Objective Recent studies of hip anatomy have turned to the posterior hip capsule to better understand the anatomic location of the posterior capsular sensory branches and identify nerves with potential for neural blockade. Current literature has shown the posterior hip capsule is primarily supplied by branches from the sciatic nerve, nerve to quadratus femoris, and superior gluteal nerve (1, 2). This cadaveric study investigated the gross anatomy of the posterior hip, while also identifying potential targets for hip analgesia, with emphasis on the superior gluteal nerve and nerve to quadratus femoris. Design Cadaveric study. Setting University of Texas Health San Antonio Anatomy Lab Methods 10 total cadavers (18 hips total), were posteriorly dissected identifying nerve to quadratus femoris, superior gluteal nerve, and sciatic nerve. Nerves were labeled with radio-opaque markers. Following the dissections, fluoroscopic images were obtained as sequential angles to identify neural anatomy and help expand anatomic knowledge for interventional pain procedures. Results The posterior hip capsule was supplied by the sciatic nerve in 1/16 hips, the nerve to quadratus femoris in 15/18 hips, and the superior gluteal nerve in 6/18 hips. Conclusions The nerve to quadratus femoris reliably innervates the posterior hip joint. Both the sciatic nerve and superior gluteal nerve may have small articular branches that may be involved in posterior hip innervation, but not this is not seen commonly. The results of this study may elucidate novel therapeutic targets for treatment of chronic refractory hip pain (i.e., the nerve to quadratus femoris).
Introduction During an anatomical dissection of the distal upper extremities, numerous muscular and nervous anomalies were found in the forearm and hand of a 94‐year‐old cadaver. These anomalies are clinically relevant with regard to medical or surgical interventions. Presentation of Case The presence of a “flexor digiti minimi longus” muscle was observed passing through Guyon’s canal; to our knowledge this passageway has never been previously reported. An aberrant first lumbrical with three origins was noted. Additionally, numerous atypical nerves were found innervating the hand; the dorsal branch of the ulnar nerve contributed to cutaneous innervation of the palm of the hand (Kaplan’s anastomosis), the superficial ulnar nerve provided muscular innervation to the flexor digiti minimi brevis muscle, and two connections between the common palmar digital branches of the median and superficial ulnar nerves were observed (Berrettini anastomosis). Discussion Here, we describe an extranumerary muscle associated with the hypothenar group of muscles. We also describe unusual origins of the first lumbrical muscle, and atypical cutaneous and muscular innervation to the palm of the hand. Conclusion Clinically, understanding the existence of these anatomical variations may influence medical care or surgical procedures.
An essential component of patient care is documentation of each patient encounter. It is often said, “If it is not documented it didn’t happen.” Each encounter with a patient requires a medical record including: the patient’s symptoms, clinical signs, the diagnosis, and treatment plan. Documentation is important for continuity of care and communication between healthcare providers. This record of the patient encounter is also an important medico‐legal document. The widely adopted Subjective, Objective, Assessment, and Plan (SOAP) Note is one form of this documentation of the physician‐patient interaction. Human Gross Anatomy is the foundational course often seen as a rite of passage and one of the most memorable parts of the medical and dental students’ learning experience in the pre‐clinical years. The body donor in this course is considered the students’ first patient. To emphasize observation skills and promote record keeping of patient encounters we instituted a new activity for our medical and dental students enrolled in gross anatomy as part of the pre‐clinical curriculum. In the medical course, each “patient” encounter is documented by completion of a brief exercise (modified Anatomy SOAP note) at the conclusion of each lab dissection. A single SOAP note activity is instituted for the dental students to be completed at the conclusion of the dental anatomy course. Preliminary observations from medical student submissions indicates a collaborative effort to complete the dissections and document anatomical variations and pathologies observed during the dissections. Faculty observations note students taking a keen interest in finding any anatomical variations or pathology present in their patient. Our faculty have witnessed an increase in level of team‐work and discussion about novel findings during dissection by members of the dissection team. Students have demonstrated, in their actions in lab as well as their write‐ups, increased collaboration and greater awareness of anatomical variations and pathology present in the body donor. Specific comments regarding teamwork, attention to pathologic changes and anatomical variations include: “Team worked well together by sharing roles and responsibilities. When one person struggled with one area [of] knowledge [our] skill was shared.” “We found that our cadaver was missing a large chunk of the right cerebral hemisphere, including loss in both the parietal and temporal lobes. We believe that this was likely due to a severe stroke.” “We have a right hepatic artery coming off of our superior mesenteric artery.” At the conclusion of both medical and dental anatomy courses survey data will be evaluated for comparison of the two methods of integration of the Anatomy SOAP note exercise. The notes themselves will be evaluated for content and observed anatomical variations and pathology. Initial observations suggest improvement of collaboration in the dissection team. We also speculate that this novel activity will be a positive tool to help reinforce patient documentation a...
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