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Ruptures of hamstring reconstructed anterior cruciate ligaments required additional surgery in five cases over a 4 year period. All transplants were primarily fixed with bioresorbable interference screws close to the joint. The average age was 31 years (range: 18-42), the average interval between primary surgery and rupture of the transplant was 13.2 months (range: 8-24) after an adequate re-trauma. After complete removal of the tibial insertion, a histological investigation was carried out. We stained the tissue-sections following the haematoxylin-eosin, Masson-Goldner and van Gieson protocols. All cases revealed direct healing with grow-over Sharpey-like fibers close to the joint, corresponding to a fibrous tendon insertion and far from the joint the formation of fibrous or cartilage callus.

Tendons and ligaments are mainly composed of type I collagen fibers surrounded by a mesh of loose connective tissue. The whole tendon transmits forces from muscle to bone. However, it also shows viscoelastic behavior such as creep or stress relaxation. Tendons respond dynamically to physical activity. Release of neurotransmitters and growth factors, as well as cell communication between tenocytes by gap junctions, initiate a cascade of transcriptions and metabolic alterations leading to enhanced activity of synthetic and degrading enzymes to ensure optimal functional adaptation of extracellular tissue. Tendons and ligaments vary greatly in shape, length, and composition. Especially where they are subject to compression, they are fibrocartilaginous. Loss of vasculature may explain the high incidence of pathological alterations in these areas. The aging tendon is characterized by a reduced ability to adapt to force transmission. Inactivity markedly decreases collagen turnover soon leading to reduced stress resistance. Counteracting these phenomena requires a full understanding of the physiological processes during mechanical loading.

Our macroanatomical studies with cadaver specimens and clinical findings in the operative treatment of tendovaginitis stenosans de Quervain confirm the high number of anatomical variations in the first dorsal compartment of the wrist. With the help of thick transparent transversal-sections in one of 14 fetal wrists manufactured by plastination histology we found the first compartment with two tendons of the abductor pollicis longus and dorsal of this compartment a connective tissue formation and a separate compartment for the extensor pollicis brevis tendon, proved as a primary anatomical disposition. Macroscopically the septation is always located distal and dorsal-ulnar to the first compartment and is evidentally more common as an intraoperative than an cadaver dissection finding and probably should be considered as a pathological condition. The secondary formation of an incomplete until complete separate septum may depend on the multiple abductor pollicis longus tendons and on chronical inflammatory reaction of the synovialis of the constricted extensor pollicis brevis tendon.

By help of thick transparent cross-sections of 10 thumbs, manufactured by plastination histology, it has been shown that the most fibres of the extensor pollicis brevis tendon insert on a special tubercle of the basis of the proximal phalanx. Our studies prove that the shape of this tubercle is configurated in the phalanx proximalis longitudinally between the first and second fifth part and in the wideness of the base, seen from radial to ulnar between the forth and fifth tenth part.

Knowledge of anatomic details is important for interpretation of diagnostic imaging particularly MRI and CT. New findings even in macroscopy in the last years increased our knowledge significantly. In this article the findings are summarized with emphasis on clinical aspects.

There are difficulties in diagnosing pathologies of the labrum-biceps tendon complex (LBTC) because of the great individual variability of this structure. Anatomical variations, such as the sublabral recess, are frequently found and can also be misinterpreted as Andrews or SLAP II lesions. The etiology and mechanisms of creating such a sublabral recess are not exactly known. The examination of 31 cadaveric shoulder specimens from an age group between 49.3 and 83.6 years showed a sublabral recess in 63.6-85%. This high frequency of sublabral detachment of the labrum in older patients indicates that according to the high range of motion of the humeral head and therefore the changing angle of the long biceps tendon (LBS) a certain mobility of the superior LBTC is physiological and should not necessarily be seen as a sign of instability. Besides mobility-increasing factors such as overhead professions and sports with high repetitive maximal abduction and external rotation and the individual age, the type of insertion of the LBT at the glenoid influences the development of sublabral recess. Accordingly, posterior oriented insertion types of the LBT determine deeper and more posterior oriented sublabral recesses whereas in cases of anterior directed types of insertions no or less deep recesses can be found. Anamnestic aspects, such as the mechanism of injury and overhead activities, these macroscopic and functional associations in MR arthrography and arthroscopic inspection have to be considered in order to differentiate between physiological and traumatic changes of the labrum-biceps tendon complex.

A relatively thick (diameter approximately 2 mm), ropelike (length ca. 20 mm) and elastic "Vinculum tendinis" connects--within the fetlock tendon sheath--the dorsal side of the deep digital flexor tendon with the dorsal part of the Manica flexoria (the communicating band of the Musculus interosseous medius to the superficial digital flexor tendon). The extensive fetlock tendon sheath can be involved in diseases such as aseptic and septic inflammations. Spreading of these inflammations makes in some of these cases the partial resection of the tendon of the deep digital flexor muscle and the cutting of these Vincula necessary. The results of this contribution, collected from 60 hindlimbs of adult bovines show variations in number, length, diameter and extent and the inner structure with blood vessels and nerves.

With the help of thick transparent cross-sections of fingers, manufactured by plastination histology, it has been shown that fibres of the extensor aponeurosis insert not only the way described in current textbook on the basis phalangis distalis and on the capsule of the distal interphalangeal joint. Our studies prove that parts of the dorsal extension plate insert dorsally to the nail matrix and others run over the edge of the basis phalangis to the proximal part of the diaphysis where they intermingle with the periost of the phalanx.

The fibrous wall of the flexor tendon sheath of the thumb is reinforced by pulleys similar to those in the fingers. As cited in the literature, there are two annular pulleys A 1 and A 2 and one oblique pulley. On the basis of our investigations, this distribution was found only in 10%. In 90%, the proximal (A 1) and the distal pulley (A 2) can be seen. However, between these two annular pulleys a Y-shaped fiber complex can be dissected at the level of the base and the shaft of the proximal phalanx. This complex can be further divided into an annular part (proximal) and an oblique part (distal). The annular part is associated with the tendon insertion of the adductor pollicis muscle. The oblique part arises distal from the annular part from the ulnar side of the tendon sheath, running to the radial side of the proximal phalanx interwoven with the interphalangeal joint capsule and the palmar plate. Some fiber strands continually pass into the cutaneous ligaments of Cleland. Thin accessory pulley fibers were found between the annular pulley A 1 and the annular part of the Y-shaped fiber complex in 9.5% and in 20.6% between the oblique part and the annular pulley A 2.

Finger flexion initiated at the distal and proximal interphalangeal joint level forces the extensor tendon to move distally. Therefore, the interosseous hood fixed to the extensor apparatus moves distally, too. The proximal part of the hood which is located at the level of the metacarpal head during extension of the finger slides distally along the basis of the proximal phalanx. Due to the much smaller cross-section of the phalanx compared to the metacarpal head, the palmar border of the interosseous hood is shifted palmarly. This produces a two-fold effect concerning the metacarpophalangeal joint. First, it leads to an increasing flexion moment of the intrinsic muscles during flexion of the metacarpophalangeal joint. Second, the same mechanism improves the ability of abduction and adduction in the metacarpophalangeal joint during extension of the finger. In this position, the proximal part of the interosseous hood covers the metacarpal head and the strong palmar bundles of the hood are pushed to the ulnar and radial sides resulting in a greater distance to the abduction/adduction axis of the MP-joint. The other effect concerns the proximal interphalangeal joint. The described transformation of the interosseous hood during flexion especially of its proximal part causes a curved deformation of the strong palmar border of the interosseous hood. The power of the intrinsic muscles inserting at the interosseous hood is passed along this smooth curve on its way to the dorsal side of the proximal interphalangeal joint thus allowing a continuous extension of the proximal interphalangeal joint in all flexion phases of the MP-joint. The typical transformation of the interosseous hood is regulated by the form of the underlying bone and ligament apparatus and can be understood as a passive mechanism effecting in a senseful change of muscle function as the active element during finger flexion and extension. These not yet described morphological data concerning the transformation of the interosseous hood during finger flexion and the functional interpretation complete the former described mechanism of flexion by Landsmeer (1955) and Landsmeer and Long (1965).

Striking synovial structures were taken and their surface was investigated by scanning electron microscopy. Depending where the probes were taken from, the stratum synovial was arranged in a different way. The synovial intima seems to miss under the tendon of the long/commune extensor muscle, the collateral ligaments and the sesamoidean collateral ligaments. That is why the subsynovial tissue forms the superficial layer. The surface of the probes taken sidewards to the tendon of the extensor muscle and of the synovial fold, which is situated between the metacarpus/metatarsus and the proximal phalanx as well as from the palmar/plantar recess is dominated by synovial intima. Synovial cells are mainly arranged as monolayer. Synovial cells are variable in their appearance. Some resemble blackberrys, others show a quite undulating surface. The length of processes of synovial cells differs from 2-10 microns, the diameter of the synovial cells from 5-10 microns. The space between two cells amounts to 2-10 microns. The intercellular gap is put in relation to the length of the cells' processes. The synovial intima is supposed to form a barrier between the articular cavity and the surrounding structures.

Primary or secondary flexor tendon surgery occasionally leads to damaged flexor pulleys. Insufficient pulley reconstruction causes loss of finger function by bow stringing of the flexor tendon. This paper reviews the anatomy and biomechanics of the flexor pulley system. Different techniques of reconstruction are discussed.

The extreme stress on the long head of the biceps tendon is defined by its specific anatomical situation with near contact to the rotator cuff, to the sulcus intertubercularis and to the acromion. We took 74 specimens from cadavera and studied the macromorphological and cross-sectional anatomy to analyze changes preceding rupture of the biceps tendon. Degenerative tendon alterations with disorganized collagen fibers and large mucoid deposits occurred especially at the distal sulcus bicipitalis and near the origin of the tendon at the superior part of the glenoid labrum. The found degenerative histological alterations are possibly precursor of tendon rupture near to the distal sulcus or precursor of the so called "SLAP"-lesions.

Taking into account its detailed morphology, an attempt has been made to explain a tendon's ability to transmit force between its muscular origin and skeletal insertion. This ability depends upon the aggregation and binding capacity of the molecular elements of type I collagen and is known to decrease with advancing age. The internal structure of a tendon is modified both at the muscle-tendon junction and near its attachment to bone. The very low elasticity of tendinous tissue (about 3% to 8%) is due partly to the texture (pseudo-elasticity) and partly to the molecular composition. The so-called degenerative changes in a tendon begin with deterioration of the internal vascular network and are obviously--so far as its failing capacity is concerned--both initiated and accelerated by the degree of over-loading.

Although the relevance of capillary and gliding spaces of the back of the hand and the finger located dorsal to the extensor aponeurosis in the metacarpo-phalangeal region between the layers of the subdermal connective tissue is often emphasized clinically in inflammatory and acute traumatic occurrences, hardly any information has been published concerning the morphology of these spaces. By means of plastic-injection techniques, varying configurations of capillary spaces in the distal region of the dorsum manus of cadavers were found. The deep connective tissue spaces located dorsal to the extensor aponeurosis were shown to have proximal connections to the dorsal tendon sheaths of the carpus, whereas superficial gliding spaces tended to vary in their expanse depending on the subcutaneous and epifascial septa. The deep as well as the superficial capillary gliding spaces are adapted as mobilizing and limiting structures for the movements of the metacarpo-phalangeal joints and the various mechanical stresses of the skin of the back of the hand. A high degree of exactness in the reconstruction of the marginal elements of such functional spaces appears to be of special importance with regard to a total restoration of the functional capability of the metacarpo-phalangeal joint region.

The flexor and extensor tendons of the hand are equipped with special gliding mechanisms. Blood supply is provided via paratenon and in the fibro-osseous tunnel via mesotenon. The tendons show different amplitudes of active excursion which decrease distally. The function of flexors and extensors is coordinated and supplemented by reflexes and by the correlating relay system of lumbricals. Activation of extensor aponeurosis results via the so-called extrinsic and intrinsic system, where the IP joints are additionally linked functionally by the oblique retinacular ligaments of Landsmeer. At the level of the MP joint, the dorsal aponeuroses are furthermore linked by oblique fibrous structures, which lead to functional impairment of the neighboring MP joints in maximal flexion and extension of a finger due to an effect of tenodesis (so-called quadriga phenomenon).

The possibilities of MRI and ultrasound in visualizing the structures of the shoulder joint are compared. Both methods have a good accuracy in detecting changes of the soft tissue of the shoulder. Changes of the cartilage and the bony structures are better seen in the MRI. The MRI gives a static and clear view of the shoulder joint, meanwhile the ultrasound depends on the dynamic examination. Ultrasound and MRI are both reproducible and non-invasive methods, who seem to complete one another at the examination of the shoulder.

The biomechanical process which lead to the development of cracking sounds in the temporomandibular joints have received contradictory treatment in the literature. Most of the authors regard consider the cracking sounds to be caused by mechanical friction produced in translational movements of the condylus. According to this hypothesis the discus articularis which is dislocated in an anterior direction active pulling of the lateral pterygoid muscle, is regarded as being a mechanical obstacle. The morphological relationships however, between the lateral pterygoid muscle and the discus articularis are unclear. Our histomorphological investigations of 16 human temporomandibular joint samples from fresh cadavers of victims of accidental death revealed evidence that in the majority of cases a tendon connected the upper head of the lateral pterygoid muscle with the discus articularis. This would suggest that an anterior dislocation of the discus, resulting from an active pulling movement of the lateral pterygoid muscle, cannot be ruled out as a possible morphological cause for cracking sounds.

Full function of finger flexion requires an intact pulley system. After destruction of the pulleys, reconstruction over the metacarpal head (A1) and over the center of the proximal and middle phalanges (A2, A4) should be carried out. Calculations on a computer model suggest that the reconstructed pulley must hold the tendon close to the underlying bone. Width of the pulley and distance from the next proximal or distal joint of the inserted pulley are of minor functional importance. The amount of maximum load on the pulley, exceeding the tension of the tendon, must be considered in operation and postoperative treatment. The extensor pollicis longus tendon lies at the dorsal tubercle (tubercle of Lister) within an osseous gliding surface, where it changes direction. The deviation angle depends on the radiocarpal position and causes, in addition to the usual tension, a pressure stress to that part of the tendon. A graphical analysis of statics, based on X-rays, demonstrates maximum loads on the gliding surface. They can increase in relation to the tension force of the tendon to about 50% in the antero-posterior and to 100% in the radioulnar projection. Densitography of the distal radius shows a maximum of density where the dorsal tubercle is most prominent. Nutritional problems of that tendon are predisposed by that particular mechanical stress. Therefore spontaneous rupture of the extensor pollicis longus tendon in patients with rheumatoid arthritis or after fracture of the distal radius occurs, though infrequently. In the case of immobilization, slight ulnar abduction within the radiocarpal joint remarkably reduces the tension and pressure stresses on the tendon.

Passive movement of nerves is possible because the epifascicular epineurium is connected to the surrounding tissue by a loose connective tissue. In the carpal tunnel tendon sheaths have been developed to facilitate gliding of tendons produced by muscle contraction. By cadaveric dissection and by intraoperative examination of the carpal tunnel, a special gliding tissue of the median nerve could be demonstrated. Injection of fluid into the tissue revealed a sheath-like structure with a space between the layers limited both proximally and distally. Intraoperatively a parietal layer of loose connective tissue and several layers surrounding the median nerve could be demonstrated.

26 shoulders are studied by polariscopic and histologic examination. It can be confirmed that the origin of the long biceps tendon is not only at the supraglenoid tubercle, but also y-shaped in the glenoid labrum. This finding can be explained by phylogenetic means. Further details are found during the course of the tendon through the bicipital groove. A mesotenonium is seen regularly. This is fixed either to the roof or the ground of the sulcus by a band of connective tissue. It is shown also, that the roof of the groove is not a ligament (ligamentum transversum humeri) but consists of collagen fibers continuing from the subscapularis and capsular attachment at the lesser tubercle.

In 47 dissected right and left hands of adults of both sexes, kept in a moist condition, significant practical-clinical investigations of the transitional zone between forearm and hand were undertaken. In particular it was sought to determine the characteristic sizes of the extensor retinaculum, the osteofibrous tunnels, the insertion tendons of the hand and finger extensor muscles, and their tendon sheaths. Together with the palmar carpal ligament, the 2 to 3 cm wide extensor retinaculum annularly surrounds the whole circumference of the carpus. It extends obliquely from radial-proximal to ulnar-distal and conducts the extensor tendons over the carpal articulations. According to recent studies, it is divided into a superficial and a deep fibrous layer. From the undermost surface, vertical and oblique septa run to the plane of the forearm and carpal bones. They separate the fibrous portion of the 6 tendinous compartments of the dorsum manus. In 8.5% of cases, an accessory and completely independent tunnel of the extensor pollicis brevis muscle exists in the material investigated, and in 2.2% of cases, there is an additional tunnel for the extensor carpi radialis muscle. Hence, one occasionally finds 8 separate osteofibrous gliding compartments for the extensor muscles in the dorsal hand region. The longest tunnel belongs, as a rule, to the extensor digiti minimi muscle, whilst the widest pertains to the extensor digitorum muscle. Within the tunnel and also proximal and distal to it, the extensor tendons are surrounded by synovial sheaths. Because of its wide encroachment on the dorsum of the hand, the insertion tendon of the extensor digiti minimi muscle possesses the longest tendon sheath, measuring 68.8 mm. The next longest sheath, that of the extensor pollicis longus muscle, which measures 56.2 mm, begins further proximal to the gap of the radiocarpal articulation. In 12.8% of cases, there are divided sheaths of the abductor pollicis longus and of the extensor pollicis brevis muscle. The tendon sheath of both extensor carpi radiales muscles is frequently divided into 2 compartments which, in 2/3 of cases, communicate. The compartment of the extensor carpi radialis brevis muscle, in 91.5% of cases, shares a window-like opening with the roof of the synovial vagina of the extensor pollicis longus muscle. The tendon sheath of the long extensor muscles of the fingers originates 5 mm proximal to the forearm border of the extensor retinaculum and has a communal recess. The IVth tendon sheath opens distally and splays out in a glove-like manner to some distal recesses.(ABSTRACT TRUNCATED AT 400 WORDS)

Sonography of the rotator cuff with measurement of relevant soft tissue structures was performed in 120 persons without evidence of shoulder pathology. Although the extension of all structures varied markedly, no significant differences were found on comparing both sides. However, with regard to the variability of side differences, a limited side difference must be accepted as a normal finding. Sex, age and other body-related variables did not correlate well and were not useful in the assessment of the dimension of rotator cuff structures.

There were examined in situ the length, the diameter and the insertions of the 4 recti and the levator on 59 orbits, furthermore the mm. obliqui in the same way. The M. levator palpebrae superioris has an average length of 42.13 mm on the right (r) and 40,24 mm on the left (l). It is at the origin 3,93/3,54 (r/l)1 mm wide and 15.23/4.89 mm on the transitional area to its aponeurosis. The M. rectus superior is (mean) 37.31/37.02 mm long, in the middle area 8.59/7.83 mm wide and 2.32/2.20 mm thick. Its tendon in 4.29/4.26 mm long and 10.43/9.84 mm wide. The M. rectus medialis has an averaged length of 37.68/37.33 mm, a width of 9.41/9.73 mm and a thickness of 3.80/3.70 mm. Its tendon is 3.04/3.90 mm long and 10.39/9.92 mm wide. The M. rectus inferior is (mean) 36.95/37.70 mm long, 4.73/4.50 mm wide and 3.87/3.92 mm thick. Its tendon is 4.70/4.66 mm long and 8.50/8.68 mm wide. The M. lateralis has an average length of 36.36/35.94 mm, a width of 10.87/10.32 mm and a thickness of 2.87/2.54 mm. Its tendon is 7.19/7.82 mm long and 9.57/9.22 mm wide. Its longitudinal part is (mean) 37.59 mm (right) and 38.54 mm (left) long and 5.74/5.63 mm wide and 2.30/1.94 mm thick. Its oblique tendinous part has an average length of 22.12/22.93 mm, a width of 9.85/9.55 mm and a thickness of 1.50 mm (r/l). The M. obliques inferior is 31.46/30.92 mm long, 7.56/7.13 mm wide and 2.54/2.50 mm thick. The bulbus oculi has a longitudinal outer diameter of 24.57/24.8 mm and transversal diameter of 23.63/23.56 mm (mean). Its vertical diameter is 23.29/23.18 mm. The transversal diameter of the cornea is 11.70/12.08 mm, the vertical diameter 10.80/11,06 mm. Besides of these measurements the distances were estimated between the muscle-tendons and the cornea as well as the optic nerve.

The following anatomical objects were studied with regard to myology during evolution: M. extensor hallucis longus (MEHL), M. extensor digitorum longus (MEDL) with M. peroneus tertius (MP III), M. peroneus brevis (MPB) with M. peroneus digiti V (MPD V), M. extensor hallucis brevis (MEHB), M. extensor digitorum brevis (MEDB), and the Retinaculum musculorum extensorum imum (RMEI). The study was carried out by the preparation of 3 different groups of material. The 1st group consists of lower extremities of humans. The number of the extremities differs for the particular objects between 151 and 358 (see page 381). The 2nd group of material consists of 122 Membra pelvina from Marsupialia, Insectivora, and Primates. Table 1 shows as well the mammalian species as the number of the studied extremities. The extremities of the 1st and 2nd group were preserved in an manner suitable for a macroscopic preparation. The 3rd group of material consists of 71 lower extremities from embryos and fetus. The lower legs and feet were stained either according to the method described by Morel and Bassal with eosin added or according to Weigert. From this material, complete series of cross sections were prepared. Table 2 shows the age of the embryos (VCL [mm]) as well as the number of the studied extremities. It is important that up to the age of 46 mm VCL the difference in the age of the embryos usually amounts from 0.5 to 1.0 mm. This small difference in the age of the embryos and fetus allows a very good follow up of the changes in construction during the organogenesis. The comparison of the 3 different groups shows the following changes for the above mentioned muscles: The M. extensor hallucis longus (MEHL) is a muscle which is not split. The same result applies for its tendon which inserts at the distal phalanx of the hallux. This primitive form of the muscle amounts actually to 51.12% in human beings. In 48.88% of the cases, additional tendons and muscles are formed by the MEHL. Most of these supplements are positioned on the medial side of the main tendon, only a few lie to the lateral side. For the supplement tendons, the medial one as well as the lateral one occasionally possess a muscle belly. The muscle of the medial tendon is split off from the proximal margin of the MEHL. The muscle of the lateral tendon is split off from the distal margin of the MEHL.(ABSTRACT TRUNCATED AT 400 WORDS)

The postnatal changes in the structures of the masticatory muscles are explained on the basis of the Sehnenspiegel. The jaw musculature of juvenile miniature pigs is similar in structure to that of adult animals. All Sehnenspiegel can be found in animals that are only 3 d old. Postnatal development of the masticatory musculature takes place on the basis of the pinnation existing prior to birth and consists in secondary pinnation.

A brief literature review is made of the morphological changes in the bones of the lower limbs of man, which are the result of his upright walk. The author's task has been to study the morphological changes of Mm. extensores digitorum pedis from the viewpoint of evolutionary myology. The following material has been studied: Lower limbs of adults, 151 less than or equal to N less than or equal to 358. Pelvic limbs of Marsupialia, Insectivora, and non-hominide primates; N = 122. Lower limbs of human embryos and fetuses; N = 71. The following acknowledgements are the author's own studies. They begin with an evolutionary-myological study of m. extensor hallucis longus and of m. extensor digitorum longus, together with m. peroneus tertius.

At a greater number of humid preparated human hands, all the ligamentous supports of the digital tendon sheath were exposed and their dimensions were determined. The osteofibrous channels, which contain the long flexor tendons of the digits, were bounded on the one hand by transversely concave shaft areas of the phalanges and the palmar ligaments and on the other side by the fibrous parts of the tendon sheath. From the second to the 5th finger, it has a regular extension of length, which begins proximal at the heads of the metacarpal bones and runs distal to the base of the nail phalanx. In some cases, there is a continuous communication between the digital tendon sheath of the little finger and the carpal synovial sheath. The tendon sheath of the flexor pollicis longus muscle in comparison with it is always in an open communication with the radial synovial sac of the wrist. At the fibrous supports of the digital tendon sheath, one can find constant and inconstant ligamentous structures. Regular shaped ligaments consist of annular fibers (A1 to A5). The proximal complex of fiber supports is a formation of the A1 and A2 ligaments. The band A1 can be divided into 2 ligaments both of roughly equal length, which lay between the head of the metacarpal bone and the base of the proximal phalanx. The strongest fibrous support of the whole digital tendon sheath represents the band A2. It is attached to the midth of the proximal phalanx and increases in strength from proximal to distal. The middle length varies between 6.7 mm at the thumb and 18.7 mm at the middle finger. The distal margin is strengthened by fibrocartilage tissue to be in accordance with the important function as a pulley. The annular band A4 forms the distal supporting complex height above the shaft of the middle phalanx. At the 2nd to the 5th finger it is, with a middle length of 6 to 7 mm, very much shorter than A2 and restrains first of all the tendon of the flexor digitorum profundus muscle. In the area of the interphalangeal joints, we can find the annular bands A3 and A5, which fiber texture is formed variable. Both ligaments are attached on either both sides with the joint capsule and the palmar plate. The other inconstant supports of the digital sheaths are systematically recorded indeed (C1 to C3), but only in exceptional cases they exist of cruciform fibers (Lig. cruciatum).(ABSTRACT TRUNCATED AT 400 WORDS)

The ultrasonic examination of tendons and ligaments of the distal limb of the horse improves the diagnostic possibilities of these frequently injured structures. The successful application is based upon a reliable knowledge of the normal sonographic anatomy and upon a standardized, flawless technic of the examination. Practice and experience allow the recognition of minor alterations which enables a more precise diagnosis, a more reliable prognosis, and in follow-up examinations also more specific information about the further use of the horse.

The authors have analysed the variations of the M. extensor hallucis longus in man from the standpoint of evolutionary myology. The variations of the muscle indicate that in modern man it has transformed itself in the medially as well as in the laterally direction. Consequently it forms 2 new muscles: M. extensor hallucis longus accessorius medialis and M. extensor hallucis longus accessorius lateralis. The reorganization in the medial direction is phylogenetically older than that in the lateral direction. Of all primates these 2 muscles appear only in man representing a new acquisition. The new additional muscles and their transitional forms can be found independently and also together in various combinations. The additional tendons and muscles widen the insertion of the M. extensor hallucis longus medially and laterally. The authors emphasize that the reorganization in the medial direction is independent from that in the lateral direction.

Detailed and comprehensive knowledge of the knee joint's anatomy is an essential prerequisite for understanding of the joint's function and its pathophysiology, for precise diagnosis, and for satisfactory treatment of lesions of the joint capsule and ligaments. Thus, anatomy represents "the key to the knee".

Based on the statements in part I according to the evolution of the underwater flight, its biophysical consequences and summarizing our knowledge on swimming performances of Penguins, the active and passive apparatus of movement was studied by dissection of 26 individuals of Pygoscelis papua, P. antarctica, P. adeliae, Eudyptes chrysolophus, and Aptenodytes forsteri. Besides the functional explanation of the Articulatio sternocoracoidea (diverging considerably from the usual type in birds), a new interpretation is given for the structures of the Articulatio humeri. In this context, the role of the Ligamentum acrocoracohumerale as an important element for co-ordination of the motion processes in the shoulder joint is elucidated. The essential curvature of the Caput humeri is found to be satisfactorily approximated by a logarithmic spiral. The understanding of the mechanics of bones and tendons leads to a reinterpretation of the role of several groups of muscles which is described in detail. Besides of the preponderant thrust producing (flapping) muscles working mainly in the isotonic manner, muscles can be distinguished which are managing the transfer of the produced forces to the body operating thereby in the isometric way. Another group of muscles has to control the position of the humerus adjusting in this way, the hydrodynamic angle of attack corresponding to the respective flow conditions.

Statistical analysis reveals that from 4 persons one possess supernumerary tendon on the right hand, one on the left hand, one on both hands and one has no one. If a supernumerary tendon is found, the probability of appearance of further accessory tendons is enhanced. The 3 fingers of the ulnar side of the hand appear as an uniform group, while the indicis seems to play a special role. A new variation of muscle which runs through the canalis carpi is described.

The anatomy of the sulcus of the extensor carpi radialis tendon was analyzed in order to establish the importance of anatomic variation of the bony bed for the development of habitual dislocation of the tendon. Length, width and slope of the lateral walls were measured. Additional morphologic description permitted to distinguish 4 different types of sulcus. The results mean that the anatomy of the sulcus has only an indirect connection with dislocation, via laxity of the retinacula.

In 90 human foetuses between 4 and 7 months of fetal life we compared the length of the venters and tendons of Musculi palmares longi. We observed an intramuskular part of tendon and it was revealed that the mechanism of the venter reduction is due to penetration of the connective tissue streaks in place of the muscle fibres being in the course of atrophy. This process has occurred significantly higher in the female foetuses.

Soft tissue and osseous structures of joints can be differentiated by magnetic resonance tomography. Knee and ankle joints of three volunteers were systematically examined using a head coil at 1.5 Tesla and spin echo mode. Slice thickness was 5 mm. The anatomical details which could be visualized are described and directions for the most useful slices are indicated.

On 100 specimens of the fibula repeatable parameters were developed so as to measure the bony bed of the peroneal tendons and to evaluate the results statistically. The specimens were investigated frontally and in profile. And the sulcus was measured with a special tool. By determining height, width and slope of the walls of the groove absolute values were found which permitted differentiation between the various types of salcus.

We observed 2 different kinds of an arcus axillaris which might have caused neurovascular symptoms at the forearm and hand. According to our observations it seems that an arcus axillaris , which is an anomaly of the m. latissimus dorsi, occurs more often than is commonly reported in text-books of anatomy.

Therapeutic conclusions are derived from the anatomical peculiarities of the extensor apparatus of the fingers and the extensor tendons of the metacarpus and the wrist. In open wounds primary sutures are universally possible and promising except in cases with tendon defects or with special risk of infection. Our preferred technique employs a central wire suture which is barbed to resist proximal traction, combined with fine peripheral sutures. In closed ruptures at the DIP-level conservative as well as operative treatment can be advised, whereas at the PIP-joint and in more proximal regions operative measures are preferred.

The positions of the arm and of the transducer for the sonographic detection of soft tissue disorders of the shoulder have not yet been standardised. Anatomical studies were performed on 16 shoulders in different rotatory positions according to applied sonographic planes. 4 images in 3 different shoulder positions are necessary to evaluate the clinical important areas as completely as possible. With regard to the time and cost involved, this expenditure is acceptable in daily routine work.