One of the risks associated with harvesting the radial artery is hand ischemia. Accordingly, this study investigated the variations of the hand collateral circulation.Methods: Fifty hands of cadavers were examined. Variations of the palmar arches were recorded. A classic superficial palmar arch was defined as direct continuity between the ulnar artery and the superficial palmar branch of the radial artery. A classic complete deep palmar arch was defined as direct continuity between the radial artery and the deep branch of the ulnar artery.Results: A classic superficial palmar arch was found in 10% (5/50) of hands, and a classic complete deep palmar arch was found in 90% (45/50) of hands. The superficial palmar branch of the ulnar artery supplied blood to all fingers in 66% (33/50) of hands. Although the superficial palmar branch of the ulnar artery was continuous with the radial artery in only 34% (17/50) of hands (including the classic type of superficial palmar arch), every hand had at least one major branch connecting the radial and ulnar arteries. Conclusions:Variations in the terminations of the radial and ulnar arteries are common. Although the classic type of superficial palmar arch occurs relatively infrequently, there is always a significant anastomosis between the radial and the ulnar artery in the hand. This anatomic study confirms the presence of a collateral supply in the hand. In the absence of vascular disease, harvesting the radial artery should be regarded as a safe procedure.

The anatomy of the middle layer of lumbar fascia (MLF) is of biomechanical interest and potential clinical relevance, yet it has been inconsistently described. Avulsion fractures of the lumbar transverse processes (LxTP's) are traditionally attributed to traction from psoas major or quadratus lumborum (QL), rather than transversus abdominis (TrA) acting via the MLF. This attachment is also absent from many biomechanical models of segmental control. The aims of this study were to document: (1) the morphology and attachments of the MLF and (2) the attachments of psoas and QL to the LxTP's. Eighteen embalmed cadavers were dissected, measuring the thickness, fibre angle and width of the MLF and documenting the attachments of MLF, psoas and QL. The MLF was thicker at the level of the LxTP's than between them (mean 0.62: 0.40 mm). Psoas attached to the anteromedial surface of each process and QL and TrA to its lateral border; QL at its upper and lower corners and TrA (via the MLF) to its tip. In three cadavers, tension applied to the MLF fractured a transverse process. The MLF has a substantial and thickened attachment to the tips of the LxTP's which supports the involvement of TrA in lumbar segmental control and/ or avulsion fracture of the LxTP's.

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Palmaris longus contributes to the anteposition and pronation of the thumb under circumstances. It is however restricted by its medial tendon which runs into the palmar aponeurosis. The diversion of this tendon and the mobilisation of the muscular head of the abductor pollicis brevis arising from its lateral tendon will substantially accentuate the rôle of palmaris longus as a muscle of the thumb.

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The abductor pollicis brevis muscle acts In conjunction with the palmaris longus and the abductor pollicis longus to abduct the first metacarpal in the sagittal plane. S e g ments of the abductor pollicis brevis which arise fiom the tendons o f the palmaris longus and/or the abductor pollicis longus and are inserted into the extensor expansion are the lumbricals o f the thumb. The lateral border of the abductor pollicis brevis presents an important muscular (in four cases 'out of ten neurovascular) hilum. The tendinous slip t o the abductor pollicis brevis from the palmaris longus presents near its origin an orifice which the palmar branch of the median nerve traverses t o become superficial.THE abductor pollicis brevis is a thin sheet of muscle, more or less triangular in shape, forming most of the surface of the muscular thenar eminence. Descriptions of the anatomy of this muscle are various, and so are the functions attributed to it.The present study is an attempt to verify the morphological data and to integrate them into a functional concept. MATERIALS AND METHODSFifty forearms and hands taken at random from embalmed cadavers were dissected by routine techniques in order to investigate : (i) the presence of the palmaris longus muscle and its relations, when present, to the abductor pollicis brevis; (ii) the presence of a separate tendon from the abductor pollicis longus muscle to the base of the abductor pollicis brevis ; and (iii) the correlation between the tendons of the palmaris brevis and the abductor pollicis longus as origins for the abductor pollicis brevis.Ten hands taken at random from nonembalmed cadavers were injected with red latex via the radial artery, fixed in 5% formalAddress for reprints : Dr M. Fahrer, DeDartment of Anatomy, University of Queensland, St Lucia, Queensland 4067.dehyde and microdissected at magnifications ranging between x 2 and x 40, in order to investigate: (i) the details of the origins and insertions of the abductor pollicis brevis; (ii) its blood and nerve supply; (iii) the relations to the muscle of the palmar branch of the median nerve. RESULTSThe abductor pollicis brevis presents two types of origin: (i) fixed origins from the flexor retinaculum and from the distal part of the fibrous sheath of the flexor carpi radialis tendon ; and (ii) mobile origins from the lateral division of the tendon of the palmaris longus, from the anterior division of the tendon of the abductor pollicis longus and from the skin of the thenar eminence. I n the first series of 50 cases, the palmaris longus was present in 4. Its tendon bifurcates shortly above the wrist crease. The medial tendon runs into the palmar aponeurosis. The lateral tendon gives origins to muscular fibres of the abductor pollicis brevis. Two patterns of origin emerge from these dissections: ( a ) A discrete, fusiform muscular belly of the abductor pollicis brevis directly continues the lateral palmaris longus tendon in 23 cases.

Chronic groin pain is a common complaint for athletes participating in sports that involve repetitive sprinting, kicking or twisting movements, such as Australian Rules football, soccer and ice hockey. It is frequently a multifactorial condition that presents a considerable challenge for the treating sports medicine practitioner. To better understand the pathogenesis of chronic groin pain in athletes, a precise anatomical knowledge of the pubic symphysis and surrounding soft tissues is required. Several alternative descriptions of pubic region structures have been proposed. Traditionally, chronic groin pain in athletes has been described in terms of discrete pathology requiring specific intervention. While this clinical reasoning may apply in some cases, a review of anatomical findings indicates the possibility of multiple pathologies coexisting in athletes with chronic groin pain. An appreciation of these alternative descriptions may assist sports medicine practitioners with diagnostic and clinical decision-making processes. The purpose of this literature review is to reappraise the anatomy of the pubic region, considering findings from cadaveric dissection and histology studies, as well as those from diagnostic imaging studies in athletes.

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