Upper limb
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
A 25-year-old man suffers from frequent shoulder dislocations. His orthopaedic surgeon recommends surgery to stabilise the shoulder. Which of the following structure(s) is most likely to be shortened during this surgery?Coracoclavicular ligament.Capsule of the acromioclavicular joint.Acromioclavicular ligament.Glenohumeral ligaments.Serratus anterior muscle.
Principles of lung surgery
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Posterolateral thoracotomy is performed with the patient in the lateral decubitus position. An axillary roll is used and appropriate padding of the legs is placed. The upper arm is allowed to lie on the same side with support to prevent excessive stretching of the arm as well as the brachial plexus. A wide preparation is done from the vertebral column posteriorly to the sternum anteriorly (Figure 16.4). The nipple and areola are marked, as is the tip of the scapula, to help guide the incision. A gently curved thoracotomy incision is performed in the interspace chosen. In most cases, a muscle-sparing approach can be employed (see Chapter 8 for details), in which the serratus anterior is retracted anteriorly or detached from the ribcage and the latissimus dorsi is reflected posteriorly. These muscles may be partially or completely divided as needed to gain wider access during the operation. Care is taken not to divide the paraspinal muscles, but to free them up longitudinally. This move, as well as avoiding division of the trapezius and rhomboids, may help in reducing the development of scoliosis. The ribs are held apart with a self-retaining metal retractor (Finochietto). After the resection is performed, a chest tube may be placed a couple of interspaces below the incision. Pericostal sutures are placed in an interrupted fashion and appropriately secured avoiding excessive approximation of the ribs. Fascia and skin are closed as described previously.
Upper Limb Muscles
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo in Handbook of Muscle Variations and Anomalies in Humans, 2022
The superior part of serratus anterior may be split into two layers or it may be absent (Macalister 1875). The middle portion of the muscle may also be absent, or it may be reduced and replaced with connective tissue (Macalister 1875; Bergman et al. 1988; Bakkum and Miller 2016; Standring 2016). Slips to the first or eighth rib may be absent (Macalister 1875; Mori 1964; Bergman et al. 1988; Smith et al. 2003; Standring 2016). Serratus anterior may have origins from ribs nine and ten (Macalister 1875; Mori 1964; Bergman et al. 1988; Bakkum and Miller 2016; Standring 2016). Every slip beyond the first two may be absent (Macalister 1875). There may be connections to coracobrachialis, pectoralis minor, or scalenus posterior (Smith et al. 2003; Bakkum and Miller 2016). Serratus anterior may also be continuous with the external oblique, intercostal muscles, supracostalis anterior, or levator scapulae (Macalister 1875; Bergman et al. 1988; Bakkum and Miller 2016; Standring 2016).
Feasibility and significance of stimulating interscapular muscles using transcutaneous functional electrical stimulation in able-bodied individuals
Published in The Journal of Spinal Cord Medicine, 2021
Naaz Kapadia, Bastien Moineau, Melissa Marquez-Chin, Matthew Myers, Kai Lon Fok, Kei Masani, Cesar Marquez-Chin, Milos R. Popovic
The motor points and electrode positioning for FES for the various muscles were as follows (Fig. 1(a,b)): Serratus Anterior (SA): Electrode between the latissimus dorsi and the pectoralis major, on the muscular bulk of the serratus between the 4th and 9th ribs.Upper Trapezius (UT): On the superior aspect of the shoulder blade, away from the supero-medial angle of the scapula to limit stimulation of the levator scapulae muscle.Lower Trapezius (LT): Medially and in line with the muscle fibers next to the spine of T8-T12 vertebrae below the inferior tip of the scapula, to limit stimulation of the rhomboids.Anterior and middle deltoid: on the bulk of the muscle, one proximal and one distal.
Free serratus anterior fascial flap combined with vascularized scapular bone for reconstruction of dorsal hand and finger defects
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Takeshi Kitazawa, Masato Shiba, Kazuhiro Tsunekawa
The flap is harvested from the contralateral, uninjured side. The patient is placed in a semi-lateral position on the affected side with the uninvolved arm elevated and supported, and the injured hand is placed on the hand table. A lazy zigzag incision is made from the axillary fold to the level of the eighth or ninth rib and the lateral and anterior margins of the latissimus dorsi muscle are identified. The plane between the latissimus dorsi and serratus anterior muscles is developed to expose the vascular bundle and the long thoracic nerve running along the surface of the serratus anterior muscle. The areolar tissue must be kept with the serratus muscle, not with the latissimus muscle. Dissection of the thoracodorsal artery is continued in retrograde fashion to its origin at the subscapular bifurcation. The branch to the latissimus muscle is encountered and ligated, and the angular branch is dissected to the lateral border of the scapula, then preserved. After the vascular pedicle is mobilized to the required length, the serratus fascia and overlying areolar tissue of the required size are lifted off the muscle from ventrally to dorsally.
Effectiveness of adding magnesium sulfate to bupivacaine in ultrasound guided serratus anterior plane block in patients undergoing modified radical mastectomy
Published in Egyptian Journal of Anaesthesia, 2023
Rehab Abd El-Raof Abd El-Aziz, Mohamed Frouk Asal, Ayman M. Maaly
A linear US probe (10–13 MHz) was positioned in a sagittal plane on the area of mid-clavicle. Counting of the ribs till reaching the fifth rib was done in the mid-axillary line. Then, the identification of the muscles lying over the fifth rib was done, and these muscles include latissimus dorsi, teres major and serratus anterior muscle. Advancement of the needle was progressed from posterior toward antero-caudal direction till reaching superficial to serratus anterior muscle. Then, injection of the prepared drugs was done under continuous US guidance. Pinprick test was examined within 20 minutes after the block, and if its recognition was delayed for more than 20 minutes in the dermatomes from T2 to T9, failure of the block was considered and exclusion of these patients from the study was done. [21] Anaesthesiologist who did not share in patients’ management prepared the drugs. The study is considered double blinded as the participants and the staff personnel shared in the techniques and data collection was blinded to the groups’ allocation.
Related Knowledge Centers
- Serratus Anterior Muscle
- Torso
- Thorax
- Serratus Posterior Superior Muscle
- Serratus Posterior Inferior Muscle