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Background: Operative management of clavicle fractures is increasingly common. In the context of explaining the risks and benefits of surgery, understanding the impact of incisional numbness as it relates to the patient experience is key to shared decision making. This study aims to determine the prevalence, extent, and recovery of sensory changes associated with supraclavicular nerve injury after open reduction and plate internal fixation of middle or lateral clavicle shaft fractures., Methods: Eighty-six patients were identified retrospectively and completed a patient experience survey assessing sensory symptoms, perceived post-operative function, and satisfaction. Correlations between demographic factors and outcomes, as well as subgroup analyses were completed to identify factors impacting patient satisfaction., Results: Ninety percent of patients experienced sensory changes post-operatively. Numbness was the most common symptom (64%) and complete resolution occurred in 32% of patients over an average of 19 months. Patients who experienced burning were less satisfied overall with the outcome of their surgery whereas those who were informed of the risk of sensory changes pre-operatively were more satisfied overall., Conclusions: Post-operative sensory disturbance is common. While most patients improve, some symptoms persist in the majority of patients without significant negative effects on satisfaction. Patients should always be advised of the risk of persistent sensory alterations around the surgical site to increase the likelihood of their satisfaction post-operatively., (© 2021. The Author(s).)

Objective:: To compare student performance following a change in laboratory teaching methodology from cadavers to models to virtual dissection table in a musculoskeletal gross anatomy course in a doctor of chiropractic program., Methods:: Three marking periods of laboratory and lecture examination scores from 3 consecutive academic calendar years were evaluated and compared using simple analysis as well as analysis of variance and post hoc t tests. The 1st cohort of students ( n = 352) utilized cadavers. The 2nd cohort of students ( n = 350) had anatomical models as their primary gross laboratory modality. The 3rd cohort of students ( n = 393) utilized virtual dissection tables., Results:: The midterm and final laboratory examination scores were evaluated and showed successive increase in aggregate averages between cohort 1 (mean = 76.1%), cohort 2 (mean = 81.4%), and cohort 3 (mean = 85.1%). Lecture examination scores remained consistent between the cohorts at 61.2%, 62.4%, and 61.1%, respectively. Significant improvements were seen in lab exam scores between cohorts ( F [2, 2113] = 58.6, p < .001), and no significant differences were seen in lecture exam scores., Conclusion:: Students utilizing virtual dissection tables scored higher on laboratory examinations than students having models or cadavers. However, they displayed a similar testing competency in lecture examinations, suggesting a possible change in laboratory examination difficulty between the cohorts but a similar knowledge base. Further studies are warranted to evaluate the long-term retention of student knowledge.

Background: The objective of this paper is to describe the relationship of the vertebral artery (VA) to the Atlas (C1) in the sub-occipital region in the presence of arcuate foramen; and discuss the clinical implications related to manual therapies and surgical implications related to screw placement. This study is an anatomical cadaveric case report of symmetrical bilateral lateral and dorsal arcuate foramina on the C1 dorsal arch., Case Presentation: Out of 40 cadavers that were available for use in teaching anatomy in the university setting, three presented with anomalies of the C1 dorsal arch. The sub-occipital regions were skillfully prosected to preserve related structures, especially VAs, sub-occipital and greater occipital nerves. Visual observations, photographs, measurements, and radiographic examinations were performed between January 15, 2014 and August 25, 2014. One cadaver (Specimen A) presented with complete bilateral ossified arcuate foramina, and two presented with partial ossification of the atlanto-occipital membrane. Specimen A presented the bilateral anomaly which is almost symmetrical. The VAs were found passing through double foramina (lateral and dorsal) on each side., Conclusions: Arcuate foramina have been shown to be commonly found anomalies with highly variable shapes and sizes, even in the same individual with a bilateral condition. This study found a rare type of the anomaly associated with the C1 dorsal arch, which protected the VA against manual pressure. However, VA, in this case, would be more susceptible to dissection. The presence of the arcuate foramen would also complicate screw placement during surgery. Clinical pre-screening for signs of vertebrobasilar insufficiency is important for chiropractic and manual therapies.

The neuronal morphology of the rat subthalamic nucleus (STH) was studied using Golgi techniques and Nissl stain. The results show that the somatic shapes of STH neurons vary from fusiform to oval or polygonal. Somatic cross-sectional areas vary between 140 microns2 and 440 microns2. Some of the cells have a few somatic spines. Two to six primary dendrites gave rise to tapering daughter dendrites which extend up to 500 microns. These dendrites are sparsely covered with spines. Some distal dendrites and primary dendrites of the STH also bear filiform appendages. Neurons located in the deep portion of the STH have oval dendritic fields whose long axis is parallel to the long axis of the nucleus in frontal or sagittal planes. Some of these neurons have one or two dendrites which cross the borders of the STH into the zona incerta, the lateral hypothalamus, or the cerebral peduncle. Generally, neurons located at the borders of the STH have their dendritic fields extending parallel to the borders and are confined to the nucleus. However, some neurons adjacent to the ventrolateral border of the nucleus have some dendrites extending into the cerebral peduncle. Quantitative analysis of the STH neurons showed a unimodal distribution of somatic sizes as well as the number of primary dendrites. No neurons with obvious Golgi type II characteristics were found. Two types of afferent fibers were observed entering the STH. One type consists of axon collaterals arising from the cerebral peduncle ventrolaterally, or the internal capsule rostrally, while the other enters the nucleus after crossing the internal capsule rostrally. These results suggest that the rat STH is an open nucleus in contrast to other species such as man, monkey, and cat, where it is closed, and that the rat STH may contain only one type of neuron.

Corticosubthalamic projections in the rat were investigated using the autoradiographic anterograde axonal tracing technique. After unilateral injections of tritiated amino acids in the cerebral cortex, projections to the ipsilateral subthalamic nucleus (STH) could be found arising only from the frontal agranular cortex and the zone of MI-SI overlap. Injections into granular areas of the cortex (e.g., somatosensory and visual areas) did not result in labeling in STH. Following injections in the frontal agranular cortex, labeling was present in the ipsilateral but not the contralateral STH. In general, injections that involved the lateral agranular field of frontal cortex, as defined by Donoghue and Wise ('82), resulted in a greater amount of labeling in STH than injections within the medial agranular area or the zone of MI-SI overlap. The projection from the frontal agranular areas to STH is topographically organized. The rostral part of the lateral agranular cortex projects to the lateral portion of the rostral two-thirds of STH, and the caudal part of this field projects to the ventral aspect of the middle third of STH. Injections in the rostral part of the medial agranular cortex resulted in labeling throughout the ventral two-thirds of the medial half of STH. The caudal part of the medial agranular cortex projects to the dorsolateral part of the caudal two-thirds of STH. The present results reveal projections from only the frontal agranular cortex and the zone of MI-SI overlap to STH in the rat. The cortico-STH projection is ipsilateral and terminates in a topographical manner in all parts of STH.