The nerve supply of the human auricle Peuker, Elmar T.; Filler, Timm J.
Clinical anatomy (New York, N.Y.),
01/2002, Letnik:
15, Številka:
1
Journal Article
The success of arthroscopic capsular release of the glenohumeral joint depends on complete incision of the inferior capsule. This study determined the distance between capsule and the axillary nerve ...in different joint positions. In 14 human shoulder specimens the anterior joint capsule and axillary nerve were dissected, and the anterior joint capsule was incised between the 1 and 5 o'clock positions. The shortest distance between the insertion of the inferior capsule and the axillary nerve was measured at the glenoid and humeral insertions in abduction, adduction, internal, and external rotation. The axillary nerve is surrounded from soft connective tissue and is closer to the humeral than to the glenoidal attachment of the joint capsule. During abduction and external rotation the nerve stays in its position while the glenohumeral capsule tightens, which increases the distance between the two structures. This results in the following distances: to the glenoidal/humeral capsule insertion: in adduction and neutral rotation, 21.2±4.2/14.2±2.6 mm; in abduction and neutral rotation, 24.0±4.9/15.0±5.0 mm; in abduction and internal rotation, 21.1±6.6/14.6±3.7 mm; and in abduction and external rotation, 24.9±3.8/16.4±4.4 mm. Thus, when performing arthroscopic capsular release the incision of the glenohumeral joint capsule should be undertaken at the glenoidal insertion in the abducted and externally rotated shoulder.
Within the past few years, autologous osteochondral transplantation has become an established procedure in the therapy of articular cartilage defects of the knee. One significant disadvantage of this ...technique is the harvesting of grafts from the weight-bearing area. The tibiofibular articulation is less loaded. The purpose of this study was to evaluate the question of whether this joint is suitable as a donor site for osteochondral grafts. Ten fresh human knees were dissected to perform histology, immunohistochemistry, and thickness measurement of the tibiofibular cartilage. Favourable approaches and establishing of anatomical landmarks were investigated in 44 fixed tibiofibular joints. In knee extension, the shortest distance between the joint cleft and common fibular nerve was measured. A total of 389 bone specimens was analysed morphometrically (cartilage area, orientation of the joint line, signs of arthrosis). Histological and immunohistochemical examination showed hyaline cartilage and type II collagen. The area of cartilage amounted to 3.58 cm(2) (mean) at the tibia and at the fibula with a thickness of 1.6 mm (mean). The joint line is mainly orientated perpendicular to an axis course from craniomedioventral to caudolaterodorsal. Depending on the available instruments, two approaches are possible: from anteromedial or from posterolateral. The mean distance to the common fibular nerve was 19.5 mm. Signs of arthrosis were found in 1 of 10 fresh knee specimens and in 11.4% of the bone specimens. Transplantation into three patients showed no intra- or postoperative complications and a rapid and uneventful recovery. The proximal tibiofibular joint is an excellent donor site for autologous osteochondral grafts.
The independence of teachers and students is one of the main advantages of teleteaching. Specialties considered unsuitable for combined lessons are manageable using the internet. This study outlines ...simultaneous communication with students and lecturers over long distances between the anatomical dissection laboratory, the operating theatre, and the lecture hall. In several three-directional on-line lectures, different equipment was used. Students could also participate using personal computers from other locations. During the presentations, the participants have the opportunity to discuss problems with any lecturer. It was possible to demonstrate sufficient transmission capability for real-time application with the use of the new internet technology. No important qualitative differences can be reported between: hardware and software based solutions; or commercial and free offers. Although it is often difficult to reconcile the timetable of surgeries and lectures, multimedia on-line teaching via the internet provides new potential for interdisciplinary medical education.
A modified surgical approach to the posterior aspect of the glenohumeral joint and/or the dorsal glenoid is described. This access does not alter any muscle insertion or neuromuscular planes. After ...the skin incision is made, the inferior border of the spinal part of the deltoid is identified and the deltoid muscle is mobilized and retracted, thus offering an excellent approach to the interval between the infraspinatus and teres minor muscles. This interval is split parallel to the muscle fibers. This surgical approach was first established in 10 cadaverous shoulders and then performed in 12 patients with posterior shoulder pathology. In the cadaver study, the closest distance to the axillary nerve with this approach was 22 mm. In all 12 cases, the surgical procedure could be performed without any problems. (J Shoulder Elbow Surg 2001;10:265-8.)
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