RELEVANT REVIEW
A Need for Logical and Consistent Anatomical Nomenclature
for Cutaneous Nerves of the Limbs
Thomas R. Gest,* William E. Burkel, Gerald W. Cortright
Division of Anatomical Sciences, University of Michigan Medical School, Ann Arbor, Michigan
The system of anatomical nomenclature needs to be logical and consistent. However,
variations in translation to English of the Latin and Greek terminology used in Nomina
Anatomica and Terminologia Anatomica have led to some inconsistency in the nomencla-
ture of cutaneous nerves in the limbs. An historical review of cutaneous nerve nomencla-
ture reveals that there are two general naming conventions: one primarily American and
one primarily British. The American convention presents cutaneous nerves of the limbs in
the format ``medial brachial cutaneous nerve,'' while the British convention presents the
same nerve as ``medial cutaneous nerve of the arm,'' thereby translating ``brachii'' to ``of
the arm.'' If logically and consistently applied throughout the body, the British conven-
tion would rename the sural nerve to the ``nerve of the calf,'' the brachial artery would
become the ``artery of the arm,'' the femoral nerve would be ``nerve of the thigh,'' and
femur would be ``bone of the thigh'' or ``thigh bone.'' The British convention leads to
many other nomenclatural inconsistencies, which would seem to make learning anatomy
more difficult for the beginning student. In this era of contracting anatomy curricula,
every effort should be made to keep anatomical nomenclature simple, logical, and
consistent. Anat Sci Ed 2:126134, 2009. 2009 American Association of Anatomists.
Key words: cutaneous nerves; anatomical terminology; anatomical nomenclature; Termi-
nologia Anatomica; FCAT
INTRODUCTION numerous adjustments to the system of anatomical terminol-
ogy, culminating in 1998 with the publication of Terminolo-
Anatomy teachers know that the primary task that confronts gia Anatomica or TA (FCAT, 1998). In this guide, Latin/
the student of gross anatomy is the acquisition of a new Greek terms are accompanied by English equivalents. How-
vocabulary of human body structure. At one time, prior to ever, it is the English equivalent that presents a problem. In
the establishment of international nomenclatural rules, the preface to TA, it is stated that Latin terms would be
anatomical terminology as presented in textbooks contained ``accompanied by a term in current usage in English-speaking
a morass of descriptive terms and eponyms. Colorful terms, countries'' (FCAT, 1998). The problem arises as to which
such as the musculospiral nerve for the radial nerve (Gray, terms are considered to be in current usage in English-speak-
1858) and Poupart's ligament for the inguinal ligament (Gray, ing countries.
1858), may have been memorable, but without international Unfortunately, the Latin anatomical terminology in TA
standards, nomenclature varied considerably from text to can be translated in various ways, and the resulting variation
text. With the establishment of the Basle Nomina Anatomica in terminology can, and almost certainly does, cause confu-
in 1895 (His, 1895), anatomy nomenclature was placed on a sion for the beginning student of anatomy. Most of the varia-
path of regulation and standardization. There have been tions in translation occur in the terminology for the cutane-
ous nerves of the limbs. As an example, TA offers two
acceptable English equivalents for ``Nervus cutaneous brachii
*Correspondence to: Dr. Thomas R. Gest, Division of Anatomical medialis'': ``medial brachial cutaneous nerve'' and ``medial
Sciences, University of Michigan Medical School, Ann Arbor, MI cutaneous nerve of the arm.'' To the seasoned anatomist,
48109-0608, USA. E-mail: gest@umich.edu these are obviously alternate translations. However, to the
Received 22 April 2009; Revised 8 May 2009; Accepted 11 May 2009. beginning student of anatomy, the relationship between these
Published online 8 June 2009 in Wiley InterScience (www. terms may not be clear at all. To investigate the source of
interscience.wiley.com). DOI 10.1002/ase.90 this potential confusion, we have undertaken an historical
review of the terminology used for cutaneous nerves of the
2009 American Association of Anatomists limbs. In the hope of saving future students from unnecessary
Anat Sci Ed 2:126134 (2009) MAY/JUNE 2009 Anatomical Sciences Education
sources of confusion, we propose a modification to our ized in Figure 1. It is not at all surprising that all but 12 of
system of nomenclature that employs logic and consistency. the authors of American nomenclature books had affiliations
with American schools, but it is somewhat surprising that
none of the 12 with non-American affiliations were British.
MATERIALS AND METHODS On the other hand, 16 of the books using the British nomen-
clature system had authors with American affiliations, and 28
One hundred and fifty-two anatomy books and atlases in the
were not affiliated with British schools. Of the 16 books
holdings of the authors and the University of Michigan Medi-
using the British nomenclature system by authors with Ameri-
cal Library were reviewed to discern the type of terminology
can affiliations, 7 were published within the past decade, and
used for the cutaneous nerves of the limbs. These extensive
5 within the past 4 years. The first text by an American
holdings, while not comprehensive, represent a reasonable
author using the British nomenclature system appeared in
sampling of anatomy textbooks and atlases used during the
1959 (Francis, 1959). Unfortunately, it was not always possi-
past century and a half. The year of publication, affiliation(s)
ble to discern the place of training of authors, and undoubt-
of the author(s), and classification of the terminology were
edly this may have influenced the choice of nomenclature sys-
recorded. Five categories of terminology were determined.
tems. Of the 12 authors using the British nomenclature sys-
Category 1 was termed ``unclassified,'' and these books did
tem with affiliations at schools other than British or
not follow TA or Nomina Anatomica (IANC, 1983). Cate-
American, there were eight authors with affiliations in Can-
gory 2 was termed ``untranslated,'' and these books retained
ada, and one each from France, Australia, India, and the
the original Latin terminology. Category 3 was termed
Netherlands.
``American,'' and these books used the format ``medial brach-
ial cutaneous nerve.'' Category 4 was termed ``British,'' and
these books used the format ``medial cutaneous nerve of the
arm.'' Category 5 was termed ``both,'' and these books used DISCUSSION
both American and British systems at various locations within
As teachers of anatomy, we strive to make our subject acces-
the limbs. As seen in the results, Category 3 was termed
sible for our students. The most difficult task in learning
``American'' because the majority of authors using this termi-
anatomy is mastering the huge new vocabulary of the human
nology had affiliations with U.S. schools. Similarly, Category
body. It should be our goal, then, to present anatomical ter-
4 was termed ``British'' because authors in this category were
minology in the most comprehensible manner possible. We
most commonly affiliated with British schools. The relation-
suggest that a logical and consistent translation of the Latin
ship between terminology category and affiliation is treated
that serves as the foundation of anatomical terminology is
in greater depth in the results section.
our duty as anatomy educators. Confusion results when the
Latin terminology is not translated consistently and logically.
RESULTS In the British nomenclature system, Latin translation occurs
in one manner for cutaneous nerves, and in another manner
Table 1 shows the classification data of the anatomy texts for other structures. Hence, in the British system, ``arteria
used in the present study. Five books were placed in Category femoralis'' is ``femoral artery,'' and ``nervus femoralis'' is
1, the ``unclassified'' category. Three of these (Bell, 1834; ``femoral nerve,'' but ``nervus cutaneus femoris lateralis'' is
Gray, 1858; Wilson, 1858) predated the Basle Nomina Ana- ``lateral cutaneous nerve of the thigh.''
tomica (His, 1895), while the most recent ``unclassified'' text The conflict of logical and consistent translations is partic-
was on surgical anatomy (Piersol, 1923). Nine books were in ularly evident where the limbs meet the trunk. Here, in the
Category 2, ``untranslated,'' meaning that Latin terminology upper limb, we find the intercostobrachial nerve communicat-
was used, and most of these texts were English editions of ing with the medial brachial cutaneous nerve or, if the British
German texts (i.e., Anson, 1950; Anson and Maddock, 1952; system is logically applied, the medial cutaneous nerve of the
Pernkopf, 1964, 1980; Spalteholz, 1900; Spalteholz and arm communicates with the intercostal nerve of the arm. In
Spanner, 1967). In Category 5, 13 books used ``both'' the the American system, the anterior thigh is innervated by the
American and British nomenclature in various locations. lateral femoral cutaneous nerve, anterior femoral cutaneous
(DiDio, 1970; Tobin, 1973; McMinn et al., 1984; Gosling branches of the femoral nerve, and the femoral branch of the
et al., 1985; Martin, 1985; Callas, 1994; Ger et al., 1996; genitofemoral nerve, whereas in a consistent application of
Backhouse and Hutchings, 1998; Putz and Pabst, 2000; Lum- the British system, this region is supplied by the lateral cuta-
ley et al., 1995, 2002; Rohen et al., 2002; Abrahams et al., neous nerve of the thigh, anterior cutaneous branches of the
2003). For most of these, the British system was used in the thigh nerve, and the thigh branch of the genital thigh nerve.
upper limb while the American system was used in the lower The Terminologia Anatomica itself exhibits inconsistency
limb. For several books, the ``lateral femoral cutaneous in translation. As an example, the ``os femoris'' is translated
nerve'' was the only exception to an otherwise British rule. as ``thigh bone,'' while ``corpus femoris'' is ``body of femur''
One of the ``both'' books was atypical in presenting the Brit- and ``caput femoris'' is ``head of femur.'' If translation to Eng-
ish nomenclature with the American nomenclature in lish equivalents were consistent, ``corpus femoris'' would be
parentheses. translated to ``thigh body'' and ``caput femoris'' would be
Seventy-five books were placed in Category 3, using the ``thigh head.'' As noted earlier, ``n. cutaneus femoris lateralis''
American nomenclature system, while 50 books were placed is translated in TA to ``lateral cutaneous nerve of the thigh,''
in Category 4, the British nomenclature system (refer to Table while ``n. cutaneus surae lateralis'' is translated to ``lateral
1). The first book to use the American nomenclature sural cutaneous nerve'' and ``n. suralis'' is ``sural nerve.'' For
appeared in 1906 (Sobotta and McMurrich, 1906) while the the nomenclature system to be consistent and logical, this
first book to use the British nomenclature appeared in 1937 should be ``lateral cutaneous nerve of the calf,'' and ``n. sura-
(Pauchet and Dupret, 1937). The historical data are summar- lis'' should be ``calf nerve.''
Anatomical Sciences Education MAY/JUNE 2009 127
Table 1. Table 1.
Anatomy Texts Classified by Nomenclature System (Continued)
Publication Publication
Author(s) date Title Author(s) date Title
Category 1: Unclassified nomenclature Beck 1982 Mosby's Atlas of
Functional
Bell 1834 The Anatomy and Human Anatomy
Physiology of
the Human Body, Brantigan 1963 Clinical Anatomy
Vol.1
Christensen 1966 Synopsis of Gross
Gray 1858 Anatomy, Descriptive and Telford Anatomy
and Surgical
Chung 1991 Gross Anatomy
Pick and 1901 Anatomy, Descriptive
Howden and Surgical Clemente 1975 Anatomy: A Regional
Atlas of the Human
Piersol 1923 Human Anatomy Body
Wilson 1858 A System of Human Clemente 1985 Gray's Anatomy
Anatomy
Clemente 1997 Anatomy: A Regional
Category 2: Untranslated nomenclature Atlas of the Human
Body
Anson 1950 An Atlas of Human
Anatomy Colborn and 1993 Clinical Gross Anatomy
Skandalakis
Anson and 1952 Callander's Surgical
Maddock Anatomy Crafts 1966 A Textbook of Human
Anatomy
Callander 1933 Surgical Anatomy
Crafts 1985 A Textbook of Human
Callander 1939 Surgical Anatomy Anatomy
Pernkopf 1964 Atlas of Topographical Crouch 1972 Functional Human
and Applied Human Anatomy
Anatomy
Dawson 1996 Basic Human Anatomy
Pernkopf 1980 Atlas of Topographical
and Applied Human Frick et al. 1991 Human Anatomy
Anatomy
Gardner and 1973 Structure of the Human
Spalteholz 1900 Hand-Atlas of Human Osburn Body
Anatomy
Gardner and 1978 Anatomy of the Human
Spalteholz 1967 Atlas of Human Osburn Body
and Spanner Anatomy
Gest and 1994 Medcharts: Anatomy
Wolf-Heidegger 1962 Atlas of Systematic Schlesinger
Human Anatomy Goss 1954 Gray's Anatomy of the
Human Body
Category 3: American nomenclature system
Goss 1959 Gray's Anatomy of the
Agur 1991 Grant's Atlas of Human Body
Anatomy
Goss 1966 Gray's Anatomy of the
Agur and 2005 Grant's Atlas of Human Body
Dalley Anatomy
Gottlieb 1964 Anatomy Review
Anson 1966 Morris' Human
Anatomy Gray 1948 Anatomy of the Human
Body
Arnold 1968 Reconstructive
Anatomy Hall-Craggs 1990 Anatomy as a Basis for
Clinical Medicine
128 Gest et al.
Table 1. Table 1.
(Continued) (Continued)
Publication Publication
Author(s) date Title Author(s) date Title
Hansen 1998 Essential Anatomy Lopez-Antunez 1971 Atlas of Human
Dissector and Gasparo Anatomy
Healey 1969 A Synopsis of Mizeres 1981 Human Anatomy: A
Clinical Anatomy Synoptic
Approach
Hollinshead 1969 Anatomy for
Surgeons Moore 1992 Clinically Oriented
Anatomy
Hollinshead 1974 Textbook of
Anatomy Netter 1987 The Ciba Collection
of Medical
Hollinshead 1985 Textbook of Illustrations
and Rosse Anatomy
Netter 1989 Atlas of Human
Huber 1930 Piersol's Human Anatomy
Anatomy
Netter 2006 Atlas of Human
Jackson 1914 Morris's Human
Anatomy
Anatomy
Olson and 1996 A.D.A.M. Student
Jacobs 1989 Shearer's Manual of
Pawlina Atlas of Anatomy
Human Dissection
O'Rahilly and 1983 Basic Human
Kahle et al. 1992 Color Atlas and
Mu eller Anatomy: A
Textbook of
Regional Study of
Human Anatomy.
Human Structure
Vol. 1 Locomotor
System
O'Rahilly 1986 Anatomy: A
Regional Study
Kanagasuntheram 1987 Anatomy: Regional,
of Human
et al. Functional, and
Structure
Clinical
Pansky and 1975 Review of Gross
Langebartel 1977 The Anatomical
House Anatomy
Primer: An
Embryological Philo et al. 1985 Guide to Human
Explanation of Anatomy
Human Gross
Morphology Quiring and 1960 The Extremities
Warfel
Langman and 1978 Atlas of Medical
Woerdeman Anatomy Rarey et al. 1994 Human Anatomy:
Manual of Human
Leeson and 1972 Human Structure: A Dissection
Leeson Companion to
Anatomical Rosse and 1997 Hollinshead's
Studies Gaddum- Textbook of
Rosse Anatomy
Leonard 1995 Human Gross
Anatomy Schaeffer 1942 Morris' Human
Anatomy
Lewis 1918 Gray's Anatomy of
the Human Body Slaby et al. 1994 Gross Anatomy in
the Practice of
Lewis 1936 Gray's Anatomy of Medicine
the Human Body
Sobotta and 1906 Atlas and Text-Book
Lewis 1942 Gray's Anatomy of McMurrich of Human
the Human Body Anatomy
(Continued)
Anatomical Sciences Education MAY/JUNE 2009 129
Table 1. Table 1.
(Continued) (Continued)
Publication Publication
Author(s) date Title Author(s) date Title
Sobotta and 1928 Atlas of Human Boyd et al. 1956 Textbook of Human
McMurrich Anatomy Anatomy
Sobotta and 1936 Atlas of Human Anatomy Brash 1957 Cunningham's Manual of
McMurrich Practical Anatomy
Spence 1986 Basic Human Anatomy Cartmill 1987 Human Structure
et al.
Stern 1988 Essentials of Gross
Anatomy Drake et al. 2005 Gray's Anatomy for
Students
Tank 2008 Grant's Dissector
Ellis 1960 Clinical Anatomy
Tank and 2008 Lippincott Williams and
Gest Wilkins Atlas of Ellis 1999 Human Sectional
Anatomy Anatomy
Thiel 1997 Photographic Atlas of Ellis et al. 1966 Clinical Anatomy
Practical Anatomy
Francis 1959 Introduction to Human
Van De 2002 Human Anatomy Anatomy
Graaff
Gosling 2002 Human Anatomy Color
Vidic 1984 Manual of Dissection et al. Atlas and Text
Vidic 1984 Photographic Atlas Grant 1958 A Method of Anatomy
of the Human Body
Grant 1962 An Atlas of Anatomy
Wilson and 1978 Human Anatomy
Wilson Grant and 1965 Grant's Method of
Wilson 1988 Dissection Manual Basmajian Anatomy
Wischnitzer 1972 Outline of Human Green and 1981 An Introduction to
Anatomy Silver Human
Anatomy
Woodburne 1994 Essentials of Human
and Anatomy Hamilton 1976 Textbook of Human
Burkel Anatomy
Zuidema 1980 The Johns Hopkins Atlas Jacob 2002 Atlas of Human Anatomy
of Human Anatomy
Jamieson 1939 Illustrations of Regional
Category 4: British nomenclature system Anatomy
Aitken et al. 1956 A Manual of Human Jamieson 1950 A Companion to
Anatomy III Manuals of Practical
Anatomy
Akesson 1990 Thompson's Core
et al. Textbook of Anatomy Lachman 1965 Case Studies in
Anatomy
Anderson 1978 Grant's Atlas of
Anatomy Last 1955 Aids to Anatomy
Anderson 1983 Grant's Atlas of Lockhart 1959 Anatomy of the Human
Anatomy et al. Body
Basmajian 1976 Primary Anatomy McMinn and 1977 Color Atlas of Human
Hutchings Anatomy
Basmajian 1989 Grant's Method of
and Anatomy McMinn and 1988 Color Atlas of Human
Slonecker Hutchings Anatomy
130 Gest et al.
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