Morphological study of the muscle bone interface in man

MORPHOLOGICAL STUDY OF THE MUSCLE- BONE INTERFACE IN MAN THESIS Submitted for the partial Fulfillment of the Master degree "M.Sc." in Anatomy Presented by HESHAM NOAMAN ABDEL RAHEEM MUSTAFA M.B., B.Ch.

Supervised by

DR. MOSTAFA KAMEL IBRAHIM ELSAYED Professor of Anatomy Head of Anatomy Department, Faculty of Medicine Ain Shams University

DR. FOUAD YEHIA AHMED Professor of Anatomy Anatomy Department, Faculty of Medicine Ain Shams University

DR. HASSAN MOSTAFA SERRY Professor of Anatomy Assistant Anatomy Department, Faculty of Medicine Ain Shams University

2003

Introduction and Aim of the work Each skeletal muscle has at least two attachments; one at each end. These attachments might be purely tendinous, fleshy, or an admixture of flesh and tendon. The pure tendinous, always leave a smooth mark on the bone, the fleshy ones generally leave no mark on the bone, while the rough marks are made where there is an admixture of flesh and tendon (Last, 1978). Tendons are usually attached to mark bony processes either on the epiphyses e.g. the attachment of iliopsoas to the lesser trochanter, or the diaphyses as in most of the fleshy attachments e.g. Deltoid insertion. (Biermann et al., 1975).

Most tendons present four histological zones at their bony attachments: dense fibrous tissue, uncalcified fibrocartilage, calcified fibrocartilage, and bone (Benjamin et al., 1986; Benjamin & Ralphs, 2001). The presence of the uncalcified fibrocartilage offers some protection from wear and tear, while the calcified fibrocartilage anchors the tendon to the bone and enables it to withstand shear so that traumatic avulsion of tendon insertion rarely occur at the actual interface with bone (Clark & Stechschulte, 1998).

The muscle – bone interface show considerable regional heterogenicity in different tendons ,that should be taken in consideration for selecting tendons for particular surgical transfers or joint reconstruction (Benjamin et al., 1995).

Reviewing literature, a lot of papers dealt with the tendinous – bone attachment while few studies has been found to investigate the fleshy- bone attachment .Therefore ,the present study aims at investigating the structure of fleshy muscle-bone interface in selected limb muscles of man, both macroscopically and microscopically .

Material and Methods

Two types of muscle – bone interface will be used in the present study; namely: muscle with broad attachment as brachialis and another possessing a linear attachment as brachioradialis. The specimens will be taken from the dissecting room dissected by scalpel and bone nibbling forceps to remove the whole interface up to the bone.

The specimens will be fixed in 10% neutral formalin, decalcified in Eddeta followed by ascending dehydration and paraffin embedding.

Serial sections of 8 thick will be taken with the long axis of the tendon, and at right angle to the bone. They will be stained with haematoxylin and eosin, Masson's trichrome for light microscopy examination.

References 1. Benjamin, M., Evans, E.J., and Copp, L. (1986): The histology of tendon attachments to bone in man. J. Anat., 149: 89-100.

2. Benjamin, M. Qin, S., and Ralphs, J.R. (1995): Fibrocartilage associated with human tendons and their pulleys. J. Anat., 187: 625-633.

3. Benjamin, M., and Ralphs J.R. (2001): Entheses - the bony attachments of tendons and ligaments. Ital. J. Anat. Embryol., 106: 151-157.

4. Biermann,H.(1975): Die knochenbildung im Bereich periostalerdiaphysarer Sehnen- und Bandansatze. Zeitschrift fur Zellforschung und mikroskopische Anatomie 46,635-671.

5. Clark, J., and Stechschulte, D.J. Jr. (1998): The interface between bone and tendon at an insertion site: a study of the quadriceps tendon insertion. J.Anat., 192: 605-616.

6. Last, R. J., (1978): Tissues and structures. In: Anatomy Regional and Applied, 6th ed., Churchill Livingstone. pp6.