Compression of the dorsal scapular nerve (DSN) is associated with pain in the upper extremity and back. Even though entrapment of the DSN within the middle scalene muscle is typically the primary cause of pain, it is still easily missed during diagnosis. The purpose of this study was to document the DSN's anatomy and measure the oblique course it takes with regard to the middle scalene muscle. From 20 embalmed adult cadavers, 23 DSNs were documented regarding the nerve's spinal root origin, anatomical route, and muscular innervations. A transverse plane through the laryngeal prominence was established to measure the distance of the DSN from this plane as it enters, crosses, and exits the middle scalene muscle. Approximately 70% of the DSNs originated from C5, with 74% piercing the middle scalene muscle. About 48% of the DSNs supplied the levator scapulae muscle only and 52% innervated both the levator scapulae and rhomboid muscles. The average distances from a transverse plane at the laryngeal prominence where the DSN entered, crossed, and exited the middle scalene muscle were 1.50 cm, 1.79 cm, and 2.08 cm, respectively. Our goal is to help improve clinicians' ability to locate the site of DSN entrapment so that appropriate management can be implemented.

During a routine dissection of a 51-year-old Caucasian male cadaver, bilateral symmetrical supernumerary heads (SH) of the biceps brachii muscles with insertion into the pectoralis major (PM) muscles were discovered. Multiple case reports have documented supernumerary heads for the biceps brachii; however, none have shown bilateral insertion into the pectoralis major. This study describes a previously undocumented variation of the SH that has potential for clinical impact. Healthcare providers could be confounded by patients presenting with shoulder pain or muscle tears as a result of the anomaly. Furthermore, MRI studies on patients with possible shoulder muscle tears could reveal unexpected results. Such cases would warrant consideration of SH anomaly and treatment should be adjusted accordingly. The significant bulk and angle of the SH insertion on the PM we observed changes force vectors which would have an unknown effect in performance, surgical interventions and pain syndromes. A second biceps brachii anomaly was observed on the left brachium in addition to the bilateral SH. We postulate that these variants provide the potential for clinical complications regarding muscular injury to these aforementioned muscle groups.

Background: Dorsal scapular nerve (DSN) syndrome is often associated by dull or aching pain along the medial border of the scapula that can radiate to the lateral aspect of the upper limb. The primary cause of this syndrome is due to the impingement or entrapment of this nerve at the middle scalene muscle. The purpose of this study is to identify the surface projection of the DSN relative to the middle scalene muscle by using the transverse plane of the laryngeal prominence and the posterior border of the sternocleidomastoid (SCM) muscle as reference points along with approximating the nerve's location using thumb interphalangeal joint (IPJ) width. Methods:The surface location of the DSN was examined in 10 embalmed adult cadavers. The posterior border of the SCM muscle was palpated and outlined along with the transverse plane of the laryngeal prominence. A resin dye was injected at a distance of 2.08 cm (~ 1 thumb IPJ width) medial to the intersection of the posterior border of the SCM and the transverse plane of the laryngeal prominence. Dissections were performed to reveal and record the location of the dye. The distance between the location of the dye to the DSN was also measured. Results:The overall accuracy of the injection study revealed that the scalene muscles were consistently located. Specifically, 50% of the injections were found at the middle scalene muscle, 20% was between the anterior and middle scalene muscles, 10% at the anterior scalene muscle, 10% between the middle and posterior scalene muscles, and 10% was located at the posterior scalene muscle. Conclusion:This investigation will provide clinicians a useful and convenient method to determine the surface projection of the DSN at its entrapment site for the purpose of diagnosis and therapeutic treatment.

SUMMARY A blood cyst of the orbit is an unusual cause of proptosis and most likely arises in a pre-existing haemangioma. If the cyst occurs at the apex of the orbit the blood should be aspirated. This is followed by excision of the cyst wall, the dissection being done with the aid of an operating microscope. If there is evidence of intracranial connection of the blood cyst, namely, splayed superior orbital fissure or cerebrospinal fluid leak, then the patient should be treated with an antibiotic to prevent intracranial infection.

Arterial variations of the distal lower limbs are well documented. However, the absence of a fibular artery is a rare finding. During medical students’ dissection of a cadaver, bilateral missing fibular arteries were discovered and are reported here. The precise knowledge of the popliteal artery and its branches' anatomic variations is relevant to the clinical practice of vascular medicine, surgery, and interventional procedures. Radiologist and vascular surgeons in recent studies use the following terminology to describe the vascular branching pattern. The most common branching pattern in the lower extremity is the popliteal artery branching into the anterior tibial artery and tibiofibular trunk. The tibiofibular trunk bifurcates into the two terminal branches: the posterior tibial artery and the fibular artery. The fibular artery runs along the medial aspect of the fibula supplying the lateral compartment of the lower extremity. In this case report, there is a normal branching of the popliteal artery into the anterior tibial artery. As the popliteal artery continues, it transforms into the posterior tibial artery without the formation of the tibiofibular trunk and fibular artery. To compensate for the absent fibular artery, the posterior tibial artery was found to have smaller branching vessels that supply the lateral compartment of the lower extremity. This variation was found bilaterally in the subject.