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On two muscle anomalies of the lower extremity.

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ON TWO MUSCLE ANOMALIES OF THE LOWER
EXTREMITY
J. PARSONS SCHAEFFER
Yale Universitu
From the Anc~tomicalLabornlory of the Yule M e d i c a l School
TWO F I G U R E S
The anomalous muscles described and figured in this brief
note were encountered, among others, in the Anatomical Laboratory of the Yale Medical School, during the session of 1911-12.
The muscles to be considered are (A) an anomalous sartorius
(fig. 1) and (B) a well differentiated and developed tensor fasciae
suralis (fig. 2 ) . Since both of the anomalies are of rather infrequent occurrence a descriptive note on the anatomy of the muscles
may not be amiss at this time.
It is well known that the sartorius muscle is occasionally wholly
or partially duplicated. Cases have also been reported in which
the muscle was rendered digastric by an intervening tendon, or
merely crossed by a tendinous inscription. The muscle also
varies in its origin and insertion, and i t is very rarely entirely
absent. The anomalies and comparative anatomy of this muscle are fully considered by Dr. LeDouble in his ‘Trait6 des Variations du SystGme musculaire de l’Homme,’ to which the reader
is referred.
The anomalous sartorius muscle in question was found on the
left side of a white, male cadaver, aged approximately sixty-five
years. The muscle was duplicated for a goodly portion of its
course and incidentally it had two heads of origin (fig. 1).
1
THE A N A T O M I C A L R E C O R D , VOI.. ’i, X O . 1
JANUARY.
1913
2
J. PARSONS SCHAEFFER
The lateral head of the anomalous muscle represented the normal
sartorius in every respect; arising, as is usual for the normal
muscle, from the anterior superior spine of the 0s ilium and from
the area of the latter immediately caudal to its anterior superior
spine. After taking the usual course of the normal muscle and
uniting with the medial or anomalous head, the combined heads
inserted on the medial surface of the tibia near its tuberosity and
into the neighboring deep fascia of the leg (fig. 1).
The medial or anomalous head arose by means of a very narrow
but distinct tendon from the eminentia iliopectinea, just medial
to the psoas major muscle and the external iliac vein. The tendinous head of origin at once passed dorsal to the external iliac
vein, and after reaching a point immediately distal to the inguinal
ligament of Poupart the tendon passed dorsal and between the
femoral artery and the femoral vein, here resting on the iliopsoas
musc’e. The medial head then deviated lateralward and passed
between the femoral and profunda femoral arteries, i.e., the head
was ventral to the latter vessel and dorsal to the former. The
medial head here was just distal to the point of origin of the profunda femoral (fig. 1).
The medial head now became fleshy and coursed ventral to
some of the branches of the femoral (anterior crural) nerve, and
from here took a course more or less parallel to the lateral head
of the sartorius, and at a plane ventral to the femoral artery a n d
the vastus medialis muscle.
At a point 17 em. from the insertion of the anomalous sartorius
muscle its medial and lateral heads joined, and from here the
two heads coursed as a single muscle to the usual point of inscrtion of the normal sartorius (fig. 1).
The fleshy portion of the medial head was 24 em. long and
the tendinous portion measured about 7 cm. in length. The
fleshy portion of the medial head had a more or less uniform
breadth of 4 mm. and the tendinous portion measured uniformly
slightly less than 1 mm. in breadth.
Both heads of the muscle were supplied by branches from thr
femoral (anterior crural) nerve.
MUSCLE ANOMALIES O F T H E LOWER EXTREMITY
3
B. MUSCULUS TENSOR FACIAE SURALIS
Supernumerary inuscles of the dorsum of the thigh and calf
of various dispositions and types have been observed and reported
by a number of anatomists; however the cases in which additional muscles appear in the thigh and sural regions are not very
common. Gruber, Halliburton, Kelch, LeDouble, Testut, Turner, and others have observed supernumerary muscles of these
regions.
One-bellied supernumerary muscles arising from the biceps
femoris muscle and inserting into the tendo calcaneus (Achillis)
have been described by Kelch, Gruber, Turner, and others.
Halliburton observed a ‘ supernumerary two-bellied slip of the
biceps being continued into the gastrocnemius.’ Gruber reported
a similar case of a digastric supernumerary muscular slip which
arose from the long head of the biceps femoris muscle and inserted
into the tendo calcaneus (Achillis), and another one-bellied
slip which also arose from the long head of the biceps femoris
but which inserted into the fascia suralis. Turner and Gruber
reported muscular slips with similar insertions into the fascia
suralis but the origin of those slips was from the semitendinosus
muscle. Turner
a m. tensor fasciae poplitealis
also S:LW,
which arose by two heads; one, a broad, thin band of muscle arose from
the linen nspera, betwccn the origins of the short head of the biceps and
the vnstus externus, and the fibers of which passed directly backwards;
the other arose from the long tendon of the biceps, 4 inches below the
ischial tuber, and passed down the back of the thigh to join the other
head. and to be inserted along with it into the deep surface of the fascia
st the upper angle of the popliteal space.
The reader is referred to the writings of Gruber, LeDouble,
and Testut for a fuller consideration of the supernumerary muscles of these regions.
The supernumerary muscle-the subject of this note-was
found on the right side of a male cadaver, aged sixty-four years.
The muscle obviously tensed the sural fascia when in action and
doubtless should be classed as a ‘tensor fasciae suralis muscle.’
4
J. PARSONS S C H A E F F E R
I t s anatomy fit fairly well the description given by Wenzel
Gruber for a supernumerary muscle of this region observed by
him.
The tensor fasciae suralis muscle in question (fig. 2) was well
differentiated and strongly developed, more or less fusiform in
shape, and about 5 inches in length. I t arose by means of a distinct tendon which was more or less confluent with the tendon
of‘ the long head of the biceps femoris muscle.
its point of
origin the accessory muscle was somewhat hidden by the overlying long head of the biceps fernoris.
,\fter arising from the latter, the tensor fasciae suralis soon
became fleshy and took a direction more or less parallel to the
long head of the biceps femoris muscle, and in its course bounded
the popliteal space laterally.
The muscle again became tendinous and after an expansion
of this tendon the musclc inserted into the sural f2scia over
the latcrnl head of the gastrocnemius muscle, just distal to the
popliteal space (fig. 2). At the point of inscrtioii of the tensor
fasciae suralis muscle it more or less replaced the usual fibrous
prolongations from the tendon of the biceps femoris muscle into
the sural fascia.
The supernumerary muscle was supplied by a twig from the
nerve to the long head of the biceps fernoris muscle which was
supplied by a branch from the great sciatic nerve (n. ischiadicus).
The cadavera in which the aforementioned anomalous inusclrs
were found were dissected by Messrs. Berman and Gaylord, of
the class of 1915, Yale Medical School.
LITERLllTU1lE CITED
G R ~ B E I\VENZEL
~,
1870 Bull. de 1’Acnd. imp. d e S t . Petersburg.
1871-72.
I‘cbcr cinen vom SIusculus Scmitendinosus abgegrrigcnen 3Iusculus
tensor fasciae suralis. SIclnngas b i d . .\end. imp. d. sc. d e St. Petcxrsburg, vol. 8, pp. 437440.
1879 Uchcr d i e ungewvijhnlichen RIusculi tensores fasciac s u r d i s h i i n
Menschen. M6langes biol. Acad. imp. d. sc. de St. I’ctcrsbmg, vcrl.
10, pp. 199-209.
MUSCLE ANOMALIES O F THE LOWER EXTREMITY
5
E L 1879 Bcobachtungen aus der menschlichen und vcrgleichcnden Anatomic, 2 Heft, Berlin.
Har,r,muiwo;v, IV. D. 1881 Remarlcable abnormality of the musculus biccps
flexor cruris. Jour. Anat. and Physiol., vol. 15, p. 296.
I<KLCFI,
\VII,IIELN G. 1813 l\bweichung des Biceps Fcmoris. Beitragc z. pathol.
-Anatomic., Ed. 8, art. 36, s. 42.
T , ~ l > o r u r ,A.
~ ~F.
, 1897 Triiit6 dcs variations du systi.me musculaire de I’homnic.
Paris.
TESTLIT,
L. 1884 Les anom:ilics musculaircs chcz I’hommc expliqu6es par 1’:matomic cornpark, lcur importance cn anthropologie. Paris.
1892. IAXanomalics rnuscu1:iiron considerks ziti point dc vuc de la ligature des arti:rcs. Paris.
1 C I ~ K E I L , i V . 1872 iIlriscu1:rr systeiri.
series, vol. 5), 11. 441.
, I
Jorir. hn:it. : ~ n d Physiol., vol. G (2d
1885 I’rcsencc of :m accrssory sural muscle.
vol. 19, 1’. 334.
Jour. Anat. and Physiol..
PLATE 1
EXPLAXATIOX OF F I G U R E S
1 Drawing from an actual dissection of the ventral aspect of the thigh. N o
detailed drawing of the dissection was attempted. The anomalous sartorius
muscle with its partial duplicity and double head of origin should especially be
noted. The medial or anomalous head passes between the femoral and profunda
femoral arteries and then t o its point of origin on the iliopectineal eminence:
(see text for a further consideration of thc sartorius muscle).
2 Drawing from a n actual dissection of the dorsum of the thigh and the most
cephalic portion of the s u r d region. The details of the dissection are purposely omitted in the drawing. The supernumerary tensor fasciae suralis muscle
should especially be noted; (for a. description of this muscle, see text).
MUSCLE ANOJIALIES O F THE LOWER EXTREMITY
J. P 4 R S O Y S SCHALPFFER
7
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