Determining physiological cross-sectional area of extensor carpi radialis longus and brevis as a whole and by regions using 3D computer muscle models created from digitized fiber bundle data

The 3D muscle morphology and intramuscular innervation of the digital bellies of flexor digitorum profundus: Clinical implications for botulinum toxin injection sites

Spasticity of flexor digitorum profundus is frequently managed with botulinum toxin injections. Knowledge of the 3D morphology and intramuscular innervation of the digital bellies of flexor digitorum profundus is necessary to optimize the injections. The purpose of this study was to digitize and model in 3D the contractile and connective tissue elements of flexor digitorum profundus to determine muscle morphology, model and map the intramuscular innervation and propose sites for botulinum toxin injection. Fiber bundles (FBs)/aponeuroses and intramuscular nerve branches were dissected and digitized in 12 formalin embalmed cadaveric specimens. Cartesian coordinate data were reconstructed into 3D models as in situ to visualize and compare the muscle morphology and intramuscular innervation patterns of the bellies of flexor digitorum profundus. The 3rd, 4th and 5th digital bellies were superficial to the 2nd digital belly and located adjacent to each other in all specimens. Each digital belly had distinct intramuscular innervation patterns. The 2nd digital belly received intramuscular branches from the anterior interosseus nerve (AIN). The superior half of the 3rd digital belly was innervated intramuscularly by the ulnar nerve (n = 4) or by both the anterior interosseus and ulnar nerves (n = 1). The inferior half of the belly received dual innervation from the anterior interosseus and ulnar nerves in 2 specimens, or exclusively from the AIN (n = 2) or the ulnar nerve (n = 1). The 4th digital belly was innervated by intramuscular branches of the ulnar nerve. One main branch, after coursing through the 4th digital belly, entered the lateral aspect of the 5th digital belly and arborized intramuscularly. The morphology of the FBs, aponeuroses and intramuscular innervation of the digital bellies of FDP were mapped and modelled volumetrically in 3D as in situ. Previous studies were not volumetric nor identified the course of the intramuscular nerve branches within each digital belly. Based on the intramuscular innervation of each of the digital bellies, one possible optimized botulinum toxin injection location was proposed. This injection location, at the junction of the superior and middle thirds of the forearm, would be located in dense nerve terminal zones of the anterior interosseus and ulnar nerves. Future anatomical and clinical investigations are necessary to evaluate the efficacy of these anatomical findings in the management of spasticity.

Dissection, digitization, and three-dimensional modelling: a high-fidelity anatomical visualization and imaging technology

Technological advances have enabled the development of a novel technique of dissection, digitization and three-dimensional modelling of skeletal muscle and other tissues including neurovascular structures as in situ over the last 25 years. Meticulous serial dissection followed by digitization is used to collect Cartesian coordinate data of the contractile and connective tissue elements throughout the entire muscle volume. The Cartesian coordinate can then be used to construct high-fidelity three-dimensional models that capture the spatial arrangement of the contractile and connective tissue elements as in situ enabling detailed studies of the arrangement of the fiber bundles and their attachment sites to aponeuroses, tendon, and bone. In the laboratory, we have concurrently developed a computational methodology to quantify architectural parameters, including fiber bundle length, pennation angle, volume, physiological cross-sectional area in three-dimensional space. In this paper, a flexor digitorum superficialis specimen will be used to demonstrate the high-fidelity outcomes of dissection, digitization, and three-dimensional modelling. This three-step methodology provides a unique opportunity to study muscle architecture in three dimensions, as in situ. Knowledge translation from the anatomy laboratory to the clinical setting has been highly successful.

Intramuscular aponeuroses and fiber bundle morphology of the five bellies of flexor digitorum superficialis: A three-dimensional modeling study

Restoring balanced function of the five bellies of flexor digitorum superficialis (FDS) following injury requires knowledge of the muscle architecture and the arrangement of the contractile and connective tissue elements. No three-dimensional (3D) studies of FDS architecture were found in the literature. The purpose was to (1) digitize/model in 3D the contractile/connective tissue elements of FDS, (2) quantify/compare architectural parameters of the bellies and (3) assess functional implications. The fiber bundles (FBs)/aponeuroses of the bellies of FDS were dissected and digitized (MicroScribe® Digitizer) in 10 embalmed specimens. Data were used to construct 3D models of FDS to determine/compare the morphology of each digital belly and quantify architectural parameters to assess functional implications. FDS consists of five morphologically and architecturally distinct bellies, a proximal belly, and four digital bellies. FBs of each belly have unique attachment sites to one or more of the three aponeuroses (proximal/distal/median). The proximal belly is connected through the median aponeurosis to the bellies of the second and fifth digits. The third belly exhibited the longest mean FB length (72.84 ± 16.26 mm) and the proximal belly the shortest (30.49 ± 6.45 mm). The third belly also had the greatest mean physiological cross-sectional area, followed by proximal/second/fourth/fifth. Each belly was found to have distinct excursion and force-generating capabilities based on their 3D morphology and architectural parameters. Results of this study provide the basis for the development of in vivo ultrasound protocols to study activation patterns of FDS during functional activities in normal and pathologic states.

Using Stereoscopic Virtual Presentation for Clinical Anatomy Instruction and Procedural Training in Medical Education

This chapter begins by exploring the current landscape of virtual and augmented reality technologies in a post-pandemic world and asserting the importance of virtual technologies that improve students' learning outcomes while also reducing costs. Next, the chapter describes clinical anatomy instruction concepts in medical education, including applied anatomy content knowledge, pedagogical anatomy content knowledge, and virtual stereoscopic visualization studies that exemplify these concept areas, respectively. The chapter then explores the concept of procedural training with a specific emphasis on virtual stereoscopic anatomy visualization studies that exemplify or have implications for procedural training in medical education. Subsequently, the chapter discusses the benefits and challenges as well as the potential future positive and negative implications of virtual stereoscopic visualizations in medical education before finally concluding with some pensive considerations for the present and future of anatomy education and training using virtual technologies.

Parametric Multi-Scale Modeling of the Zygomaticus Major and Minor: Implications for Facial Reanimation

ABSTRACT

Facial paralysis can severely impact functionality and mental health. Facial reanimation surgery can improve facial symmetry and movement. Zygomaticus minor (Zmin) and zygomaticus major (Zmaj) are 2 important perioral muscles, that function to elevate the upper lip, contributing to the formation of a smile. The objective of this study was to analyze the morphology in three-dimensional (3D) and quantify architectural parameters of Zmin and Zmaj. In ten formalin-embalmed specimens, Zmin and Zmaj were serially dissected and digitized at the fiber bundle level. The 2 muscles were modeled in 3D to construct high fidelity models. The 3D models were used to assess muscle morphology and quantify architectural parameters including mean fiber bundle length, physiological cross-sectional area, and line of action. Zygomaticus minor fiber bundles were oriented horizontally or slightly obliquely and had a muscular attachment to the medial modiolus. Zygomaticus minor was found to either have no partitions or medial and lateral partitions. Specimens with partitions were divided into type 1 and type 2. Type 1 consisted of a medial partition with fiber bundles attaching to the zygomatic bone at the inferior margin of the orbit. The type 2 medial partition attached to the lateral margin of the orbit to attach to the zygomatic bone. Zygomaticus major had obliquely oriented fiber bundles with most specimens having inferior and superior partitions attaching to the inferior aspect of the zygomatic bone. Zygomaticus major was found to have a greater mean fiber bundle length and physiological cross-sectional area than Zmin. The direction of the line of action of Zmin and Zmaj was closely related to fiber bundle arrangement. Detailed 3D anatomical understanding of Zmin and Zmaj, at the fiber bundle level, is critical for reconstructive surgeons performing dynamic facial reanimation. This data can be used to assist with selecting the ideal donor site for reconstruction.

Surgical Mobilization of Skeletal Muscles Changes Functional Properties-Implications for Tendon Transfers

PURPOSE

Tendon transfer surgery restores function by rerouting working muscle-tendon units to replace the function of injured or paralyzed muscles. This procedure requires mobilizing a donor muscle relative to its surrounding myofascial connections, which improves the muscle's new line of action and increases excursion. However, the biomechanical effect of mobilization on a donor muscle's force-generating function has not been previously studied under in vivo conditions. The purpose of this study was to quantify the effect of surgical mobilization on active and passive biomechanical properties of 3 large rabbit hind limb muscles.

METHODS

Myofascial connections were mobilized stepwise from the distal end to the proximal end of muscles (0%, 25%, 50%, and 75% of muscle length) and their active and passive length-tension curves were measured after each degree of mobilization.

RESULTS

Second toe extensor, a short-fibered muscle, exhibited a 30% decline in peak stress and 70% decline in passive stress, whereas extensor digitorum longus, a short-fibered muscle, and tibialis anterior, a long-fibered muscle, both exhibited similar smaller declines in active (about 18%) and passive stress (about 65%).

CONCLUSIONS

The results highlight 3 important points: (1) a trade-off exists between increasing muscle mobility and decreasing force-generating capacity; (2) intermuscular force transmission is important, especially in second toe extensor, because it was able to generate 70% of its premobilization active force although most fibers were freed from their native origin; and (3) muscle architecture is not the major influence on mobilization-induced force impairment.

CLINICAL RELEVANCE

These data demonstrate that surgical mobilization itself alters the passive and active force-generating capacity of skeletal muscles. Thus, surgical mobilization should not be viewed simply as a method to redirect the line of action of a donor muscle because this procedure has an impact on the functional properties of the donor muscle itself.

Quantitative comparison of cranial approaches in the anatomy laboratory: A neuronavigation based research method

AIM

To describe the development and validation of a novel neuronavigation-based method, which allows the quantification of the anatomical features that define an approach, as well as real-time visualization of the surgical pyramid.

METHODS

The method was initially developed with commercially-available hardware for coordinate collection (a digitizer and a frameless navigation system) and software for volume rendering; dedicated neuronavigation software (ApproachViewer, part of GTx-UHN) was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachViewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method.

RESULTS

The accuracy of ApproachViewer is comparable to commercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachViewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration: with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches.

CONCLUSION

This new research method and software allows semi-automated visualization, quantification, and comparison of neurosurgical approaches in the anatomy laboratory.

Automatic reconstruction of the muscle architecture from the superficial layer fibres data

BACKGROUND AND OBJECTIVE

Physiological cross-sectional area (PCSA) of a muscle plays a significant role in determining the force contribution of muscle fascicles to skeletal movement. This parameter is typically calculated from the lengths of muscle fibres selectively sampled from the superficial layer of the muscle. However, recent studies have found that the length of fibres in the superficial layer often differs significantly (p < 0.5) from the length of fibres in the deep layer. As a result, PCSA estimation is inaccurate. In this paper, we propose a method to automatically reconstruct fibres in the whole volume of a muscle from those selectively sampled on the superficial layer.

METHODS

The method performs a centripetal Catmull-Rom interpolation of the input fibres within the volume of a muscle represented by its 3D surface model, automatically distributing the fibres among multiple heads of the muscle and shortening the deep fibres to support large attachment areas with extremely acute angles.

RESULTS

Our C++ implementation runs in a couple of seconds on commodity hardware providing realistic results for both artificial and real data sets we tested.

CONCLUSIONS

The fibres produced by the method can be used directly to determine the personalised mechanical muscle functioning. Our implementation is publicly available for the researchers at https://mi.kiv.zcu.cz/.

Investigation of supraspinatus muscle architecture following concentric and eccentric training

OBJECTIVES

To investigate the effects of concentric or eccentric abduction strength training on supraspinatus fiber bundle architecture and strength.

DESIGN

A pre-post single-subject design.

METHODS

Thirteen participants were randomized to concentric (n=6) or eccentric (n=7) training groups. Participants completed an eight week shoulder abduction training program in the scapular plane using an isokinetic dynamometer. Resistance training, requiring maximal effort on contraction, consisted of 4 sets of 8 reps at 60°/s in weeks 1-4, and 6 sets of 6 reps at 60°/s in weeks 5-8 with a frequency of 3×/week. Primary outcome measures included fiber bundle length, pennation angle, and muscle thickness of supraspinatus and these were quantified using ultrasound. Secondary outcome measures included isometric, eccentric and concentric abduction strength and these were evaluated using the isokinetic dynamometer.

RESULTS

Mean fiber bundle length in the relaxed (p=0.033) and contracted (p=0.036) states significantly decreased with concentric training but remained unchanged with eccentric training. A significant increase in pennation angle, muscle thickness, and peak torque were found with training but no significant differences were detected between concentric and eccentric groups.

CONCLUSIONS

Training mode has a significant impact on fiber bundle length changes of the supraspinatus. Eccentric training of shoulder abduction leads to similar strength gains as concentric, but it may also have the added advantages of maintaining fiber bundle lengths and promoting tendon healing. Study is needed to confirm fiber bundle changes in a clinical population which would further support the use of eccentric abduction strength training in rehabilitation settings.

Micro-biomechanics of the Kebara 2 hyoid and its implications for speech in Neanderthals

The description of a Neanderthal hyoid from Kebara Cave (Israel) in 1989 fuelled scientific debate on the evolution of speech and complex language. Gross anatomy of the Kebara 2 hyoid differs little from that of modern humans. However, whether Homo neanderthalensis could use speech or complex language remains controversial. Similarity in overall shape does not necessarily demonstrate that the Kebara 2 hyoid was used in the same way as that of Homo sapiens. The mechanical performance of whole bones is partly controlled by internal trabecular geometries, regulated by bone-remodelling in response to the forces applied. Here we show that the Neanderthal and modern human hyoids also present very similar internal architectures and micro-biomechanical behaviours. Our study incorporates detailed analysis of histology, meticulous reconstruction of musculature, and computational biomechanical analysis with models incorporating internal micro-geometry. Because internal architecture reflects the loadings to which a bone is routinely subjected, our findings are consistent with a capacity for speech in the Neanderthals.

Three types of the serial segmented images suitable for surface reconstruction

Stereoscopic surface models of human organs can be manipulated in real time. This is a significant feature of an interactive simulation system used for clinical practice. Objective surface models are obtainable from the accumulation of each structure's serial outlines, followed by surface reconstruction. The segmented images including the outlines can be divided into outlined images, white-filled images, and color-filled images. The purpose of this study was to report the benefits of the three types of segmented images for surface reconstruction. For the raw data, sectioned images of a male cadaver head were used. In the sectioned images, 91 structures were delineated for the preparation of 234 serial outlined images. The outlined images were converted into white-filled and color-filled images; the reverse conversion was also possible. The outlined images, including the original sectioned images, could be the source not only of surface models but also of volume models. The white-filled images, with a minimal file size, were preferred for separate surface reconstruction of the individual structures. The color-filled images, which allowed for recognition of the entire outlined structures simultaneously, were regarded as a good choice for the construction of several surface models. For the process, we employed a variety of software packages including those for animation, where the images were compatible. This information can be used by other investigators to build their own three-dimensional models. In addition, the surface models of detailed structures in the head, accompanied by the corresponding sectioned and segmented images, will hopefully contribute to various simulations that can be useful to clinicians.

Musculotendinous architecture of pathological supraspinatus: a pilot in vivo ultrasonography study

Architectural changes associated with tendon tears of the supraspinatus muscle (SP) have not been thoroughly investigated in vivo with the muscle in relaxed and contracted states. The purpose of this study was to quantify the geometric properties within the distinct regions of SP in subjects with full-thickness tendon tears using an ultrasound protocol previously developed in our laboratory, and to compare findings with age/gender matched normal controls. Twelve SP from eight participants (6 male/2 female), mean age 57 ± 6.0 years, were investigated. Muscle geometric properties of the anterior region (middle and deep parts) and posterior region (deep part) were measured using image analysis software. Along with whole muscle thickness, fiber bundle length (FBL) and pennation angle (PA) were computed for architecturally distinct regions and/or parts. Pathologic SP was categorized according to the extent of the tear in the tendon (with or without retraction). In the anterior region, mean FBL of the pathologic SP was similar with normal controls; however, mean PA was significantly smaller in pathologic SP with retraction compared with normal controls, in the contracted state (P < 0.05). Mean FBL in the posterior region in both relaxed and contracted states was significantly shorter in the pathologic SP with retraction compared with normal controls (P < 0.05). Findings suggest FBL changes associated with tendon pathology vary between the distinct regions, and PA changes are related to whether there is retraction of the tendon. The ultrasound protocol may provide important information on architectural changes that may assist in decision making and surgical planning.

Structural analysis of muscles elevating the hyolaryngeal complex

A critical event of pharyngeal swallowing is the elevation of the hyolaryngeal complex to open the upper esophageal sphincter. Current swallowing theory assigns this function to the submental and thyrohyoid muscles. However, the attachments of the long pharyngeal muscles indicate that they could contribute to this function, yet their role is uninvestigated in humans. In addition, there is evidence the posterior digastric and stylohyoid contribute to hyoid elevation. A cadaver model was used to document the structural properties of muscles. These properties were used to model muscle groups as force vectors and analyze their potential for hyolaryngeal elevation. Vector magnitude was determined using physiological cross-sectional areas (PCSAs) of muscles calculated from structural properties of muscle taken from 12 hemisected cadaver specimens. Vector direction (lines of action) was calculated from the three-dimensional coordinates of muscle attachment sites. Unit force vectors in the superior direction of submental, suprahyoid (which includes the submental muscles), long pharyngeal, and thyrohyoid muscles were derived and compared by an analysis of variance (ANOVA) to document each muscle's potential contribution to hyolaryngeal elevation. An ANOVA with Tukey HSD post hoc analysis of unit force vectors showed no statistically significant difference between the submental (0.92 ± 0.24 cm(2)) and long pharyngeal (0.73 ± 0.20 cm(2)) muscles. Both demonstrated greater potential to elevate the hyolaryngeal complex than the thyrohyoid (0.49 ± 0.18 cm(2)), with P < 0.01 and P < 0.05, respectively. The suprahyoid muscles (1.52 ± 0.35 cm(2)) demonstrated the greatest potential to elevate the hyolaryngeal complex: greater than both the long pharyngeal muscles (P < 0.01) and the thyrohyoid (P < 0.01). The submental and thyrohyoid muscles by convention are thought to elevate the hyolaryngeal complex. This study demonstrates that structurally the long pharyngeal muscles have similar potential to contribute to this critical function, with the suprahyoid muscles having the greatest potential. If verified by functional data, these findings would amend current swallowing theory.