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Eby SF, Teramoto M, Lider J, Lash M, Caragea M, Cushman DM. Sonographic peripheral nerve cross-sectional area in adults, excluding median and ulnar nerves: A systematic review and meta-analysis. Muscle Nerve 2023; 68:20-28. [PMID: 36583383 DOI: 10.1002/mus.27783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/AIMS Although electromyography remains the "gold standard" for assessing and diagnosing peripheral nerve disorders, ultrasound has emerged as a useful adjunct, providing valuable anatomic information. The objective of this study was to conduct a systematic review and meta-analysis evaluating the normative sonographic values for adult peripheral nerve cross-sectional area (CSA). METHODS Medline and Cochrane Library databases were systematically searched for healthy adult peripheral nerve CSA, excluding the median and ulnar nerves. Data were meta-analyzed, using a random-effects model, to calculate the mean nerve CSA and its 95% confidence interval (CI) for each nerve at a specific anatomical location (= group). RESULTS Thirty groups were identified and meta-analyzed, which comprised 16 from the upper extremity and 15 from the lower extremity. The tibial nerve (n = 2916 nerves) was reported most commonly, followed by the common fibular nerve (n = 2580 nerves) and the radial nerve (n = 2326 nerves). Means and 95% confidence interval (CIs) of nerve CSA for the largest number of combined nerves were: radial nerve assessed at the spiral groove (n = 1810; mean, 5.14 mm2 ; 95% CI, 4.33 to 5.96); common fibular nerve assessed at the fibular head (n = 1460; mean, 10.18 mm2 ; 95% CI, 8.91 to 11.45); and common fibular nerve assessed at the popliteal fossa (n = 1120; mean, 12.90 mm2 ; 95% CI, 9.12 to 16.68). Publication bias was suspected, but its influence on the results was minimal. DISCUSSION Two hundred thirty mean CSAs from 15 857 adult nerves are included in the meta-analysis. These are further categorized into 30 groups, based on anatomical location, providing a comprehensive reference for the clinician and researcher investigating adult peripheral nerve anatomy.
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Affiliation(s)
- Sarah F Eby
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Lider
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Madison Lash
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marc Caragea
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel M Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Neto WK, Gama EF, de Assis Silva W, de Oliveira TVA, Dos Santos Vilas Boas AE, Ciena AP, Anaruma CA, Caperuto ÉC. Ladder-based resistance training elicited similar ultrastructural adjustments in forelimb and hindlimb peripheral nerves of young adult Wistar rats. Exp Brain Res 2021; 239:2583-2592. [PMID: 34191117 DOI: 10.1007/s00221-021-06156-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/19/2021] [Indexed: 12/22/2022]
Abstract
To analyze the morphological response induced by high-volume, high-intensity ladder-based resistance training (LRT) on the ultrastructure of the radial (forelimb) and sciatic (hindlimb) nerves of adults Wistar rats. Twenty rats were equally distributed into groups: sedentary (SED) and LRT. After the rodents were subjected to the maximum load (ML) carrying test, the LRT group performed 6-8 progressive climbs (2 × 50% ML, 2 × 75% ML, 2 × 100% ML, and 2 × 100% ML + 30 g) three times per week. After 8 weeks, the radial and sciatic nerves were removed and prepared for transmission electron microscopy. In the radial nerve, myelinated axons cross-sectional area (CSA), unmyelinated axons CSA, myelin sheath thickness, and Schwann cells nuclei area were statistically larger in the LRT group than SED (p < 0.05). Also, the number of microtubules and neurofilaments per field were statistically higher in the LRT group than in SED (p < 0.01). For sciatic nerve, myelinated fibers CSA, unmyelinated axons CSA, myelin sheath thickness, Schwann cells nuclei area, and the number of neurofilaments per field were statistically larger in the LRT group compared to the SED group (p < 0.05). LRT with high-volume and high-intensity effectively induce similar changes in adult Wistar rats' radial and sciatic nerves' ultrastructure.
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Affiliation(s)
- Walter Krause Neto
- Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry, São Judas Tadeu University, Rua Taquari, 546-Mooca Unit, P. O. Box 03166-000, São Paulo, SP, Brazil.
| | - Eliane Florencio Gama
- Department of Morphology, Faculty of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Wellington de Assis Silva
- Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry, São Judas Tadeu University, Rua Taquari, 546-Mooca Unit, P. O. Box 03166-000, São Paulo, SP, Brazil
| | - Tony Vinicius Apolinário de Oliveira
- Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry, São Judas Tadeu University, Rua Taquari, 546-Mooca Unit, P. O. Box 03166-000, São Paulo, SP, Brazil
| | - Alan Esaú Dos Santos Vilas Boas
- Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry, São Judas Tadeu University, Rua Taquari, 546-Mooca Unit, P. O. Box 03166-000, São Paulo, SP, Brazil
| | - Adriano Polican Ciena
- Department of Physical Education, Laboratory of Morphology and Physical Activity, São Paulo State University "Júlio de Mesquita Filho", Rio Claro, SP, Brazil
| | - Carlos Alberto Anaruma
- Department of Physical Education, Laboratory of Morphology and Physical Activity, São Paulo State University "Júlio de Mesquita Filho", Rio Claro, SP, Brazil
| | - Érico Chagas Caperuto
- Depatment of Physical Education, Laboratory of Human Movement, São Judas Tadeu University, São Paulo, SP, Brazil
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Tahmaz M, Yoon M, Schellinger PD, Philipps J. Cross‐sectional area in median and ulnar nerve ultrasound correlates with hand volume. Muscle Nerve 2020; 62:83-88. [DOI: 10.1002/mus.26881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Melis Tahmaz
- Department of Neurology and Neurogeriatrics Ruhr‐University Bochum, Johannes‐Wesling‐Klinikum Minden, UK RUB Minden Germany
| | - Min‐Suk Yoon
- Department of Neurology Evangelisches Krankenhaus Hattingen gGmbH Hattingen Germany
| | - Peter D. Schellinger
- Department of Neurology and Neurogeriatrics Ruhr‐University Bochum, Johannes‐Wesling‐Klinikum Minden, UK RUB Minden Germany
| | - Jörg Philipps
- Department of Neurology and Neurogeriatrics Ruhr‐University Bochum, Johannes‐Wesling‐Klinikum Minden, UK RUB Minden Germany
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Westerberg E, Molin CJ, Spörndly Nees S, Widenfalk J, Punga AR. The impact of physical exercise on neuromuscular function in Myasthenia gravis patients: A single-subject design study. Medicine (Baltimore) 2018; 97:e11510. [PMID: 30075515 PMCID: PMC6081147 DOI: 10.1097/md.0000000000011510] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/20/2018] [Indexed: 11/30/2022] Open
Abstract
There is a need for tailored exercise recommendations to patients with Myasthenia gravis (MG). A few pilot studies have recently shown that physical exercise in accordance with general recommendations to healthy adults can be applied safely to patients with mild MG symptoms. How physical exercise affects muscle parameters and risk factors for lifestyle diseases in patients with MG is, however, only poorly known. We evaluated functional skeletal muscle parameters in 11 MG patients, before and after conducting a 12-week supervised physical therapy regimen of aerobic and resistance strength training. After the training program, parameters of the rectus femoris muscle improved: compound motor action potential (from 4.5 ± 2.6 to 5.3 ± 2.8 mV, P = .016), isometric muscle force (from 25.2 ± 4.4 to 30.2 ± 3.8 kg; P = .014), and ultrasound muscle thickness (from 19.6 ± 5.6 to 23.0 ± 3.9 mm, P = .0098) all increased. Further, physical performance based measures improved, including the 30-Second Chair Stand Test (median change +2, P = .0039) as well as the clinical MG composite score [from 3 (2-5) to 2 (0-4), P = .043]. No improvement in muscle function was observed in the biceps brachii muscle. These findings indicate that MG patients can improve their muscular functions by incorporating aerobic and resistance strength training, especially in proximal leg muscles. This is important knowledge when physical therapy is considered for this patient group, for whom no guidelines on physical exercise currently exist.
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Affiliation(s)
| | | | - Sören Spörndly Nees
- Department of Physiotherapy, Department of Neuroscience, Uppsala University, Uppsala, Sweden
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