INTRODUCTIONKnowledge of anatomical variations and anomalies along the course of the suprascapular nerve (SSN) is important in the treatment of SSN entrapment syndrome, and bony and brachial plexus injuries. This knowledge is also important for surgeons carrying out surgical interventions at the shoulder region.The SSN provides sensory innervation to the posterosuperior aspect of the shoulder and motor innervation to the supraspinatus and infraspinatus muscles. The SSN passes beneath the superior transverse scapular ligament (STSL) and inferior transverse scapular ligament (ITSL) at the fibro-osseous canals of the suprascapular notch and spinoglenoid notch, respectively. Therefore, the STSL and ITSL are potential sites of SSN compression. Complete ossification of the STSL with formation of bony foramina is the most recognised predisposing factor for compression at the suprascapular notch;(1) it is also a risk factor in surgical exploration for SSN decompression. In a recent histological and immunohistochemical study, it was found that all five cadaveric shoulders that had STSL ossification showed signs of neural degeneration in the nerve specimens.(3) However, a high incidence of ossified STSL does not proportionally correlate with the occurrence of SSN entrapment; (4,5) this could be due to the lack of focus on the influence that the body ridge shape (created by the ossified STSL) has on SSN entrapment. With this in mind, the present study was designed to analyse the variable morphological aspects of the ossified STSL, along with other ossified ligaments found in the scapula. We also document any rare findings of ossified ITSL and bony tunnels (i.e. the bony canal found between the suprascapular notch and spinoglenoid notch), as well as their dimensions, as these structures could potentially compress vascular and neural elements by reducing available space in the spinoglenoid notch. (6,7) In short, the present study explored the incidence of ossified ligaments and bony tunnels along the course of the SSN in dry human scapulae from a North Indian population. We also measured and recorded the dimensions of osseous ligaments and any rare bony tunnel and foramina at the suprascapular notch and spinoglenoid notch. As the existing data on ossified ligaments of dry human scapulae is limited, the data obtained in the present study would augment the current anatomical and morphological reference values. This would also aid in defining the anatomical risk factors for SSN entrapment and identifying the surgical hazards present during open and arthroscopic interventions in the suprascapular and spinoglenoid notch regions. METHODSThe present study was conducted on 268 dry human adult scapulae of unknown gender from a North Indian population. Among the 268 scapulae, 126 were right-sided and 142 were

Background: Problem Based Learning (PBL) for teaching preclinical sciences has been proposed in curricular reform by Medical Council of India. PBL is a student-centred approach, enabling deep and transformative student learning. A 'hybrid' approach to PBL uses a range of class-based teaching methods; delivering a mode of PBL which is less resource intensive and more flexible than 'pure' PBL. In hybrid PBL, problems are solved in groups, but lectures are used to present the fundamental concepts and difficult topics. Our institution follows a traditional lecturebased curriculum. The present cohort study was undertaken to determine student and faculty perceptions for hybrid PBL as well as impact on student engagement. Methods: Hybrid PBL method was implemented for one cohort of hundred first year medical students. Previous batch was used as control taught by traditional lecture-based curriculum alone. Methodological triangulation design was employed for impact of hybrid PBL on student engagement (attendance scores-Chi square) and student and faculty perception to hybrid PBL (reflections-grounded theory) Results: The mean attendance score of MBBS batch 2016 was significantly better than batch 2015 (p=0.0001). The emerging themes in student reflections were innovative method, collaborative learning, quest for knowledge, promote long term retention and links to real-life scenario. Acquisition of soft skills (social and moral responsibility) was novel emerging theme in student reflections. Active student participation and improved critical thinking were themes expressed in faculty perceptions. Conclusions: Hybrid PBL with small groups is successful in large classrooms. Introduced at the initial phase of undergraduate medical education, it can assist robust self-appraisal in students and strengthen soft skills.

The documented variations of the inferior transverse scapular (spinoglenoid) ligament include bilaminar or unilaminar membranous band, ligamentous band, and absence (Cummins et al., 1998;Demirhan et al., 1998;Demirhan, 2000;Ide et al., 2003;Plancher et al., 2005). Standard textbooks of anatomy do not describe the ossification of the spinoglenoid ligament.During routine bone extraction from a male cadaver for the bone library, it was observed that the left inferior transverse scapular (spinoglenoid) ligament was ossified. The ossified ligament stretched across the superior-most part of the spinoglenoid notch, converting it into a foramen (Fig. 1A). The foramen was oval (8 mm 3 3 mm) proximally, in the supraspinous fossa, and circular (5 mm 3 5 mm) distally, in the infraspinous fossa. The nutrient foramen of the scapula was 5 mm from the edge of the spinoglenoid foramen in the supraspinous fossa, as seen in Figure 1B.The ossified ligament was 24 mm in length. It was twisted in such a way that the lateral-most fibers Fig. 1. To show the spinoglenoid ligament and foramen in an adult Indian male. A: Spinoglenoid foramen due to ossified spinoglenoid ligament. B: Ossified spinoglenoid ligament extending between root of the spine and coracoglenoidal junction. Nutrient foramen is seen in the supraspinous fossa (5 mm from the spinoglenoid foramen).