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Clinical Tips
Published in John Larkin, 101 Top Tips in Medicine, 2021
Now, you all know (’cept the girl in today’s teaching session) that you don’t start from the clavicle, counting that as ‘rib zero’. Nor do you start from the bottom, rupturing the patient’s spleen whilst attempting to isolate a floating twelfth rib. You start at the sternal angle (‘Angle of Louis’ – as I like to term it for various reasons) – which is the angle between the manubrium and the sternum proper (NOT the sternal notch – which is the bit at the top of the sternum which is shaped rather like a notch) and absolutely everybody knows that the sternal angle is at the level of the second intercostal space… except IT ISN’T.
Pectoral Region and Breast
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The sternal angle is formed by the junction of the manubrium and body of the sternum and marks the attachment of the costal cartilages of the second pair of ribs. As will be seen later, the sternal angle is an important topographical landmark, a palpable external point of reference to the location of numerous underlying visceral structures within the chest. Beginning at this point one may also count the ribs and the intercostal spaces between the ribs. In a small percentage of people, it is the third rib which articulates at the sternal angle.
Ewing’s sarcoma of the sternum necessitating complex resection and reconstruction
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Gino Vissers, Lucas Van Houtven, Jérôme Corthouts, Annemie Snoeckx, Marloes Luijks, Filip Thiessen, Thierry Tondu, Paul Van Schil
The patient was treated with three series cycles of neo-adjuvant VIDE (Vincristine, Ifosfamide, Doxorubicin and Etoposide) chemotherapy with very good response on CT (Figure 1(D)). Subsequently, resection of the sternal body was performed via an elliptical parasternal incision incorporating the major pectoral muscles. Rib cartilages from the second till seventh rib were cut and both internal mammary arteries were sacrificed. Resection included the retrosternal mediastinal pleura and part of the right parietal pleura. The sternectomy was completed by a vertical osteotomy at the sternal angle. The resected sternal body measured 16 cm craniocaudal and 10 cm laterolateral. Histopathological examination of the sternal body showed a complete resection with negative margins but with >50% viable tumour cells (TNM 8th edition 2017: ypT1 N0(0/2) M0 R0).
Autonomic modulations of heart rate variability are associated with sports injury incidence in sprint swimmers
Published in The Physician and Sportsmedicine, 2018
Dayanne S. Lima-Borges, Paula F. Martinez, Luiz Carlos M. Vanderlei, Fernando S. S. Barbosa, Silvio A. Oliveira-Junior
An electrode was placed on the participant’s chest at the sternal angle using an elastic strap, and the heart rate receiver (Polar Electro, model V800, Finland) was attached to the patient’s wrist after participants were given an explanation on the data collection procedures. The equipment previously had been validated to record beat-to-beat heart rate and for use in collecting HRV data for analysis [31]. Afterward, volunteers were instructed to remain alert, in silence, with spontaneous breathing while resting in a supine position for 20 min on a couch. To analyze HRV, 1000 intervals of consecutive heart beats were used, selected after digital filtering, and complemented by manual depuration to cut out artifact and ectopic beats; only series with greater than 95% of sinus beats were included in the study [9].
The Impact of Segmental Trunk Support on Posture and Reaching While Sitting in Healthy Adults
Published in Journal of Motor Behavior, 2018
Victor Santamaria, Jaya Rachwani, Wayne Manselle, Sandra L. Saavedra, Marjorie Woollacott
Electromyography (EMG) from nine muscles was recorded via bipolar self-adhesive surface electrodes (Ag-AgCL) with poles placed 0.5–1.0 cm apart. Muscles from the dorsal surface of the trunk were bilaterally sampled (ipsilateral [ipsi] and contralateral [contra]), including: semispinalis and splenius capitis (cervical segment), longissimus thoracis and middle fibers of trapezius (thoracic or midribs segment,) and iliocostalis lumborum (lumbar segment). For the upper extremity, the muscles were unilaterally analyzed depending on the dominant arm of the subject. These muscles were: anterior deltoid (Ant. Delt), long head of biceps (Bic) and long head of triceps (Tric). An additional channel was utilized to detect the heart beat signal. The heart beat electrodes were placed over the seventh intercostal space, below pectoralis major, and over the sternal angle. EMG signals were preamplified (gain × 20) and band-pass filtered (10–375 Hz). The preamplifiers were attached in a custom harness made of light Velcro-sensitive neoprene that was placed over the subject's shoulders.