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Cutaneous innervation of the handSulaiman, Sara January 2014 (has links)
With the increase of hand pathologies in the last decade, the need to better understand the anatomy of the hand is becoming more vital. The cutaneous innervation of the hand is classically described to be supplied by palmar cutaneous branch of the median nerve (PCBMN), common digital nerves (CDNs), ulnar nerve (UN), palmar cutaneous branch of the ulnar nerve, dorsal branch of the ulnar nerve (DBUN), superficial branch of the radial nerve (SBRN) and occasionally the lateral antebrachial cutaneous nerve (LABCN). Although the sensory distribution of the hand has been described in the literature, reports have often shown contradicting views and occasionally different or incomplete descriptions. Furthermore, clinical procedures in the hand and wrist can result in painful and/or disabling postoperative complications. This thesis outlines, categorizes and describes the distribution and branching patterns of cutaneous branches supplying the palmar and dorsal surface of the hand and their relationship to the distal area of the forearm and wrist. It also investigates the palmar and dorsal communicating branches, their patterns and common locations. Moreover, the project discusses the impact of the distribution and branching patterns of the cutaneous nerves on surgical and diagnostic procedures performed in the hand, wrist and distal forearm. 160 cadaveric hands were dissected in the Centre for Anatomy and Human Identification (CAHID), University of Dundee. All cadavers were musculoskeletally mature adults with mean age of 82.5±9.4 (range: 53-101) years. Skin was removed from the distal half of the forearm to the metacarpophalangeal joints. Nerves under investigation were identified, dissected, and traced. Sketches, photographs, and measurements to predefined landmarks including the wrist crease (WC), bistyloid line (BSL) and the third metacarpophalangeal (MCP) joint were taken and results expressed as means, standard deviations and ranges. Patterns are classified and expressed with frequencies. The PCBMN was found to originate from the main trunk of the median nerve (MN) 54.1±15.7 mm proximal to the WC and course distally between flexor carpi radialis and palmaris longus (if present) to innervate the proximal palmar surface of the hand by branching into one of three types identified. Furthermore, two PCBMN were found in 8.9% of cases. The second, third, fourth CDNs were found to divide into proper digital nerves at a point located distal to the 70% of the distance between the third MCP joint and the BSL in 88% of cases. The cutaneous innervation of the palm was found to be relatively constant with the lateral 3½ digits being supplied by the MN and the medial 1½ being supplied by the UN. A palmar CB was found between the third CDN-MN and fourth CDN-UN in 86.9% of the cases coursing in different patterns and changing the palmar sensory innervation of that previously described. The sensory innervation of the dorsum of the hand was variable. The most common pattern was being supplied by the SBRN innervating the lateral dorsal skin and the skin covering the lateral 2½ digits and the DBUN innervating the medial dorsal skin and the skin covering the medial 1½ digits found in 37.3%. All radial supply to the dorsum of the hand with the absence of the DBUN was found in 6.7%. The SBRN connected with the LABCN in 30.7% and with the DBUN in 26.4% complicating the sensory innervation in the dorsum of the hand. Understanding the cutaneous innervation of the hand, appreciation of the possible variations and presence of communicating branches will result in a better evaluation of signs and symptoms, establishing a proper therapeutic plan, avoiding iatrogenic injuries during surgical interventions, and properly diagnose postoperative complications leading to an increased quality of medical service and patient satisfaction.
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Diversité biologique des enfants décédés en période périnatale et traitements funéraires au Kerma classique : Les exemples de la nécropole 8B-51 (Kerma classique, Nord Soudan) et des cimetières de Blandy-les-Tours (Xe-XIIe siècle, France) et de Provins (XIIIe-XVIIIe siècle, France) / Biological Diversity of Children Deceased in Perinatal Period and Funerary Treatments in the Classic Kerma : The examples of the necropolis 8B-51 (Classic Kerma, North-Sudan) and the cemeteries of Blandy-les-Tours (XIh-XIIth centuries, France) and Provins (XIIIth-XVIIIth centuries, France)Partiot, Caroline 28 November 2018 (has links)
En dépit des taux élevés de mortalité infantile dans les populations du passé, les sujets décédés en période périnatale ont longtemps été délaissés dans les travaux anthropologiques et paléoanthropologiques. Alors que les analyses biologiques portant sur les individus adultes intègrent l’étude de la variabilité comme une composante majeure, rares sont celles permettant de replacer un individu décédé en période périnatale dans le cadre de la variabilité individuelle ou populationnelle de cette classe d’âge. Le présent travail se propose ainsi d’investir le sujet de la diversité métrique et non-métrique des sujets décédés entre 22 et 48 semaines d’aménorrhée à partir de l’étude biologique de 116 sujets de trois collections archéologiques (une kerma et deux médiévales et modernes) et d’une collection actuelle virtuelle comportant 364 individus. Un premier axe de recherche caractérise la variabilité des corpus dans ses composantes intra-individuelles, inter-individuelles, populationnelles, ainsi que du point de vue des corrélations à l’âge au décès. Un second axe de recherche vise à identifier des caractères permettant d’estimer l’état de morbidité et de vitalité à la naissance de l’individu, donnée déterminante pour le statut du sujet dans la société. Pour le premier axe, l’étude révèle des différences de conformation selon l’âge au décès et les groupes populationnels, de même que l’existence d’asymétries directionnelles et fluctuantes. Les résultats vont ensuite dans le sens d’une forte proximité biologique pour le groupe kerma, traduisant potentiellement une certaine endogamie, au contraire du groupe médiéval et moderne dont la diversité plus importante pourrait refléter des facteurs socio-géographiques ou séculaires. Le second axe de recherche a permis de souligner que la mécano-sensibilité des régions d’insertion musculaire apparaît comme un nouveau paramètre à considérer pour discerner les sujets ayant survécu à la naissance. L’étude de la collection kerma livre également la première identification en contexte archéologique d’un critère de morbidité spécifique, la côte surnuméraire cervicale. Enfin, le croisement des analyses biologiques et des données archéologiques de la nécropole 8B-51 de l’île de Saï, permet d’appréhender et de discuter les traitements funéraires dévolus à la classe d’âge périnatale au Kerma classique. / Despite the high rates of child mortality in past populations, subjects deceased in perinatal period were often neglected in bioarchaeological and paleoanthropology studies. Unlike biological analysis on adults, investigations on newborns rarely include individual or populational variability comparisons as a major component. In the present work, we will focus on metrical and non-metrical diversity of subject deceased between 22 and 48 amenorrhea weeks, based on the biological study of 116 subjects from three archaeological collections (one kerma and two medieval and modern) and one current virtual collection with 364 individuals. The first research axis characterizes the intra-individual, inter-individual and populational variability, and differences by age at death in both samples. The second line of research aims to identify criteria making it possible to estimate individual morbidity and live birth on dry bones, informations that are needed to understand the child’s position in society. Biological studies reveal for the first research axis shape differences by age at death and populations, as well as the existence of directional and fluctuating asymmetries. Results provide evidences of strong biological proximity in the kerma group, potentially indicating of endogamy. On the contrary, the diversity of the medieval and modern group appears broader and could reflect socio-geographical factors or secular trends. The second line of research reveals the mechanical sensitivity of muscular insertions as a key parameter for tracking of live-born subjects. The study of the kerma collection provides the first archaeological identification of the supernumerary cervical rib, detected as a morbidity criterion in perinatal period. Lastly, crossing of biological and archaeological data on the 8B-51 necropolis provides an interpretative framework for funerary treatments dedicated to the perinatal age group in Classic Kerma.
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