A very rare case of an accessory subscapularis muscle and its potential clinical significance

Zielinska, Nicol; Olewnik, Łukasz; Karauda, Piotr; Tubbs, R. Shane; Polguj, Michał

doi:10.1007/s00276-020-02531-6

Cited by 18 publications

(36 citation statements)

References 22 publications

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“…5 Mention of an accessory subscapularis muscle was recently reported by Zielinska et al., however it is a finding of an accessory tendon and not a bifurcation of a single subscapularis tendon, which does not resemble our case. 21 The fact that the subscapularis insertions were intact, confirms that the unusual presence of the bilateral biceps tendons inside the substance of the subscapularis is a bilateral congenital anomaly and not the result of a traumatic process with a subsequent dislocation.…”

Section: Discussionmentioning

confidence: 69%

A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons

Ayoubi

Darwish

Nassour

et al. 2021

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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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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Section: Discussionmentioning

confidence: 69%

A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons

Ayoubi

Darwish

Nassour

et al. 2021

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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“…When the AIN courses underneath the additional muscle belly it can be compressed, causing AIS [2]. This is analogous, for example to an accessory subscapularis muscle potentially causing quadrilateral space syndrome [33], or the tendency of an additional head of the coracobrachialis muscle to compress the median and musculocutaneous nerves [27].…”

Section: Discussionmentioning

confidence: 99%

“…Additional structures typically compress nerves, arteries or other muscles. For example, an accessory subscapularis muscle can cause quadrilateral space syndrome [33]. A very rare variant of the coracobrachialis longus muscle can entrap the musculocutaneous, media, and ulnar nerves [23].…”

Section: Discussionmentioning

confidence: 99%

Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure?

et al. 2021

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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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“…Any upper limbs with evidence of surgical intervention in the dissected area were excluded. All dissection of the shoulder and arm area were performed in accordance with an pre-established protocol [15][16][17][18][19].…”

Section: Methodsmentioning

confidence: 99%

A proposal for a new classification of coracobrachialis muscle morphology

et al. 2021

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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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A very rare case of an accessory subscapularis muscle and its potential clinical significance

Cited by 18 publications

References 22 publications

A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons

A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons

Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure?

A proposal for a new classification of coracobrachialis muscle morphology

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