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PURPOSE To determine the association between coracoacromial ligament (CAL) morphology and rotator cuff tears. MATERIALS AND METHODS The present study is a prospective cohort study based on the dissection of 172 shoulders from 86 (46 female, 40 male) formalin embalmed European Caucasian cadavers, with a median age of 82 years. The anatomy of CAL was examined, including its morphology and parametric measurements, while the rotator cuff tendons were inspected for the presence of tears. RESULTS Gross examination of the CAL in 155 shoulders revealed a variable number of bands as follows: 28 (18%) had one band, 56 (36%) two bands and 71 (46%) three or more bands. Inspection of the rotator cuff tendons showed the presence of tears in 77 (50%) shoulders, of which 37 (24%) were partial and 40 (26%) were full-thickness tears. Statistical analysis showed a significant association (P

Objectives: Although the glenoid labrum is linked to glenohumeral joint stability, its anatomy remains controversial. This study aimed to investigate the shape, consistency of the glenoid labrum, and whether these and its thickness and depth are age related. Methods: A total of 140 shoulders were dissected to expose the glenoid labrum. the shape and consistency of the glenoid labrum were assessed at a gross level. Measurements were taken of the labrum depth and thickness, using callipers, in the superior, anterior, inferior and posterior regions. ANOVA and chi-square tests were conducted to determine statistical significance, which was set at p

Sleep quality is known to affect and be affected by multiple factors in one's life through physiological and psychological manners. The study aimed to assess the influence of diet, water intake, exercise, level of education, and income on the quality of sleep of the Saudi population.The study was a cross-sectional design that used a validated standardized fact-based questionnaire developed based on the Insomnia Severity Index. The data collection continued for three months, during which subjects were approached and interviewed in many locations, ensuring the Saudi population's best representation.The study included 496 subjects, of whom 74% were men. Most of the participants (51.4%) were aged between 18 and 25 years old and were unmarried (64.2%). The education level of participants was between high school and bachelor's level (45-43%), respectively. Around 53% believed that they were following an unhealthy diet, although 42% of the total had a normal BMI. About 44% of participants consumed about 1-2 L of water daily, and 42% never exercised. The majority (39%) earned an income of5000 Saudi Riyals. Forty-two percent of the participants reported subthreshold insomnia. The data analysis showed that social status and diet were significantly related to sleeping quality (P = 0.051, P = 0.027). Additionally, the level of education was found to be an important confounding factor.Diet and social status were significantly related to insomnia, and educational level served as a significant confounding factor. Neither water intake, exercise, BMI category, age, nor gender were associated with insomnia.

A spot test is commonly used to assess practical knowledge through a series of specific questions related to the marked anatomical structures on cadavers. However, the continuous reviewing and developing of the medical curricula demands the need to improve the assessment method of the practical examination of anatomical knowledge. Therefore, the aim of the study was to examine the effectiveness of a free response short-answer questions (FRSAQs) test and traditional questions on medical students’ performance. This is an experimental study using a Randomized Posttest-Only Control Group Design to compare the mean of students’ performance in addition to their perceptions about the two versions of the spot tests. Two hundred and ninety preclinical-year medical students were invited to participate in this study. Only 109 (38%) students participated in this study. The data analysis showed a significant improvement in students’ performance in the FRSAQs test (5.3 ± 2.7) than the traditional spot test (4.7 ± 2.6), (P = 0.04). The majority of the students (70%) preferred the FRSAQs spot test, citing that it is good test to assess practical knowledge. The psychometric analysis revealed that the FRSAQs produced more ideal stations (60%) when compared to the traditional spot test (10%). The current study found that the FRSAQs spot test had a significant impact on students’ performance, and it was considered an ideal, flexible, and stress-free assessment method when compared to the traditional spot test. Implementation of the strategy in teaching and in assessment is recommended.

Background We investigated and compared the effect of the radiofrequency electromagnetic field (RF-EM) emitted by a cell phone on the electrocardiogram and heart rate variability (HRV) of normotensive normal-weight and obese medical students. Method Twenty medical student volunteers, normal weight (age = 23 ± 2, BMI = 23.05 ± 1.72) or obese (age = 24 ± 2, BMI = 32.39 ± 4.78), were exposed to a cell phone (1) close to the heart in silent mode, no ringing or vibrating; (2) close to the heart in ring and vibration mode; (3) next to the ear (brain) while listening; and (4) next to the ear while listening and speaking. Results The average basal HR of obese students significantly increased, while the PR interval; time domains, including standard deviation (SD) of all normal R–R intervals (SDNN), mean of the SD of all normal R–R intervals (SDNNi), SD of the average of normal R–R intervals (SDANN), and percentage of R–R intervals at least 50 ms different from the previous interval (pNN50); and high-power frequency (HF) decreased. The LF/HF ratio also significantly increased. The SDNN, SDNNi, SDANN, pNN50, and HF levels significantly decreased and the LF/HF significantly increased in normal-weight and obese individuals only when the phone was near the apex of the heart in ring and vibration mode. All changes were more profound in obese students. Conclusion Keeping the phone in a chest pocket reduced the HRV of normal-weight and obese medical students and exaggerated the effect of obesity on sympathetic activation.

This article is a comprehensive literature review on anatomical variations, shedding some light on their clinical significance, identification approaches, and teaching strategies. Anatomical variation is a normal presentation of body structure with morphological features different from those that have been classically described in several anatomy textbooks. Under normal circumstances, it has no impact on the function of the structure. However, it may influence different aspects of clinical practice. As a result, accurate knowledge of common anatomical variations in the treated area may improve clinical practice outcomes. On the other hand, anatomical variations are usually identified during routine dissection and clinical practice, including preoperative imaging and surgical procedures. Additionally, scientific research, such as observational studies using cadaveric dissection, medical images, and evidence-based anatomy, are effective approaches to identify anatomical variations. With regard to the teaching of anatomical variations, cadaveric dissection is the most commonly used and recommended learning tool for teaching anatomy and relevant variations in medical schools. However, the literature emphasizes introducing anatomical variations in the clinical phase of medical curricula and postgraduate training of surgical and radiological programs. The current study suggests creating a registry of anatomical variations encountered during practice that may enhance best care and prevent any confusion about those variations. In addition, there is a need to conduct more educational studies to research the best learning strategies for teaching and assessing anatomical variations in the medical curricula.

A spot test is commonly used to assess practical knowledge through a series of specific questions related to the marked anatomical structures on cadavers. However, the continuous reviewing and developing of the medical curricula demands the need to improve the assessment method of the practical examination of anatomical knowledge. Therefore, the aim of the study was to examine the effectiveness of a free response short-answer questions (FRSAQs) test and traditional questions on medical students' performance.This is an experimental study using a Randomized Posttest-Only Control Group Design to compare the mean of students' performance in addition to their perceptions about the two versions of the spot tests. Two hundred and ninety preclinical-year medical students were invited to participate in this study.Only 109 (38%) students participated in this study. The data analysis showed a significant improvement in students' performance in the FRSAQs test (5.3 ± 2.7) than the traditional spot test (4.7 ± 2.6), (P = 0.04). The majority of the students (70%) preferred the FRSAQs spot test, citing that it is good test to assess practical knowledge. The psychometric analysis revealed that the FRSAQs produced more ideal stations (60%) when compared to the traditional spot test (10%).The current study found that the FRSAQs spot test had a significant impact on students' performance, and it was considered an ideal, flexible, and stress-free assessment method when compared to the traditional spot test. Implementation of the strategy in teaching and in assessment is recommended.

Introduction Poor knowledge retention is one reason for medical student attrition in learning and has been a huge concern in medical education. Three-dimensional virtual reality (3D-VR)-based teaching and learning in medical education has been promoted to improve student learning outcomes. This study aimed to determine the effectiveness of 3D-VR in knowledge retention in human anatomy courses as compared to traditional teaching methods among medical students. Methods A convergent mixed methods design was utilized to evaluate learning outcomes in terms of short- and long-term knowledge retention scores among students using 3D-VR and those using traditional models and to describe students' experiences and views of the use of 3D-VR as a teaching and learning tool. Results Male students who used the 3D-VR tool had significantly higher short- and long-term knowledge scores than males who used the traditional methods. Meanwhile, females who used traditional methods showed significantly higher short-term knowledge scores than females who used 3D-VR. Conclusion Medical students described 3D-VR as a learning tool with a great deal to offer for learning human anatomy as compared to traditional methods. Therefore, we recommend adding the use of 3D-VR in the anatomy curriculum. However, several 3D-VR limitations were also identified, which may hinder its utilization for teaching and learning. These concerns must be addressed before 3D-VR tools are considered for implementation in medical education human anatomy courses.

The coracoacromial ligament (CAL) presents with variable morphology and plays a significant role in the development of subacromial impingement syndrome. Sectioning the CAL has been suggested to relieve impingement of the rotator cuff. The aim of the current study was to investigate the CAL attachment in relation with ligament morphology. The CAL was investigated in 220 cadaveric shoulders from 58 males and 59 females, with a median age of 82 years (range 53–102 years). CALs were classified according to three factors: (1) number of bands present; (2) shape; and (3) attachment to the acromial and coracoid processes. 35 (16%) CALs had a single band, 84 (38%) two bands, and 101 (46%) three or more bands. CAL shape was either broadband (14: 6%), quadrangular (21: 10%), Y-shaped (84: 38%), or multiple-banded (101: 46%). More ligaments were attached to the medial aspect of the acromion (60%) and medial end of the coracoid (75%) than those restricted to the anterior edge of the acromion (40%) and posterior aspect of the coracoid (25%). Multiple-banded ligaments attached significantly more medially at the acromion and coracoid processes, while single band ligament attachments were restricted to the anterior edge of the acromion and posterior aspect of the coracoid process. The CAL has variable morphology and attachments with interconnections to different structures around the shoulder. CALs with a medial acromial attachment may narrow the subacromial space leading to further shoulder impingement.

To understand the geometry of the proximal humerus and glenoid fossa to facilitate the design of components used in shoulder arthroplasty. The aim is to evaluate the geometry of the proximal humerus and glenoid fossa and their relationship using a MicroScribe 3D digitizer. Scans and measurements were obtained from 20 pairs of dry proximal humeri and scapulae [10 female and 10 male cadavers: median age 81 years (range 70–94 years)] using a MicroScribe 3D digitizer and Rhinoceros software. Means (±SD) of humeral inclination, medial wall angle of the bicipital groove, and radius of the humeral head values were 135 ± 11°, 39 ± 19°, and 14 ± 3 mm, respectively. Means (±SD) of glenoid height and width were 35 ± 4 and 26 ± 4 mm, while the means (±SD) of the angles of glenoid inclination, retroversion, and rotation were 87 ± 32°, 96 ± 10°, and 9 ± 6°, respectively. A significant difference in glenoid height (P ≤ 0.002) and width (P ≤ 0.0001) was observed between males and females, despite them having almost an identical radius of the humeral head, glenoid inclination, retroversion, and angle of rotation. There was also a significant difference (P ≤ 0.01) in the angle of glenoid retroversion between the right and left sides. Using a MicroScribe 3D digitizer, the glenoid fossa was observed to be significantly smaller in females than males; furthermore, there was a difference in glenoid retroversion between the right and left sides.

Background The definition of the bare spot and tubercle of Assaki is controversial, with studies reporting different incidences, locations, and clinical significance. The aims of this study were to evaluate the incidence of the bare spot, to determine the length and width of the bare spot, and to assess the relationship between the bare spot and tubercle of Assaki. Materials and methods A total of 140 shoulders from 30 men and 40 women were dissected and examined. After exposure of the glenoid fossa with the glenoid labrum attached, direct measurement of the length and width of the bare spot was undertaken using digital calipers. The repeatability and reliability of the measurements was assessed using Kruskal-Wallis one way analysis of variance on ranks, with statistical significance set at P Results A bare spot was observed in 80.7% (n = 113) of shoulders, being more common in men than in women, with an overall mean length and width of 7.2 mm and 6.2 mm. It was significantly longer ( P = .002) and wider ( P = .018) in men. Conclusion A bare spot exists within the glenoid fossa and differs from the tubercle of Assaki. It is a characteristic round to oval lesion in the central or eccentric cartilage. It should not be misdiagnosed as a pathologic lesion.

Objectives: Car accidents (CAs) are considered as one of the leading causes of mortality worldwide. They cause various ramifications on individuals and society, with fractures being a major one. Because of poor local epidemiological data, economic burden, and the enormity of the outcomes of CA, the aim of this study was to provide vital statistics about the most frequent sites of fractures due to CA. Methods: This is a retrospective cross-sectional study conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia. It included individuals who were admitted to the hospital with fractures from CA. The study looked for bone fractures related to CA, the length of hospital stay, the age, and the gender of each individual. The data included all patients aged ≥15 years who were admitted to inpatient departments from January 2011 to December 2015. Results: A total of 1396 individuals were included, of which 86% were male. The median age of injured patients was 26 years. The median length of hospital stay was 10 days. The most common fracture found was in the acetabulum (10%). The most common region to be fractured was the skull (n = 376, 27%). Males were more predisposed to fractures in the acetabulum (11%) and the base of the skull (10%). Females were more prone to develop fractures in the pubis (10%) and the malar and maxillary bones (9%). Conclusions: The study showed that the young population has the highest number of fractures after CA, and these fractures are common in the acetabulum and skull.

Although acromial morphology is classified as flat, curved, and hooked, whether the morphology is primary or acquired is debated. There have been no investigations on the effect of acromial spurs on acromial morphology. This study therefore aimed to evaluate acromial morphology in relation to spur formation at the anterior edge of the acromion. Acromial morphology was investigated in 40 scapulae taken from 20 cadavers (10 male and 10 female), with a median age of 82 years (range 62–97 years). Ink prints of the anteroposterior aspect of the acromion were used to evaluate acromial slope angle and curvature height in relation to spur incidence, length, and shape at the anterior edge of the acromion. Differences were observed in acromial morphology and acromial curvature in relation to acromial spurs (incidence, size, and shape). A hooked acromion was observed as a primary structure in 25% of specimens, which increased to 43% when acromial spurs were involved. No differences were observed in relation to sex or side, while a significant correlation was observed between acromial curvature and the age of the specimens. Acromial spurs increase acromial curvature and therefore change acromion morphology. Nevertheless, it is concluded that a hooked acromion occurs as a primary formed structure. Basic science study, anatomy, cadaver dissection.

Background:Although the glenoid labrum has an important role in shoulder stability, little is known about its composition, vascularity and innervation. The aims of this study were therefore to evaluate the histology, vascularity and innervation of the glenoid labrum.Materials and methods:Ten glenoid labrum specimens (three male, two female: mean age 81.2 years, range 76–90 years) were detached at the glenoid neck. Following decalcification, sections were cut through the whole thickness of each specimen perpendicular to the glenoid labrum at 12 radii corresponding to a clock face superimposed on the glenoid fossa. Then they were stained using haematoxylin and eosin, a silver nitrate protocol or subjected to immunohistochemistry using anti-protein gene protein 9.5 to demonstrate neuronal processes.Results:The labrum was fibrocartilaginous, being more fibrous in its free margin. There was a variable distribution of blood vessels, being more vascular in its periphery, with many originating from the fibrous capsule and piercing the glenoid labrum. Immunohistochemistry revealed positive staining of nerve fibres within the glenoid labrum.Conclusion:The glenoid labrum is fibrocartilaginous, being more fibrous in its periphery, and is vascularized, with the anterosuperior aspect having a rich blood supply. Free sensory nerve fibres were also present; no encapsulated mechanoreceptors were observed. The presence of sensory nerve fibres in the glenoid labrum could explain why tears induce pain. It is postulated that these sensory fibres could play a role in glenohumeral joint proprioception.

A notch is often observed on the anterosuperior aspect of the glenoid fossa, however its association with gender remains unexplored. The aims of this study were to: (i) investigate the incidence and type of glenoid notch, and (ii) its association with gender, age and side. A total of 140 shoulders from 30 male and 40 female cadavers were examined. All muscles and blood vessels surrounding the glenohumeral joint, as well as the fibrous capsule, were removed to expose the glenoid fossa: the presence of a notch was classified as type I (mild), type II (moderate) or type III (severe). The mean age of specimens was 81.5 years (±9.8 years). A type III notch was the most commonly observed (32 male, 21 female specimens), followed by type I (14 male, 34 female specimens) and finally type II (14 male, 25 female specimens). Multivariate analysis showed that the type of glenoid notch was significantly associated with gender (?2 (2, n=140) = 11.088, p = 0.004). Females are significantly more likely to have a type I or II glenoid notch, while males are significantly more likely to have a type III notch. This difference could explain the higher incidence of shoulder dislocation in males compared to females. A menudo se observa una muesca en el lado anterosuperior de la fosa glenoidea, sin embargo su relación con el sexo sigue siendo inexplorada. Los objetivos de este estudio fueron: (i) investigar la incidencia y el tipo de muesca glenoidea, y (ii) su relación con el sexo, la edad y el lado en el que se observa. Se examinaron un total de 140 hombros de entre 30 cadáveres masculinos y 40 femeninos. Todos los músculos y vasos sanguíneos que rodean la articulación glenohumeral, así como la cápsula fibrosa, fueron retirados para permitir el acceso a la fosa glenoidea: la presencia de la muesca fue clasificada como tipo I (leve), tipo II (moderado) o tipo III (grave). La edad media de los especímenes examinados fue de 81,5 años (± 9,8 años). La muesca de tipo III fue la más comúnmente observada (32 varones, 21 hembras), seguida por la muesca de tipo I (14 varones, 34 hembras) y finalmente seguida de la de tipo II (14 varones, 25 hembras). El análisis multivariado mostró que el tipo de muesca glenoidea está significativamente relacionado con el sexo (?2 (2, n = 140) = 11.088, p = 0.004). Las mujeres son significativamente más propensas a presentar una muesca glenoidea de tipo I o II, mientras que los varones son significativamente más propensos a presentar una muesca de tipo III. Esta diferencia podría explicar la mayor incidencia de luxación de hombro que se produce en los varones en comparación con la que se produce en las mujeres.

Objetivo: El propósito del presente estudio es evaluar la geometría del acromion en relación con las ruptura del manguito de los rotadores. Materiales y métodos: Se utilizaron 30 pares de escápulas, 20 del sexo femenino y 10 del sexo masculino, con una edad promedio de 82 años (con intervalo de 62 a 101 años). Las escápulas fueron escaneadas y las mediciones se realizaron con un digitalizador Microscribe 3D y el software de rinoceronte. Principales Resultados: La media encontrada para el ángulo de inclinación acromial y la vertiente fueron 38,70 ± 5,91° y 48,87 ± 9,94° respectivamente. La media de los ángulos acromial lateral y acromio-glenoideo fueron 81,13 ± 8,72° y 182,80 ± 12,09°, respectivamente. Las distancias entre el acromial (la extremidad anterior y posterior) y el glenoideo fueron 28,7 ± 3,77 mm y 20,75 ± 4,45 mm, respectivamente. Los ángulos entre el acromion y la glena son más grandes en el lado izquierdo en comparación con el lado derecho, 186.49° y 179,16° (P

Incidence of anterior cruciate ligament (ACL) rupture and its consequent reconstruction is on the rise. In contributing to the achievement of anatomic reconstruction this study seek to provide information regarding the position and variability of the tibial attachment sites, dimensions of femoral insertions and compare these measurements in males and females, and in right and left knees. Thirty one cadaveric knees (15 right and 16 left from 9 females and 7 males, mean age 77 years) were dissected. Various ACL footprint dimensions were taken. The mean length and width of the tibial anteromedial (AM) bundle footprint were 8.9 and 9.8 mm while that of the posterolateral (PL) bundle were 9.3 and 8.0 mm respectively. The mean length and width of the tibial AM and PL bundles in males were 8.5 and 9.8 mm, and 9.1 and 8.3 mm while corresponding values in females were and 9.2 and 9.7 mm, and 9.4 and 7.8 mm respectively. Males had larger femoral footprints (P=0.020) and tibial plateau (P