A Need for Logical and Consistent Anatomical Nomenclature

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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
``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
      Bell                1834       The Anatomy and                                             Human Anatomy
                                       Physiology of
                                       the Human Body,            Brantigan          1963       Clinical Anatomy
                                                                  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
                                                                  Clemente           1997       Anatomy: A Regional
  Category 2: Untranslated nomenclature                                                           Atlas of the Human
      Anson               1950       An Atlas of Human
                                       Anatomy                    Colborn and        1993       Clinical Gross Anatomy
      Anson and           1952       Callander's Surgical
        Maddock                        Anatomy                    Crafts             1966       A Textbook of Human
      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
                                                                  Dawson             1996       Basic Human Anatomy
      Pernkopf            1980       Atlas of Topographical
                                       and Applied Human          Frick et al.       1991       Human Anatomy
                                                                  Gardner and        1973       Structure of the Human
      Spalteholz          1900       Hand-Atlas of Human           Osburn                         Body
                                                                  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
                                                                  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
      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
    Hollinshead             1969            Anatomy for
                                              Surgeons                Moore              1992       Clinically Oriented
    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
                                                                      Netter             2006       Atlas of Human
    Jackson                 1914            Morris's Human
                                                                      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
                                                                      O'Rahilly          1986       Anatomy: A
                                                                                                      Regional Study
    Kanagasuntheram         1987            Anatomy: Regional,
                                                                                                      of Human
      et al.                                  Functional, and
                                                                      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
    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
    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


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
      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
                                                                  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
      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
      Akesson            1990       Thompson's Core
        et al.                        Textbook of Anatomy         Lachman           1965       Case Studies in
      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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