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BackgroundUnderstanding muscle and tendon anatomy is of tremendous importance to achieve optimal surgical execution and results in tendon transfers around the shoulder. The aim of this study was to introduce and describe an additional distal muscle slip of the teres major (TM).MethodsSixteen fresh-frozen cadaver shoulders were dissected with the deltopectoral approach. The ventral latissimus dorsi (LD) tendon was harvested, and the shoulders were analyzed for the presence/absence of a distal teres major slip (dTMs) and its dimensions and relationship with the TM and LD tendons.ResultsThe dTMs was identified in 12 shoulders (75%). It was always distal to the TM tendon and visible during the deltopectoral approach. There was a clear separation between the TM proximally and dTMs tendon distally. At the humeral insertion, both tendons had a common epimyseal sheet around the teres major and inserted continuously at the humerus. The mean width of the dTMs tendon at the insertion was 13 ± 4 mm (range, 7–22 mm). The total lengths of the dTMs tendon and LD tendon were 40 ± 7 mm (range, 25–57 mm) and 69 ± 7 mm (range, 57–79 mm), respectively (p ConclusionsThis is the first macroscopic description of an additional distal slip of the teres major muscle. The dTMs has a separate (distal) but continuous (mediolateral) insertion at the humerus within a common epimyseal sheet around the TM. The dTMs tendon is visible during the deltopectoral approach and can therefore provide a lead structure, particularly in ventral LD transfers with the deltopectoral approach.

Muscle coordination plays an important role in glenohumeral stability. The rotator cuff and the long head of the biceps are considered the primary dynamic stabilizers muscles. However, the fact that a subgroup of patients with a massive tear in the rotator cuff were able to keep a normal function, should make us question this traditional view. We hypothesize that the teres major which is also a monoarticular scapulohumeral muscle, although it is not part of the conjoined tendon of the rotator cuff, can play a role in glenohumeral stability by a direct support of the humeral head generated by the particular posteroanterior location of this muscle under the humeral head and which, as far as we know, has not been written up previously. This particular effect could appear while the arm is being lifted and the humeral head could be leaning on against the teres major muscle belly underneath it. An anatomical a radiological study was carried out to substantiate our hypothesis. Two cadaver specimens were used for the anatomical study. Frist body was studied through conventional dissection. The second body was analysed through sectional anatomy. Then a radiological study was carried out using magnetic resonance imaging in a healthy male volunteer. Both anatomically and radiologically, the anteroinferior surface of the humeral head was showed firmly resting against the muscle belly of the teres major, to the point of misshaping it from 110 degrees of arm elevation with external rotation. The specific contribution of this effect to the glenohumeral stability needs to be confirmed by further studies and can help us to prevent the high incidence of glenohumeral dislocations. info:eu-repo/semantics/publishedVersion

The quadrangular space is a space in the axilla bounded by the inferior margin of the teres minor muscle, the superior margin of the teres major muscle, the lateral margin of the long head of the triceps brachii muscle and the surgical neck of the humerus, medially. The axillary nerve (C5-C6) and the posterior circumflex humeral artery and veins pass through this space in order to supply their territories. The subscapularis muscle is situated into the scapular fossa and inserts itself into the lesser tubercle of the humerus, thus helping stabilize the shoulder joint. A supernumerary muscle known as accessory subscapularis muscle originates from the anterior surface of the muscle and usually inserts itself into the shoulder joint. It is a rare variation with few reports of its existence and incidence. We present a case of the accessory subscapularis muscle in a male cadaver fixated with a 10% formalin solution. The muscle passed anteriorly to the axillary nerve, thus, predisposing an individual to quadrangular space compression syndrome. We perform a review of the literature and address its clinical, anthropological and anatomical significance.

Teres major muscle (TM) and latissimus dorsi muscle (LD) are frequently used in muscle transfers around the shoulder girdle. Some authors have suggested harvesting techniques in which the muscle is detached in continuity with a bone segment. Information on the bony attachment footprint of these muscles is lacking. The purpose of this study was to investigate the region of attachment of the TM to facilitate safe and complete harvesting with a bone segment where it is indicated, and to determine the relationship of the TM footprint with that of the LD. Twenty‐eight upper extremities of 14 human cadavers (six female, eight male) were investigated during the students’ dissection course in the winter term 2012. The attachment footprints were photographed and the images were processed with imageJ Version 1.46r. The TM attachment footprint at the crest of the lesser tubercle had an average dimension of 187 ± 89 mm2. It was 49.6 ± 7.9 mm long and 7.4 ± 2.5 mm wide. The bony attachment of the LD within the bicipital groove, just below the tendon of the long head of the biceps muscle, had an area of 94 ± 37 mm2. It was 36.5 ± 8 mm long and 3.7 ± 1.2 mm wide. Both muscles were separated by 4.4 ± 1.7 mm and their attachments overlapped in the craniocaudal direction by 24.4 ± 12.4 mm. Earlier studies have investigated the dimensions of the muscles’ tendons close to the attachment not the bony attachment itself. The dimension of the attachment of the TM was larger than that of the LD. The ratio between the footprint areas was approximately 2:1. This information should be considered by surgeons undertaking transfers, which include a bony segment of the muscle insertion.

The teres major and latissimus dorsi muscles (TM, LD) are considered to be the so-called brother muscles. Actually, being similar to the TM, an uppermost part of the LD usually arises from the scapular plate. In embryos of 11 mm CRL, anlagen of the TM and LD appeared to be fused to provide a single mass at an angle between the axillary and radial nerves. However, splitting had already finished in not only the TM and LD but also the other muscles at and around the shoulder in specimens of 14 mm CRL. Thus, muscle splitting at the region appeared to occur simultaneously at a short stage of 12-13 mm CRL.The TM and LD carried a common tendon still at 6 weeks (14-16 mm CRL), but their muscle bellies were separated clearly. A concept of brother muscles might be applied to the TM and LD according to a bias from the gross and comparative anatomy, not from the embryological view.

Information in recent literature on the teres major muscle (TM) is limited and, at times, contradictory. Exact information on its neurovascular supply is clinically relevant for its use in a free or pedicled muscle transfer in reconstructive shoulder surgery. Therefore, the aim of this study was to analyze the TM topographically, especially its neurovascular supply and its macroscopic appearance.Thirty upper extremities of 15 human cadavers (7 female and 8 male cadavers) were investigated during the students' dissection course of our anatomic department in the winter term of 2012.The lower subscapular nerve (LSN) innervated the TM in 86.6% of shoulders. In 13.3%, the thoracodorsal nerve (TDN) supplied the muscle. The LSN's branch was 49.8 ± 11.8 mm long. The TDN's branch was 83.5 ± 9.8 mm long. The entry of the neurovascular pedicle was located almost in the center part of the muscle. The arterial branch was 33.6 ± 7.3 mm long.In general, the LSN innervates the TM. However, in 10% to 20% of shoulders, the TDN innervates this muscle. The branch of the TDN supplying the TM is longer than the branch of the LSN. In a muscle transfer, the vessels are the predictable limiting factor for translation because they are shorter than the nerve. The artery, nerve, and vein enter the muscle in a close relationship (2 cm). It is useful to describe the entry point as an area of 2 cm in diameter around the middle of the TM.

Background The posterolateral and medial aspect of the arm is supplied by the axillary (AXN) and intercostobrachial nerves (ICBN), which are not anaesthetised by an axillary brachial plexus block (ABPB). Blockade of the AXN and the ICBN has been reported in the quadrangular space (QS) posteriorly or by serratus plane block, respectively. An anterior ultrasound-guided approach to block the AXN and ICBN would be desirable to complete an ABPB at a single insertion site. Methods After a preliminary dissection study in six cadavers, ultrasound-guided AXN and ICBN injection was performed in 46 Thiel embalmed cadavers bilaterally. Key sonographic landmarks to identify the AXN in the QS are the humerus, teres major muscle, and subscapular muscle. With the same probe position, the ICBN was identified in the subfascial axillary space. Then, 2 ml latex was injected at each nerve and confirmed by dissection. Results Muscular and bony landmarks were identified in all cadavers. The AXN was seen in 99% in the QS or at the inferolateral margin of the subscapular muscle and surrounded by latex in 96% of cases. Latex spread to the axillary fossa, within the subscapular muscle, or to the radial nerve was noted in 8% of the injections. The ICBN was seen and surrounded by latex in 100% of cases. Conclusions We describe a reliable ultrasonographic approach to visualise the AXN and ICBN anteriorly from the conventional ABPB approach as confirmed in this cadaver study.

There are many articles reporting anomalies of various blood vessels of upper extremity. In the present article, we are reporting a case of high division of brachial artery into medial and lateral branches, 9.5 cm distal to the lower border of teres major muscle. It was also observed that the two branches are crossing over near the lower part of front of arm and the lateral branch continued into the cubital fossa and trifurcated at the proximal border of pronator teres muscle. We have discussed the anatomy, embryological basis, and clinical implications of these variations along with relevant literature review. The importance of knowledge about these variations in therapeutic and diagnostic interventions is discussed.

Variations in the arteries of the upper limb are commonly seen. Most of these variations are seen as variant division of axillary artery and as high origin of radial or ulnar artery. In the present case a higher division of brachial artery was seen, with the artery dividing in the arm just distal to teres major muscle into its terminal branches, the radial artery laterally and ulnar artery medially, the artery had passed superficial to the median nerve before its division. The other branches, profunda brachii and superior ulnar collateral arteries arose from brachial artery whereas the inferior ulnar collateral artery arose from the ulnar artery. Knowledge of such variations is important in view of their clinical significance and they need to be considered prior to surgical procedures.

WOS: 000398816300004 The axillary artery is the main artery supplying the shoulder region and is clinically important. In the present case we report an arterial variation of the left upper extremity of a 65 year-old female cadaver. The radial artery arose from the axillary artery 2.5 cm below the anterior humeral circumflex artery and above the teres major muscle. It first coursed along the medial aspect of the arm, then it passed laterally between the biceps brachii and the brachialis muscle. Reaching the upper part of the elbow, it coursed medial to the brachioradialis muscle. It did not give off any branches in either the arm or in the forearm regions. It contributed to the formation of the superficial palmar arch in the palm of the hand. Further, the brachial artery entered the cubital fossa and divided into ulnar and common interosseous arteries. The right upper extremity had a normal arterial branching pattern. Being aware of the variations of the axillary artery may help to prevent diagnostic errors and avoid complications during the surgery of the region. (C) 2017 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.

Purpose To evaluate the relative axonal match between potential donor and recipient nerves, so that maximal reinnervation potential may be reached with the least chance of donor site morbidity. Methods In 10 fresh-frozen cadaveric specimens, the main trunk and anterior, posterior, sensory and teres minor branches of the axillary nerve were identified, as were the radial nerve branches to the long, medial, and lateral heads of the triceps. The swing distances of the triceps fascicular nerve branches and the axillary nerve branches relative to the inferior border of the teres major muscle were recorded. Histomorphological analysis and axon counts were performed on sections of each branch. Results The median number of axons in the main axillary trunk was 7,887, with 4,052, 1,242, and 1,161 axons in the anterior, posterior, and teres minor branches, respectively. All specimens had a single long head triceps branch (median, 2,302 axons), a range of 1 to 3 branches to the medial head of the triceps (composite axon count, 2,198 axons), and 1 to 3 branches to the lateral head of the triceps (composite average, 1,462 axons). The medial and lateral head branches had sufficient swing distance to reach the anterior branch of the axillary nerve in all 10 specimens, with only 4 specimens having adequate long head branch swing distances. Conclusions It is anatomically feasible to transfer multiple branches of the radial nerve supplying the medial, lateral, and sometimes, long head of the triceps to all branches of the axillary nerve in an attempt to reinnervate the deltoid and teres minor muscles. Clinical relevance Understanding the axon counts of the different possible transfer combinations will improve operative flexibility and enable peripheral nerve surgeons to reinnervate for both abduction and external rotation with the highest donor/recipient axon count ratios.

The objectives of the study are to demonstrate the innervation patterns of the triceps muscles and the most suitable branch of the radial nerve for nerve transfer to restore the motor function of the deltoid muscle in patients with complete C5-C6 root injury. Seventy-nine arms (40 left arms and 39 right arms) from 46 embalmed cadavers (24 male and 22 female) were included in the study. The nerves to the triceps were dissected from the triceps muscles (long head, lateral head, and medial head). The lengths of the branches were measured from the main trunk. The distance from the inferior margin of the teres major muscle to the origin of the nerve to the long head, lateral head, and medial head of the triceps were recorded as well. The first branch was the nerve to the long head of the triceps in 79 arms (100%). The second branch was the nerve to the upper medial head in 30 arms (38%), nerve to the medial head in 8 arms (10.1%), nerve to the upper lateral head in 35 arms (44.3%) and nerve to the lateral head in 6 arms (7.6%). The patterns of branches to the triceps were classified according to our dissections. The nerve to the long head of the triceps was constant as the first branch of the nerve to the triceps branch of the radial nerve in the vicinity of the inferior margin of the teres major muscle.

Descriptive cadaveric laboratory study.To identify the fiber type composition of the rotator cuff and teres major muscles in human subjects.The rotator cuff is commonly injured in athletics and is a major focus of sports medicine. Although the anatomy and architecture of each muscle have been described in great detail, these muscles have never been fiber typed using immunohistochemistry or gel electrophoresis. Fiber typing is important in modeling function, exercise training, and rehabilitation.We harvested tissue samples for all 4 rotator cuff muscles, as well as the teres major muscle from cadavers. Tissues were frozen in liquid nitrogen and sectioned. Cryosections were labeled with commercially available antibodies against fast and slow isoforms of myosin heavy chain (MHC). We also harvested fresh (unembalmed) tissue from deceased subjects and labeled tissue sections with antibodies against fast or slow MHC and wheat germ agglutinin. Gel electrophoresis followed by silver staining was also used to identify and quantify MHC isoforms in fresh tissue samples.All of the muscles were of mixed fiber type composition. As a whole, 44% of rotator cuff fibers labeled positively for slow MHC, with slow MHC content of 54% in supraspinatus, 41% in infraspinatus, 49% in teres minor, 38% in subscapularis, and 40% in teres major. Mixed MHC isoform distribution was confirmed by SDS-PAGE, which also indicated that the IIa and IIx isoforms were roughly equally present across the muscles.Human rotator cuff muscles, at least in older subjects, have a mixed fiber type. Because we only examined older subjects, we must limit our interpretation to this population.

The red panda (Ailurus fulgens) is distributed primarily in the Himalayas and southern China. It is classified as a vulnerable species by the International Union for Conservation of Nature. The aim of this study was to describe the normal osteology and radiographic anatomy of the thoracic limb of the red panda. Radiography of the right thoracic limb was performed in seven captive adult red pandas. Radiographic findings were correlated with bone specimens from three adult animals. The scapula was wide craniocaudally and presented with a large area for the origin of the teres major muscle. The square-shaped major tubercle did not extend proximal to the head of the humerus. The medial epicondyle was prominent. A supracondylar foramen was present. The radial tuberosity and sesamoid bone for the abductor digiti I longus were prominent. The accessory carpal bone was directed palmarolaterally. Metacarpal bones were widely spread. The thoracic limb morphology of the red panda evidenced by osteology and radiography indicated flexibility of the thoracic limb joints and well-developed flexor and supinator muscles, which are important in arboreal quadrupedal locomotion. Knowledge gained during this study may prove useful in identifying skeletal material or remains and diagnosing musculoskeletal diseases and injuries of the thoracic limb.

The teres major (TerMa) muscle has a clinical significance for tendon transfer procedures in patients with massive rotator cuff tears. Individually, it originates from the dorsum of the inferior angle of scapula and inserts into the medial lip of bicepital groove of the humerus. Functionally, TerMa in cooperation with latissimus dorsi (LD) adducts arm, medially rotates arm, and assists in arm extension. The variation of TerMa insertion is very rare. In the shoulder and axillary regions of a 33-year-old Thai male cadaver, the variant insertion of the right TerMa was found. The muscle fibers of TerMa are directly attached at the supero-medial border of LD tendon. Notably, there was no terminal tendon of TerMa. To explain an unusual movement of the arm, this rare variation of the TerMa insertion is necessary to be recognized. This case report is very important for surgeons to preoperatively consider using the terminal tendon of TerMa for tendon transfer in treating patients with irreparable cuff tears.

Eleven fresh-frozen cadaver shoulders were dissected to define the anatomy of the teres major muscle and tendon and to determine the muscle's potential for use as a tendon transfer to the humeral head. Of the 11 specimens, 7 had Mathes type II circulation. The primary and secondary pedicles, from the circumflex scapular artery, entered the muscle 4.1 cm and 0.5 cm from the scapula, respectively. The lower subscapular nerve entered 4.1 cm from the scapula. Mean tendon and muscle lengths were 2.0 and 11.8 cm, respectively. As a unipolar transfer, the tendon reached the greater tuberosity in all but 1 specimen. The bipolar transfer offered numerous theoretical possibilities. We believe that the teres major has an appropriate vascular supply and adequate length to make it suitable for tendon transfer to the humeral head.

The axillary artery, a continuation of the subclavian artery, begins at the first rib's outer border and ending normally at the inferior border of the Teres major muscle and continuing further distally as Brachial artery. The axillary artery has several branches that supplies axillary region. Several variations about the Axillary artery and it's branches were have been reported. In this case, from the second part of this artery, we found a common trunk between Lateral thoracic and Subscapular arteries. Other branches of subscapular also has been separated from this trunk.

Variations in the venous pattern of the arm are common. In this case report, we are presenting the variations of the brachial vein and the basilic vein. During the routine dissections which were done by medical undergraduate students, we observed some variations in the veins of the upper limb. In the current case, there was only one brachial vein which accompanied the brachial artery. The basilic vein originated from the medial side of the dorsal venous network, ascended along the medial side of the forearm and joined the brachial vein to form the axillary vein at the distal border of the teres major muscle. The basilic vein and the brachial vein joined with one another in the middle of the arm to form a unique venous chiasma. A large number of invasive procedures are carried out by using the veins of the upper limb, particularly in and distal to the axillary region. This type of a venous chiasma may lead to complications in these procedures.

The purpose of this study was to investigate whether the stretch-shortening cycle (SSC) contraction is integrated in neuromuscular activation in upper body muscles during double poling in cross-country skiing. Thirteen elite skiers performed double poling roller-skiing at increasing treadmill velocities of 9, 15, 21, 27 km h(-1) and their individual maximal velocity. Elbow angle, axial pole force and surface EMG in the triceps brachii, pectoralis major, latissimus dorsi and teres major muscle were recorded. Increases in peak pole force, rate of force development and elbow flexion angular velocities were identified (P < 0.05). The mean MVC-normalized EMG amplitudes increased during the pre-activation phase before pole plant, elbow flexion and the reflex-mediated phase between 30 and 120 ms after pole plant due to velocity increases (P < 0.05). It is thus suggested that elite cross-country skiers use SSC during double poling, particularly in the triceps muscle in order to generate high forces.

Information regarding branches of the brachial plexus can be of utility to the surgeon for neurotization procedures following injury. Sixty-two adult cadaveric upper extremities were dissected and the subscapular nerves identified and measured. The upper subscapular nerve originated from the posterior cord in 97% of the cases and in 3% of the cases directly from the axillary nerve. The upper subscapular nerve originated as a single nerve in 90.3% of the cases, as two independent nerve trunks in 8% of the cases and as three independent nerve trunks in 1.6% of the cases. The thoracodorsal nerve originated from the posterior cord in 98.5% of the cases and in 1.5% of the cases directly from the proximal segment of the radial nerve. The thoracodorsal nerve always originated as a single nerve from the brachial plexus. The lower subscapular nerve originated from the posterior cord in 79% of the cases and in 21% of the cases directly from the proximal segment of the axillary nerve. The lower subscapular nerve originated as a single nerve in 93.6% of the cases and as two independent nerve trunks in 6.4% of the cases. The mean length of the lower subscapular nerve from its origin until it provided its branch into the subscapularis muscle was 3.5 cm and the mean distance from this branch until its termination into the teres major muscle was 6 cm. The mean diameter of this nerve was 1.9 mm. The mean length of the upper subscapular nerve from its origin to its termination into the subscapularis muscle was 5 cm and the mean diameter of the nerve was 2.3 mm. The mean length of the thoracodorsal nerve from its origin to its termination into the latissimus dorsi muscle was 13.7 cm. The mean diameter of this nerve was 2.6 mm. Our hopes are that these data will prove useful to the surgeon in surgical planning for potential neurotization procedures of the brachial plexus.

The teres major can be seen as an additional head of the latissimus dorsi muscle for three-dimensional movement of the arm. It gained importance in pedicled muscle transfers for the treatment of plexus palsies and shoulder instability. Its supplying vessels belong to the subscapular system. According to the literature, the muscle was transferred only once as a free microvascular but nonfunctional graft.Eleven flaps from fresh cadavers were dissected and perfused with radiopaque media. The detailed macroscopic and microangiographic anatomy was investigated to determine its potential use as a free functional muscle flap.Three different access routes are possible. The mean length of the flap was 158 mm, and the distal and proximal tendinous widths were 24 mm and 52 mm, respectively. A Taylor type 1 nerve and Mathes type 2 vessel distribution was found in all specimens. The main pedicle is situated in the middle third of the superomedial border of the flap and derives almost exclusively from the circumflex scapular artery. Radioangiograms indicate possible splitting of the muscle in the transverse and longitudinal directions. The nerve could always be isolated to a considerable length (66 mm) before reaching the posterior cord.This anatomical study indicates that the teres major can be seen as a separate entity in the subscapular system and can be transferred as a free flap either alone or in combination. According to what is known from pedicled transfers, the donor-site morbidity should be low if the latissimus dorsi is left intact.

Rotator cuff tears following shoulder dislocation are the most common cause of prolonged shoulder pain. However, 9 to 18% of patients who have anterior dislocation actually suffer from prolonged pain due to axillary nerve injury [1]. The axillary nerve (C5, C6) is a branch of the posterior cord of the brachial plexus and exits the axilla to enter the quadrilateral space. This space is bounded by the teres minor muscle superiorly, the teres major muscle inferiorly, the long head of the triceps muscle medially, and the surgical neck of the humerus laterally. The anterior branch of the axillary nerve supplies the anterior deltoid muscle and overlying skin, while the posterior branch supplies the teres minor muscle, the posterior deltoid muscle, the skin overlying the distal deltoid muscle, and proximal triceps [2]. In an anterior shoulder dislocation, axillary nerve injury presumably occurs because of inferior displacement of the humeral head causing compression of the quadrilateral space [1]. Clinical symptoms of axillary nerve injury include vague shoulder pain, decreased strength on abduction, and abnormal sensation in the cutaneous distribution of the axillary nerve. The definitive diagnostic test used to confirm the clinical diagnosis of axillary nerve injury is electromyography (EMG). However, EMG is painful and operatordependent. MR imaging, on the other hand, is a noninvasive technique that can help provide a diagnosis, especially when other diagnoses besides axillary nerve injury are being considered [3]. Anatomical distribution of the signal changes on MR distinguishes nerve injury from direct traumatic injury of muscles. With axillary nerve injury, some or all of the muscles supplied by the axillary nerve will be affected, depending on the location of the injury along the path of the axillary nerve [1]. MR signal from acute denervation within the first 24 h may manifest as increased short tau inversion recovery (STIR) signal and as increased apparent diffusion coefficient (ADC) [4, 5]. Absence of edema of overlying soft tissues allows distinction of acute denervation from acute traumatic muscle injury. Subacute muscle denervation causes uniform muscle edema in approximately 2–4 weeks. Shifting of water from the intracellular to the extracellular space causes increased MR signal in the fluid-sensitive The case presentation can be found at doi:10.1007/s00256-009-0846-z.

We found a left superficial ulnar artery in the cadaver of a Japanese woman. This anomalous vessel originated from the brachial artery at a site 55 mm distal to the inferior border of the teres major muscle and medial to the median nerve, ran downward and medially superficial to the forearm flexor muscles, and then downward to enter the hand. It formed superficial and deep palmar arches with the radial artery. The clinical importance of the anomalous ulnar artery is discussed.

The authors suggest transfer of teres major muscle for a detached and atrophic infraspinatus muscle in irreparable rotator cuff tears. Original studies were done on cadavers. In the period between November 1993 and June 1994, we used this technique on 6 patients. Those patients were evaluated with the Constant-Murley test and improved from an average of 40 points (minimum 27 to maximum 54) before surgery to an average of 62 points (minimum 47 to maximum 78) after surgery. Active external rotation recovered 35 degrees in abduction and 24 degrees in adduction. The teres major transferred on great tuberosity is able to restore continuity of the cuff and to depress the head of the humerus. It is important to re-educate the transferred muscle because it initially contracts more in adduction and internal rotation than in external rotation. One patient was very satisfied and 5 patients were satisfied after surgical treatment.

Axillary artery is a continuation of subclavian artery, extending from the outer border of first rib to the lower border of teres major muscle.During routine dissection for the undergraduate medical students, a rare variations was seen in an approximately 55‑year‑old male cadaver. This case showed a variation in branching pattern of right axillary and subscapular arteries. The subscapular artery originated from 2nd part of axillary artery, gave origin to posterior circumflex humeral and lateral thoracic arteries in addition to its normal branches. The ulnar artery originated from the 3rd part of the axillary artery, just above the lower border of teres major muscle. The variant ulnar artery passed deep to the median cubital vein, bicipital aponeurosis, and tendon of palmaris longus muscle. Then, it passed superficial to flexor digitorum superficialis muscle and flexor retinaculum to enter the palm. In the palm, it formed the superficial palmar arch. This variant ulnar artery was much smaller in caliber than the radial artery.

Previously overlooked, the concept of a triceps muscle flap has been recently proven valid. By using only the long head portion, necessary function preservation may be achieved. A distinct proximal neurovascular source to this component alone allows an axis of rotation at the level of the teres major muscle. This permits transposition either in an anterior or posterior direction as a local muscle flap that has usefulness, albeit in a secondary role, for axillary reconstruction such as commonly required as a sequela to burn contracture.

A 21-year-old right-handed male tennis player presented with a complaint of pain in the posterior aspect of the right shoulder that started suddenly, earlier that day, after hitting a tennis ball in the overhead position. The pain was initially mild and he was able to continue playing tennis for a short time. However, he eventually had to stop playing tennis as the pain gradually increased and right shoulder range of motion progressively decreased. Frontal plane magnetic resonance T2-weighted imaging showed increased signal intensity and a complete rupture of the teres major muscle belly. Sagittal plane magnetic resonance imaging showed increased signal intensity and marked enlargement of the teres major muscle. The patient was managed nonoperatively. Magnetic resonance imaging at 6 months following the injury revealed that the teres major muscle had demonstrated appropriate healing, normal signal intensity, and normal muscle size. J Orthop Sports Phys Ther. 2008;38(7):439. doi:10.2519/jospt.2008.0407

This study investigates several musculoskeletal scapular correlates of quadrupedal behavior in predominantly plantigrade, Papio cynocephalus anubis and acrobatic, less plantigrade, Macaca fascicularis. Positional behaviors differ in these two primates reflecting the amount of time spent emphasizing one or the other of these captive behavioral regimes. Stresses associated with particular patterns of behavior result in different scapular morphologies. Papio exhibits a significantly broader scapula with a more dorsoventrally curved blade accompanying an enlarged teres major muscle. The supraspinous fossa is wider in Papio, while the infraspinous/teres major attachment is wider in Macaca. Angular measurements reflect the breadth dimension of the various fossae. These results utilize two species of primates to extend a methodology developed in previous studies and to suggest that a predictable interdependence occurs between scapular dimensions and certain behavioral activities.

The complete survival of a teres major--latissimus dorsi skin-muscle flap for chest reconstruction is reported in a patient in whom the primary neurovascular pedicle of the latissimus muscle had previously been sacrificed. At operation, collateral vessels of 1-mm proportions were noted to have developed between the innervated teres major and denervated latissimus dorsi muscle. In this case, the teres major muscle rotated with the latissimus muscle to affect reconstruction of a full-thickness anterior chest resection. This report suggests the possibility of a denervated, relatively devascularized muscle obtaining additional blood supply from adjacent innervated vascularized muscles and supports the concept of rotating the muscles as a unit to encourage viability of the denervated component.

The Brachial artery usually begins as the continuation of the Axillary Artery at the inferior border of the Teres Major muscle and terminates by bifurcating into radial and ulnar arteries in the cubital fossa. A case of unilateral bifurcation of the artery 7.5 cm distal to the inferior border of the Teres Major muscle in the proximal half of the right arm was identified in a northern Nigerian cadaver that was dissected by medical students of Usmanu Danfodiyo University, Sokoto. The Profunda Brachii, Superior Ulnar Collateral and Inferior Ulnar Collateral arteries arose from the relatively short brachial arterial trunk. Although the documented incidence of this anatomical variation is low in Nigeria, its concomitant widespread documentation in other parts of the world makes it a sufficiently important anatomical variation of the Brachial Artery, to warrant its being taught to students of Anatomy and Medicine. The knowledge of anatomical variations of the brachial artery and its branches is also important in radiological and clinical practice.Keywords: Anatomical variation, brachial, artery, Nigeria

The function of the supraspinatus, infraspinatus, teres minor and teres major muscles was tested electromyographically during driving in a simulator. The supraspinatus muscle appears to stabilize the glenohumeral joint and at the same time to participate in moving the steering wheel contralaterally during driving. The infraspinatus, teres minor and teres major muscles showed very little activity. When activity occurred in the teres major muscle it was usually during ipsilateral rotation of the steering wheel.

Electromyographic activity of the teres major and latissimus dorsi muscles using indwelling bipolar fine-wire electrodes was recorded during motion of the arm and shoulder without resistance, against resistance, and during static resisted activity. The teres major is active during static motion and during motion against resistance with medial rotation, adduction, and extension of the arm. It is not active during motion without resistance, although latissimus dorsi usually is.