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ABSTRACT: The insertion of the tendon of subscapularis is accepted as being on the lesser tubercle of the humerus. The transverse humeral ligament (THL) is described as a distinct entity in most textbooks, overlying the long tendon of biceps as it emerges from the capsule of the shoulder joint. In this study, we dissected 85 embalmed shoulders to clarify the anatomy of the THL and variation in the insertion of the tendon of subscapularis. In all specimens no distinct THL could be identified, but in every shoulder a fibrous expansion arose from the posterior lamina of the tendon of pectoralis major overlying the long tendon of biceps. In 86% of shoulders, fibres from the tendon of subscapularis passed over the long tendon of biceps within this fibrous expansion and inserted on to the greater tubercle of the humerus where one would expect to find the THL. In 33% of dissections, fibres from the tendon of subscapularis lay deep to the long tendon of biceps, inserting either into the bicipital groove or on to the greater tubercle. In only 8% of cases did the tendon of subscapularis insert exclusively on to the lesser tubercle. We conclude that the THL does not exist as a separate entity. We suggest that in the majority of cases, the structure overlying the long tendon of biceps as it emerges from the capsule of the shoulder joint consists of tendinous fibres from subscapularis, contained within a fibrous expansion derived from the posterior lamina of the tendon of pectoralis major. In the minority of shoulders, where the tendon of subscapularis inserts exclusively on to the lesser tubercle, we hypothesise that this fibrous expansion acts as a retinaculum preventing the long tendon of biceps from "bowstringing."
Clinical Anatomy 09/2007; 20(6):663-7. · 1.29 Impact Factor
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ABSTRACT: This paper describes techniques for the visualization and processing of three-dimensional (3D) ultrasound data. The nature of such data demands specialized algorithms, which differ from those employed for other medical imaging modalities. In this paper, the emphasis is placed on generic processing techniques, which are relevant across a wide range of 3D ultrasound application domains.
British Journal of Radiology 02/2004; 77 Spec No 2:S186-93. · 1.31 Impact Factor
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ABSTRACT: Objective
The aim of this study was to assess the sensitivity and specificity of antenatal ultrasound in the detection of facial clefts in a low risk screening population.DesignThis retrospective study covered a five year period from January 1993 to December 1997. From the study of antenatal, postnatal surgical and pathological records, a complete number of second trimestre fetuses with a cleft defect was identified. Correlation was made with the routine 18–20 week anomaly ultrasound examination in order to assess accuracy of diagnosis.ResultsAfter necessary exclusions there were 26 fetuses with cleft defects out of 23 577 live and stillbirths. The defect was detected in 17 of these 26 cases (65%). In 12 of these 17 (70.5%) the antenatal diagnosis was completely accurate, in the remaining 5 cases part of the defect was not detected.Conclusion
In a low risk population it is possible to detect approximately two thirds of all fetuses with a cleft lip or palate. With the increasing emphasis on clinical governance, this study helps to set an achievable standard.
Ultrasound in Obstetrics and Gynecology 01/2002; 16(s1):73 - 73. · 3.01 Impact Factor
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ABSTRACT: To evaluate the accuracy of prenatal ultrasound in the detection of facial clefts in a low-risk screening population and to report on the outcome of these pregnancies.
We retrospectively reviewed antenatal ultrasound records from the obstetric ultrasound department, postnatal records from the regional craniofacial unit and autopsy reports of fetuses over 16 weeks' gestational age from the regional pathology department over a 5-year period (1993-97). Cross-referencing between the three data sets identified all cases of facial clefts.
Out of 23 577 live and still births, 30 had facial clefts; four were excluded from the study. Of the remaining 26 cases, 10 had associated major anomalies. There were 19 live births and seven terminations. Six of the seven terminations had other major abnormalities. Our detection rate for cleft lip and palate was 93% and the detection rate for isolated cleft palate was 22%. Isolated cleft lip was detected in 67% of cases. The overall detection rate for facial clefts was 65%.
From our results and a review of the literature it is clear that before standards can be set we need to define which facial clefts are sonographically demonstrable. Our data provide information for effective counseling and setting of standards for clinical practice.
Ultrasound in Obstetrics and Gynecology 12/2001; 18(5):432-6. · 3.01 Impact Factor
