A number of studies have looked at the incidence of cervical rib in various ethnic groups, but have a number of limitations. This is the first large scale study looking at the incidence in White British with direct comparison to the Asian population. A total of 1545 consecutive cervical spine radiographs performed for any reason were collected and reviewed. 5.9% of White British and 24.9% of Asian patients had evidence of cervical rib. This was statistically significant (p<
0.0001, χ2 test). Asians are 5 times more likely compared to White British to have cervical rib (OR=5.303, 95% CI=3.825–7.354). An analysis of male Vs female difference as well as incidence of the various subtypes of cervical rib will be presented. We reccomend that the results of this study should
be considered in the assessment of patients with symptoms of thoracic outlet syndrome, taken into account during review of cervical spine radiographs and included in anatomy textbooks in the future.
In addition, using the characteristics of the inserted screw as a scaleable marker, it was calculated what would have been the optimum length of screw thread in order to maximise screw thread length in the target bone whilst preventing the screw threads being across the fusion site.
Currently available screws have thread lengths that are either too long (breaching the fusion site) or too short for ideal fixation and we propose a different thread length to those currently available. However, even with current screws, we found no correlation between thread length, thread positioning across the fusion site and non-union.
A significant number of patients return with persistent symptoms following surgical release of the posterior interosseous nerve for radial tunnel syndrome. The aim of this study was to attempt to explain this fact in anatomical terms by defining the anatomy of the posterior interosseous nerve and its branches in relation to the supinator muscle and arcade of Frohse. Using standard dissection tools 20 preserved cadaveric upper limbs were dissected. The radial nerve and all its branches within the radial tunnel were exposed and a digital calliper was used to measure distances. The bifurcation of the radial nerve to posterior interosseous nerve and superficial sensory branch occurred at a median distance of 4.35mm proximal to the elbow joint-line. The bifurcation was proximal to the joint-line in 11 cases, at the level of the joint-line in one case and distal in eight cases. There was a range of 0–5 branches to the supinator originating proximal to the entry point of the posterior interosseous nerve under the arcade of Frohse at a median distance of 10.27mm (medial branches) or 11.11mm (lateral branches) distal to the elbow join-line. These branches either passed under the arcade of Frohse or entered through the proximal edge of the superficial belly of the supinator. In 10 limbs there was a variable number of branches to the supinator originating under its superficial belly and in five limbs multiple perforating posterior interosseous nerve branches within the muscle were identified. This variation in anatomy we believe may explain the persistence of symptoms following surgical release of the posterior interosseous nerve for radial tunnel syndrome and suggests that careful exploration of all the nerve branches during surgical decompression should be routinely performed.