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Mann MR, Plutecki D, Janda P, Pękala J, Malinowski K, Walocha J, Ghosh SK, Balawender K, Pękala P. The subscapularis muscle: A meta-analysis of its variations, prevalence, and anatomy. Clin Anat 2023; 36:527-541. [PMID: 36597929 DOI: 10.1002/ca.24008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The subscapularis (SSC) is the largest rotator cuff muscle and is involved in the medial rotation, abduction, adduction, and anterior stabilization of the shoulder. It is anatomically variable, as is the morphology and prevalence of the accessory SSC (aSSC), a rare muscle slip attached to the SSC. There is no current review investigating the prevalence and morphometrics of the SSC and aSSC. PURPOSE To investigate the prevalence of the morphological variants of the SSC and aSSC via meta-analysis and review the relevant literature involving cadaveric, magnetic resonance imaging, and ultrasonographic studies. STUDY DESIGN Meta-analysis. MATERIALS AND METHODS Literature data reporting the prevalence rates and morphometrics of the SSC and aSSC and their variants were pooled. Literature searches and data analyses were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Anatomical Quality Assurance guidelines. RESULTS Forty-six studies, totaling 2166 shoulders, were assessed. The SSC showed an overall length, thickness, cross-sectional area, and volume of 152.2 mm (95% confidence interval, CI, 103.8-200.5 mm), 5.6 mm (95% CI, 4.6-6.6 mm), 18.1 cm2 (95% CI, 14.2-22.0 cm2 ), and 126.9 cm3 (95% CI, 87.2-166.5 cm3 ), respectively. The SSC displayed substantial variations in its origin and insertion points and in the composition of its tendon. The aSSC had an overall pooled prevalence of 24.6% (95% CI, 0.0%-76.9%). CONCLUSIONS The SSC and aSSC have been implicated in multiple shoulder pathologies, including muscle and tendon ruptures and neurovascular compromise. A better understanding of SSC and aSSC variants when diagnosing and treating their related pathologies will reduce patient morbidity and improve treatment regimens.
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Affiliation(s)
- Mitchell R Mann
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Dawid Plutecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Patryk Janda
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Konrad Malinowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Sanjib Kumar Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Krzysztof Balawender
- Department of Morphological Sciences, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Koptas K, Zielinska N, Tubbs RS, Olewnik Ł. An unreported infraspinatus muscle variation-two-headed infraspinatus minor muscle and three-headed fusion with the teres minor muscle. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1305-1308. [PMID: 35962136 PMCID: PMC9492577 DOI: 10.1007/s00276-022-02999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
The infraspinatus muscle is situated under the scapular spine in the infraspinous fossa and inserts into the greater tuberosity of the humerus. It is a component of a crucial shoulder muscle group, the rotator cuff. There are a few interesting additional muscles in the infraspinal region. In the literature they are called the infraspinatus superficialis, infraspinatus minor and infraspinatus accessory muscles. The infraspinatus minor muscle is described as a superficial muscle bundle running under the scapular spine. During routine anatomical dissection, an unreported variation of the infraspinatus minor muscle was found. It derived from the inferior surface of the scapular spine and the infraspinous fossa. It had two heads. The superior head inserted on the greater tuberosity of the humerus. The inferior head inserted on the tendinous part of the infraspinatus muscle. There was also an unusual fusion of the infraspinatus muscle with the teres minor muscle. In this paper we will discuss the anatomical and physiological relationships of this morphological variation.
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Affiliation(s)
- Krzysztof Koptas
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, West Indies, Grenada.,Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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A Proposal for a New Classification of the Supernumerary Heads of the Biceps Brachii Muscle. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1510363. [PMID: 35496043 PMCID: PMC9054453 DOI: 10.1155/2022/1510363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
Introduction The anterior compartment of the arm consists of three muscles: the biceps brachii (BB), brachialis, and coracobrachialis muscle. The aim of the present study was to characterize possible variations in the supernumerary heads of the biceps brachii and use these to prepare an accurate classification of the area that could be used for planning surgical procedures in the region. Material and Methods. One hundred (51 left and 49 right, 52 females and 48 males) upper limbs fixed in 10% formalin solution were examined. Results Four types of supernumerary BB heads were identified, with subtypes. Type I was the most common type, characterized by the two heads (64%); this was subdivided into Type IA, with a single muscle belly, and Type IB with two muscle bellies. The second most common type was Type II, which was characterized by the three BB heads (26%). This type was divided into four subtypes (A-D): Type IIa characterized by attachment to the middle part of the shaft of the humerus; Type IIb characterized by the origin to the coracoid process together with the short head of the BB; Type IIc characterized by origin to the tendon of the pectoralis major muscle; and Type IId characterized by the attachment to the capsule of the humeral joint. The third most common type was Type III, which was characterized by four heads (6%); this was divided into Type IIIa, where two heads originated from the humerus bone, and Type IIIb, where one head originated from the short heads and the second from the long head of the BB. The rarest type was Type IV (4%) which was characterized by five heads: the short head originated from the coracoid process and the long head originated from the supraglenoid tubercle, the third and fourth head originated from the shaft of the humerus, while the fifth head originated from the pectoralis major muscle. Conclusion The biceps brachii is characterized by very high morphological variability. The new classification proposes four types of supernumerary head arrangement (I-IV), divided into subtypes. This classification has both clinical and anatomical significance.
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Relationships among Coracobrachialis, Biceps Brachii, and Pectoralis Minor Muscles and Their Correlation with Bifurcated Coracoid Process. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8939359. [PMID: 35419460 PMCID: PMC9001095 DOI: 10.1155/2022/8939359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
The aim of this study is to demonstrate the relationship between the proximal attachment of the coracobrachialis muscle and the short head of the biceps brachii and the distal attachment of the pectoralis minor. Their correlation with the bifurcated coracoid process (CP) will be also assessed. On the basis of these observations, a new classification of structures attached to the coracoid process is proposed. Classical anatomical dissection was performed on one hundred forty-five upper limbs. Three types of relationship between the coracobrachialis muscle and the short head of the biceps brachii were observed in the cadavers. In type I (occurring in 54%), the coracobrachialis and the short head of the biceps brachii created a common junction attached to a single CP. Type II was divided into two subtypes (a and b). Subtype IIa (frequency 10%) was represented by independent proximal attachments of the short head of the biceps brachii and the coracobrachialis muscles to the CP. In subtype IIb (frequency 5%), the coracobrachialis muscle was two-headed (the first head located under the second) and not connected to the short head of the biceps brachii; all heads were attached to a single CP. Type III (frequency 31%) was characterized by a two-headed coracobrachialis muscle, the first head originating from a bifurcated CP laterally to the short head of the biceps brachii and the second medially to this structure. Different variations connected with the mentioned structures could be problematic for surgeons during operations, so detailed knowledge of them could contribute to more efficient procedures.
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The Subscapularis Muscle: A Proposed Classification System. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7450000. [PMID: 34931169 PMCID: PMC8684517 DOI: 10.1155/2021/7450000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/30/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
Background On the basis of the available literature, we proposed the hypothesis that the number of muscle bellies is morphologically constant. The main purpose of this study was to examine the morphological variability of the SM and to create a new classification of it based on number of muscle bellies. Methods Sixty-six adult cadavers of Central European population (45 females, 21 males) were obtained and fixed in 10% formalin before examination. Results The SM was found in all 66 specimens (45 females, 21 males, 31 left and 35 right sides). After meticulous dissection, we distinguished nine types on the basis of number of bellies. Type I was characterized by single belly and occurred in 1.5%. Type II had a double belly and was present in 3%. Type III, the most common type, occurring in almost 32% of the studied population, had three bellies. The frequency of type IV, characterized by four bellies, was also high, just over 30%. The following types were less frequent: type V with five bellies (18.2%), type VI with six bellies (7.6%), type VII with seven bellies (3%), type VIII with eight bellies (1.5%), and type IX with nine bellies (3%). All of the types had origin on the anterior surface of the scapula. Conclusions The SM is morphologically variable in the number of its bellies. Evolutionary changes are probably the reason. The most common type was the SM with three bellies, in line with Larson's model of the division of the SM into three parts. Subsequent studies should be carried out based on MRI or ultrasonography examination to confirm if it is possible to show all types (presented in this study) among group of patients during MRI.
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Zielinska N, Tubbs RS, Konschake M, Olewnik Ł. Unknown variant of the accessory subscapularis muscle? Anat Sci Int 2021; 97:138-142. [PMID: 34591277 PMCID: PMC8732899 DOI: 10.1007/s12565-021-00633-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
Acting in medial rotation of the arm, the subscapularis (SM) is the most powerful and largest muscle of the rotator cuff. It is morphologically variable, especially in the number of tendons, place of insertion, and number of bellies, and it is sometimes fused with another muscle. An accessory subscapularis muscle (ASM) is among the morphological variations of the SM, but it is a really rare variant. The present case describes a very rare ASM that is divided into proximal tendinous attachment, intermediate fleshy muscular belly and distal tendinous attachment. Its origin is located on the lateral border of the scapula, but some fibers are connected with the muscular part of the SM. Its distal attachment is fused with the capsule of shoulder joint, above the tendinous insertion of the SM. Such an arrangement allows for greater stabilization of the joint. Moreover, there is a possibility that it could be used during treatment of ruptured SM tendons.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA USA
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA USA
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Szewczyk B, Polguj M, Paulsen F, Podgórski M, Duparc F, Karauda P, Olewnik Ł. A proposal for a new classification of coracobrachialis muscle morphology. Surg Radiol Anat 2021; 43:679-688. [PMID: 33564931 PMCID: PMC8105249 DOI: 10.1007/s00276-021-02700-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The coracobrachialis muscle (CRM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. It inserts to the medial part of the humerus between the attachment of the medial head of the triceps brachii and the brachial muscle. Both the proximal and distal attachments of the CRM, as well as its relationship with the musculocutaneus nerve, demonstrate morphological variability. MATERIAL AND METHODS One hundred and one upper limbs (52 left, and 49 right) fixed in 10% formalin solution were examined. RESULTS Three main types, with subtypes, were identified. The most common was Type I (49.5), characterized by a single muscle belly with a classical origin from the coracoid process, medially and posteriorly to the tendon of the biceps brachii. Type II (42.6%), characterized by two heads, was divided into two subtypes (A-B) depending on its origin: Type IIA, where one head originated from the coracoid process posteriorly to the tendon of the biceps brachii and the second head from the short head of the biceps brachii, and Type IIB, in which both heads originated from the coracoid process; however, the superficial head fused with the insertion of a short head of the biceps brachii, while the deep head was directly originating. Finally, Type III (7.9%) was characterized by three heads: two originated from the coracoid process (superficial and deep), and the third from a short head of the biceps brachii. Two types of insertion and two types of musculocutaneous nerve (MCN) relative to CRM could be distinguished. CONCLUSION An adapted classification is needed for all clinicians working in this area, as well as for anatomists. The CRM demonstrates morphological variability in both its proximal and distal attachments, as well as the variable course of the MCN relative to the CRM. WHAT IS KNOWN ABOUT THIS SUBJECT "AND" WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE: Not much is known about the variability of coracobrachialis muscle. The present paper introduces a completely new classification, both clinical and anatomical.
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Affiliation(s)
- Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Erlangen, Germany
- Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - Michał Podgórski
- Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine, Rouen University, Mont-Saint-Aignan, France
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Zielinska N, Szewczyk B, Tubbs RS, Olewnik Ł. Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure? Surg Radiol Anat 2021; 43:763-769. [PMID: 33656594 PMCID: PMC8105208 DOI: 10.1007/s00276-021-02721-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/18/2021] [Indexed: 02/01/2023]
Abstract
The flexor pollicis longus (FPL) is located in the anterior compartment of the forearm. It is morphologically variable in both point of origin and insertion. An additional head of the FPL can lead to anterior interosseous syndrome. This report presents a morphological variation of the FPL (additional head in proximal attachment and bifurcated tendinous insertion in distal attachment) and an unrecognized structure that has not so far been described in the literature. This structure originates in six heads (attached to the FPL or interosseous membrane) that merge together, and inserts on to the FPL. All the variations noted have clinical significance, ranging from potential nerve compression to prevention of tendon rupture.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA USA
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Two muscular variations in the elbow associated with the anterior interosseous nerve. Surg Radiol Anat 2021; 43:735-739. [PMID: 33590265 PMCID: PMC8105242 DOI: 10.1007/s00276-021-02706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/02/2021] [Indexed: 10/25/2022]
Abstract
The coexistence of different muscular-neurovascular variations is of significant clinical importance. A male cadaver, 76 years old at death, was subjected to routine anatomical dissection; the procedure was performed for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz. The right forearm and hand were dissected using standard techniques according to a strictly specified protocol. The presence accessory head of the flexor pollicis longus may potentially compress the anterior interosseous nerve. The present case report describes a rare variant of the ulnar head of the pronator teres, characterized by two independent bands (i.e., two proximal attachments). The main band originates from the coronoid process and the second originates from the tendon of the biceps brachii. This type of attachment could potentially affect the compression of the ulnar artery running between the two bands. Additionally, the accessory head of the flexor pollicis longus was observed, which started on the medial epicondyle; its coexistence with a high division median nerve creates a potential pressure site on the anterior interesosseous nerve.
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Ayoubi R, Darwish M, Nassour N, Aouad D, Maalouly J, Kanj V, El Rassi G. A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons. Asia Pac J Sports Med Arthrosc Rehabil Technol 2021; 23:18-21. [PMID: 33376677 PMCID: PMC7744595 DOI: 10.1016/j.asmart.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/09/2022] Open
Abstract
The long head of the biceps tendon is stabilized in the intertubercular groove by several anatomical structures. Dislocation or identification of the biceps tendon into or within the subscapularis tendon is very rarely mentioned in the literature. This is the first reported case of bilateral identification of the long head of the biceps tendons within the lateral subscapularis tendon. This report presents the case of a 51-year-old male patient who presented for bilateral shoulder pain. After failure of conservative treatment, MRIs were done which identified bilateral biceps tendons within the subscapularis tendons, with a concomitant supraspinatus tear on the right side. He underwent right shoulder arthroscopic biceps tenotomy, with supraspinatus repair. The symptoms of the left shoulder diminished as a result of the continuation of conservative treatment. The long head of the biceps tendon normally travels through the intertubercular groove and is stabilized by soft tissue and bony structures. Medial dislocation of the tendon is affected by the medial wall angle and by the integrity of the soft tissue stabilizers; most importantly the coracohumeral ligament in the proximal part of the groove. Dislocation of the biceps tendon into the substance of the subscapularis has been rarely mentioned in the literature; and as far as we know, bilateral occurrence without any identifiable subscapularis tears has never been previously mentioned. The bilateral occurrence with the absence of subscapularis lesions indicates that this is a congenital anomaly.
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Siwetz M, Hammer N, Ondruschka B, Kieser DC. Variations in Subscapularis Muscle Innervation-A Report on Case Series. ACTA ACUST UNITED AC 2020; 56:medicina56100532. [PMID: 33053880 PMCID: PMC7601857 DOI: 10.3390/medicina56100532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/29/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: The subscapularis muscle is typically innervated by two distinct nerve branches, namely the upper and lower subscapular nerve. These usually originate from the posterior cord of the brachial plexus. A large number of variations have been described in previous literature. Materials and Methods: Dissection was carried out in 31 cadaveric specimens. The frequency of accessory subscapular nerves was assessed and the distance from the insertion points of these nerves to the myotendinous junction was measured. Results: Accessory subscapular nerves were found in three cases (9.7%). According to their origin from the posterior cord of the brachial plexus proximal to the thoracodorsal nerve all three nerves were identified as accessory upper subscapular nerves. No accessory lower subscapular nerves were found. Conclusion: Accessory nerves occur rather commonly and need to be considered during surgery, nerve blocks, and imaging procedures.
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Affiliation(s)
- Martin Siwetz
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, 8010 Graz, Austria;
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Medical University of Graz, 8010 Graz, Austria;
- Fraunhofer IWU, Medical Branch, 01187 Dresden, Germany
- Department of Orthopedic and Trauma Surgery, University of Leipzig, 04109 Leipzig, Germany
- Correspondence: or ; Tel.: +43-316-385-71100
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
| | - David C. Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, 8140 Christchurch, New Zealand;
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