameters and their alignments.

RESULTS

Five types of suprascapular notch based on depth to superior transverse distance ratio were identified and assessed. Type-I showed low incidence of stenosis (6/333) and low frequency within type (6/28) with potential risk of horizontal compression. Type-II showed relatively low incidence of stenosis (9/333) and low frequency within type (9/50) with undetermined pattern. Type-III showed relatively higher incidence of stenosis (47/333) but low frequency within type (47/158) with potential risk of vertical compression. Type-IV (foramen) showed low incidence of stenosis (6/333) and relatively lower frequency within type (6/26) with potential risk of encircled compression. Finally, type-V (discrete) showed relatively high incidence of stenosis (40/333) and high frequency within type (40/71) with potential risk of vertical compression. The suprascapular notch was found to be stenosed beyond its capacity to accommodate the suprascapular nerve in 49/333. Type-V is at most risk followed by Type-III.

CONCLUSIONS

Suprascapular notch stenosis takes three morphological patterns: horizontal, vertical or mixed. An osteoplasty of suprascapular notch margins may be required beside the common surgical approach of the superior transverse scapular ligamentectomy.

A plea for extension of the anatomical nomenclature: Vessels

This article is the fourth and last part of a series aimed at extending and correcting the anatomical nomenclature. Because of the rapid development of internet and the use of electronic formats in communication in anatomy, embryology, histology, medical education, and clinical medicine, an appropriate, precise, and concise anatomical nomenclature is required. Such tool enables to avoid any potential confusion and possible scientific/medical mistakes. The up-to-date official anatomical terminology, Terminologia Anatomica, is available longer than 20 years and needs to be refined and extended. The authors have collected and listed 210 terms and completed them with definitions and/or explanations. We aimed to start a discussion about their potential incorporation into the new revised version of the Terminologia Anatomica. This article is primarily focused on the vessels of the human body (arteries, veins, and lymphatic system).

The arcade of Frohse: a systematic review and meta-analysis

PURPOSE

The structure of the proximal margin of the superficial layer of the supinator muscle is of high interest to many researches. Its tendinous appearance, called the arcade of Frohse, may be clinically important because of its close relationship to the deep branch of the radial nerve passing beneath it and is considered to be the cause of several syndromes. Given the importance of this structure, we aimed to provide a comprehensive and evidence-based review with meta-analytic techniques.

MATERIALS AND METHODS

The meta-analysis was performed in adherence to the PRISMA guidelines. Three medical databases were searched in order to identify all potentially eligible articles. Included studies were assessed for quality and the extracted morphological and morphometric data from the relevant articles was analyzed with the use of random effects meta-analysis.

RESULTS

A total of 20 studies were included into this meta-analysis. The pooled prevalence of the arcade of Frohse was calculated to be 66% within the adult population and 0% in the fetuses. Other variations regarding the arcade of Frohse were identified as very rare. Analysis of the morphometric parameters revealed the average proportions to be 23.22 mm for the length, 11.05 mm for the width and the mean thickness is 0.67 mm.

CONCLUSIONS

The arcade of Frohse is a commonly found structure in adults and thoughtful knowledge of its texture and morphology is especially useful in neurology, neurosurgery, orthopedics, trauma surgery and hand surgery, because it is considered to be the most common source of compression for the deep branch of the radial nerve.

Variant Anatomy and Its Terminology

Variant anatomy, which is an integral part of anatomical science, is related to abnormalities in the human body structure. Our understanding of variant anatomy is based on thousand years of anatomical experience. These abnormalities generally do not interfere with the function of the human body and do not typically manifest as pathological nosological units. However, under certain conditions, these abnormalities can worsen existing pathological states or even evoke new ones. Understanding variant anatomy is a basic skill not only of mere anatomists, but also of clinicians who work in fields involving both diagnostic techniques and therapeutic interventions. To gain and retain a good knowledge of the most frequent and clinically relevant anatomical variations, a simple, clear, and exactly defined nomenclature of variant structures is needed. A list of items comprising variant anatomy, which have been incorporated into the internationally accepted nomenclatures Terminologia Anatomica (1998) and Terminologia Neuroanatomica (2017), is described and analyzed. Examples of the most common anatomical variations related to terminology are mentioned, and variant anatomy as a whole and its role in understanding current anatomy are discussed.

Upper limb principal arteries variations: A cadaveric study with terminological implication

Although the variability of the upper limb arteries is a clinically important problem, the prevalence is varying across the existing studies and classification is rather complicated, not well established and sometimes even unclear for simple and direct understanding and usage. Multiple case reports appearing in the last years apply incorrect, inappropriate, and sometimes misleading terminology. We performed an anatomical cadaveric study of the variability of the arteries of the upper limb, namely, the axilla, arm, and forearm, in 423 upper limbs embalmed with classical formaldehyde method (Central European population). We proposed to apply the Equality system based on the common trunks for denomination of the axillary artery branches principal variations: Truncus subscapulocircumflexus (22.9%), truncus profundocircumflexus (13.75%), and truncus bicircumflexus (13.95%). Further, we proposed the terminology system developed by Rodríguez-Niedenführ et al. for the free upper limb principal arterial trunk variations based on the origin, location (in the arm only, or in the arm and forearm), and course (related to the forearm flexor muscles) of the involved artery: Arteria brachialis superficialis (9.5%), arteria brachioradialis superficialis (6.4%), arteria brachioulnaris superficialis (1.9%), arteria brachiomediana superficialis (0.5%), and arteria comitans nervi mediani manus (3.3%). Extensive development of the catheterization methods via the arteria radialis et ulnaris as well as surgical procedures using flaps based on perforating branches of these arteries (including arteria brachioradialis superficialis et brachioulnaris superficialis) necessitate thorough data on prevalence of the variant vessels for safe performance of these procedures to prevent any unexpected situations or to react adequately in such.

"Suprascapular canal": Anatomical and topographical description and its clinical implication in entrapment syndrome

BACKGROUND

Suprascapular nerve (SN) entrapment syndrome accounts for 1-2% of all shoulder pain. The SN travels within a space between the suprascapular notch (SSN) and the spinoglenoid notch (SGN).

PURPOSE

To report a detailed topographical study of the suprascapular canal (SSC) and ultimately sort the different types of SN entrapment by its anatomical localization within the canal.

BASIC PROCEDURES

Observational study on 30 free dissected limbs of formaldehyde-fixed cadavers. The SN and vessels were traced as they passed through the SSC and the boundaries of the SSC were observed and documented. The SSC was then exposed by reflecting away the bordering muscles. Dimensions of the SSC as well as parameters of the SSN and SGN were measured using a digital caliper. Finally, a thorough literature review was made to survey the SN entrapment occurrence by site.

MAIN FINDINGS

The SSC is situated in the spinoglenoid fossa, has an average width of 13 mm, and runs underneath the supraspinatus muscle with an average distance of 25 mm between the SSN and SGN sloping in an infero-postero-lateral direction. The first segment represents the SSC entrance site and is composed of two spaces: osteofibrous and musculofibrous. The second segment is bordered by the supraspinatus muscle fascia, lateral margin of the supraspinous fossa, glenohumeral joint capsule, and the bony surface of the scapula (spinoglenoid fossa). This represents the SSC passage site. The third segment represents the SSC exit site around the spinoacromial arch at the SGN.

PRINCIPAL CONCLUSIONS

The SSC is defined as an osteofibrous canal running between the SSN and SGN enclosed by the supraspinatus fascia. It is anatomically composed of three segments: an entrance, a passage, and an exit. The distal SN passes through the SSC via five intervals that correspond to five potential sites of anatomical nerve entrapment: at the pre-entrance site, entrance site, passage site, exit site, and post-exit site. Each of those sites was found to be associated with specific causes and forms of entrapment.

The venous perforators of the lower limb - A new terminology

Latin anatomical terminology of venous perforators (communications between superficial and deep venous systems of the lower limb) was adopted as late as 2001 as an appendix to the official nomenclature following the clinicians’ request. Terminologia Anatomica, last version of the Latin anatomical nomenclature, published in 1998, unfortunately contains no terms concerning these veins. During the 14th World Congress of the International Union of Phlebology, a consensus document was laid to expand the nomenclature of the lower limb veins, above all 36 new terms for perforators of the lower limb, both in Latin and English languages. This consensus document will be incorporated in the next version of the Terminologia Anatomica. But there are more constant and well-described ones, especially in the foot, and this article reviews in particular the current knowledge on the anatomy of the venous perforators of the whole lower limb.

A plea for an extension of the anatomical nomenclature: Organ systems

This article is the third part of a series aimed at correcting and extending the anatomical nomenclature. Communication in clinical medicine as well as in medical education is extensively composed of anatomical, histological, and embryological terms. Thus, to avoid any confusion, it is essential to have a concise, exact, perfect and correct anatomical nomenclature. The Terminologia Anatomica (TA) was published 20 years ago and during this period several revisions have been made. Nevertheless, some important anatomical structures are still not included in the nomenclature. Here we list a collection of 156 defined and explained technical terms related to the anatomical structures of the human body focusing on the digestive, respiratory, urinary and genital systems. These terms are set for discussion to be added into the new version of the TA.

The Terminologia Histologica after 10years: Inconsistencies, mistakes, and new proposals

This article details our experience with the Terminologia Histologica (TH) and its utility in the teaching of histology, cytology, and clinical medicine (e.g., pathology and hematology). Latin histological nomenclature has been used for 43years, and the latest version of the TH has been in use for 15years (although it was only issued publicly within the past 10years). The following findings and ensuing proposals allow us to discuss key points pertaining to the TH and make important suggestions for potential changes to the TH (such as the exclusion and inclusion of various terms). We classify these changes into six groups: 1.) mistakes in the TH, 2.) discrepancies among various Terminologiae, 3.) discrepancies within the TH, 4.) the repetition of terms, 5.) synonyms in the TH, and 6.) missing terms in the TH. Surprisingly, unlike the anatomical nomenclature, the histological nomenclature has been neglected in the literature. This article addresses this problem by reviewing and summarizing the state of this field, pointing out key discrepancies, offering solutions, and highlighting topics for further discussion.

A plea for an extension of the anatomical nomenclature: The locomotor system

Anatomical nomenclature is the main tool of communication in morphology, anatomy and other medical disciplines as well as in medical education, and thus needs to be exact, flawless, elaborate and correct. The Terminologia Anatomica (TA) is a thorough and extensive list of anatomical terms and their definitions, and the current standard for human anatomical terminology. Although several revisions to the TA have been made in the last 20 years, some important anatomical structures are still not included. This article is aimed at correcting and extending the anatomical nomenclature described in the TA. We gathered and presented a list of anatomical terms, with their definitions and explanations, to provoke a discussion about correcting and extending the TA. Our list comprises of 96 terms related to the locomotor system of the human body, i.e., the bones, joints, muscles and related structures.