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Let's talk about long bones the anatomical considerations

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for biopsy.

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Briefly, let's run through the long bones. The humerus. We

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think about the humerus. We want to avoid. Of course the nerves radial

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and ulnar being the most important

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the cephalic veins which are typically very

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superficial in nature lateral in location.

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We want to think about arteries which

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usually are a little deeper recurrent radial arteries

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running laterally into the upper arm

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and then the biceps tendon in the region of the elbow and

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the pectoralis muscle, which is essentially more proximately.

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We want to think about in the forearm.

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What are the structures we want to avoid here? We want

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to think about nerves. For example last thing we want to do is

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provoke a neuropathy in the radial all in our

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median nerves. We also don't want to provoke bleeding. So

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we want to identify the lateral radial artery and

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the more medial owner artery. We would identify the extensor tendons

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Regional to the Elbow that could

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cause pendantopathies and tendonities tendon.

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Apathies are pesky injuries that

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can really be avoided by understanding where these

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tendons are in space. And then when it

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comes to the pelvis, we want to consider multiple structures the

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sciatic nerve being sort of one of the more common

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nerves accident Freeman think about

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muscles that can cause weakening and

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pesky injuries you to traversion of

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the biopsy needle through these sites the gluteus and

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the rectus femoris muscles mean those that we would

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call to mine and when we think about the femur the head

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and neck Junction, we want to be thinking about the femoral

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Triangle thermal triangle has the

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thermal neurobascular bundle. We think about the femoral

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nerve think about the common formula artery

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think about the vein itself, which are usually

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relatively superficial in that femal triangle

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region. We want to think about the lateral scrambled circumflex. That's Rising

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sort of laterally just distal to

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that from a triangle off of the profunda femoris

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or in some cases off of the comment femoral artery

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and the greater Crow County Bursa, which when provoked

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good cause bursitis reactively

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or infection,

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When we think about the shaft of the femur, it's important to

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consider the vasculature and the nerves

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whereas the sciatic nerve terminating. Where is

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the position of the profunda femoris because

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this is going to be a deep artery that could get

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very close to the Bone when we're thinking about the rectus femoris

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and the vastus intermedius. There are the muscles themselves

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that are being Traverse, but then there are also the tendons

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that can be Traverse. So we want to be very mindful

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of where I need all eyes in space when it

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comes to the distal femur. There is the popular teal

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fossa the distal portions of the sciatic

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nerve. We want to be thinking about the

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tibial nerves which when traversed

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or an average can cause pain and

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parthenians and some weakness to

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the leg and foot the common fabula nerves which can

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cause sort of parathys and numbness in sort

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of the lateral posterior lateral compartments of the

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leg. We want to think about the arteries in that region.

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The popular artery obviously being very close to the

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bone in some cases and the superior geniculate and

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lateral geniculate vessels that come off of the papature artery.

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And then of course we want to think about the popliteal vein to be

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in fibula. The lower leg is one that

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we really want to identify and be clear

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on where the nerves are. The perineal nerve is. The peroneus tendons

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are ones that are often overlooked, but certainly the parallel

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nerve can provoke a particularly problematic neuropathy

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when touched or damaged

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or traversed if we want to sort of call that in mind

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in its lateral region when it comes to the spine

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cervical spine to sacrum very

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important to understand all the structures that

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are Regional to this and this little laundry list is

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important because there are many structures from the

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base of the spine in the region of

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the sacrum and coccyx the gastrointestinal organs

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that are sort of overlying the

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spine. You have the trachea.

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Sins of the aerodyestive tract Regional to

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the spine in the region of the thorax. We have

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the lungs Regional on either side

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and then vascular structure. So say order superior vena

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cava inferior vena cava that sort

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of sit relative Regional to the spine. So

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very important to know that when we're perhapsing these

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structures if we were to go past the site we could

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enter one of these structures inadvertently. So we

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want to sort of keep those in mind. And so wherever we

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are in space weather in the cervical region or the thoracic region

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again, if we're targeting the vertebra, if

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we go deep to that region again, we maybe

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hammering or using a drill so we want to

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make sure that we're very respectful of what lies beyond

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the spinal column so that we don't enter

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an anatomic site inadvertently.