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Mohana-Borges AVR, Souza SAL, Mohana-Borges R, Statum S, Chung CB. Deep branch of the radial nerve: effect of pronation/supination on longitudinal nerve alignment. Skeletal Radiol 2023; 52:1683-1693. [PMID: 37010538 PMCID: PMC10348978 DOI: 10.1007/s00256-023-04332-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/14/2023] [Accepted: 03/25/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To evaluate the effect of maximal pronation and supination of the forearm on the alignment and anatomic relationship of the deep branch of the radial nerve (DBRN) at the superior arcade of the supinator muscle (SASM) by using high-resolution ultrasound (HRUS). MATERIALS AND METHODS In this cross-sectional study, HRUS in the long axis of the DBRN was performed in asymptomatic participants enrolled from March to August 2021. DBRN alignment was evaluated by measuring angles of the nerve in maximal pronation and maximal supination of the forearm independently by two musculoskeletal radiologists. Forearm range of motion and biometric measurements were recorded. Student t, Shapiro-Wilk, Pearson correlation, reliability analyses, and Kruskal-Wallis test were used. RESULTS The study population included 110 nerves from 55 asymptomatic participants (median age, 37.0 years; age range, 16-63 years; 29 [52.7%] women). There was a statistically significant difference between the DBRN angle in maximal supination and maximal pronation (Reader 1: 95% CI: 5.74, 8.21, p < 0.001, and Reader 2: 95% CI: 5.82, 8.37, p < 0.001). The mean difference between the angles in maximal supination and maximal pronation was approximately 7° for both readers. ICC was very good for intraobserver agreement (Reader1: r ≥ 0.92, p < 0.001; Reader 2: r ≥ 0.93, p < 0.001), as well as for interobserver agreement (phase 1: r ≥ 0.87, p < 0.001; phase 2: r ≥ 0.90, p < 0.001). CONCLUSION The extremes of the rotational movement of the forearm affect the longitudinal morphology and anatomic relationships of the DBRN, primarily demonstrating the convergence of the nerve towards the SASM in maximal pronation and divergence in maximal supination.
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Affiliation(s)
- Aurea V R Mohana-Borges
- Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Radiology, University of California, San Diego, USA
| | - Sergio A L Souza
- Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronaldo Mohana-Borges
- Laboratory of Biotechnology and Structural Bioengineering, Biophysics Institute Carlos Chagas Filho, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Christine B Chung
- Radiology, University of California, San Diego, USA.
- Radiology, Veterans Affairs Medical Center, San Diego, USA.
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Pollins AC, Kim JS, Boyer RB, Thayer WP. Mass spectrometry comparison of nerve allograft decellularization processes. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:20. [PMID: 28012154 DOI: 10.1007/s10856-016-5834-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/25/2016] [Indexed: 06/06/2023]
Abstract
Peripheral nerve repair using nerve grafts has been investigated for several decades using traditional techniques such as histology, immunohistochemistry, and electron microscopy. Recent advances in mass spectrometry techniques have made it possible to study the proteomes of complex tissues, including extracellular matrix rich tissues similar to peripheral nerves. The present study comparatively assessed three previously described processing methods for generating acellular nerve grafts by mass spectrometry. Acellular nerve grafts were additionally examined by F-actin staining and nuclear staining for debris clearance. Application of newer techniques allowed us to detect and highlight differences among the 3 treatments. Isolated proteins were separated by mass on polyacrylamide gels serving 2 purposes. This further illustrated that these treatments differ from one another and it allowed for selective protein extractions within specific bands/molecular weights. This approach resulted in small pools of proteins that could then be analyzed by mass spectrometry for content. In total, 543 proteins were identified, many of which corroborate previous findings for these processing methods. The remaining proteins are novel discoveries that expand the field. With this pilot study, we have proven that mass spectrometry techniques complement and add value to peripheral nerve repair studies.
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Affiliation(s)
- Alonda C Pollins
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Justine S Kim
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Richard B Boyer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Henderson KK, Parker J, Heinking KP. Mountaineering-induced bilateral plantar paresthesia. J Osteopath Med 2015; 114:549-55. [PMID: 25002447 DOI: 10.7556/jaoa.2014.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Flat feet (pes planus) have been implicated in multiple musculoskeletal complaints, which are often exacerbated by lack of appropriate arch support or intense exercise. OBJECTIVE To investigate the efficacy of osteopathic manipulative treatment (OMT) on a patient (K.K.H.) with mountaineering-induced bilateral plantar paresthesia and to assess the association of pes planus with paresthesia in members of the mountaineering expedition party that accompanied the patient. METHODS A patient history and physical examination of the musculoskeletal system were performed. The hindfoot, midfoot, forefoot, big toe, and distal toes were evaluated for neurologic function, specifically pin, vibration, 10-g weight sensitivity, and 2-point discrimination during the 4-month treatment period. To determine if OMT could augment recovery, the patient volunteered to use the contralateral leg as a control, with no OMT performed on the sacrum or lower back. To determine if pes planus was associated with mountaineering-induced paresthesia, a sit-to-stand navicular drop test was performed on members of the expedition party. RESULTS Osteopathic manipulative treatment improved fibular head motion and muscular flexibility and released fascial restrictions of the soleus, hamstring, popliteus, and gastrocnemius. The patient's perception of stiffness, pain, and overall well-being improved with OMT. However, OMT did not shorten the duration of paresthesia. Of the 9 expedition members, 2 experienced paresthesia. Average navicular drop on standing was 5.1 mm for participants with no paresthesia vs 8.9 mm for participants with paresthesia (t test, P<.01; Mann-Whitney rank sum test, P=.06). CONCLUSION These preliminary findings suggest that weakened arches may contribute to mountaineering-induced plantar paresthesia. Early diagnosis of pes planus and treatment with orthotics (which may prevent neuropathies)--or, less ideally, OMT after extreme exercise--should be sought to relieve tension and discomfort.
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Affiliation(s)
- Kyle K Henderson
- From the departments of physiology (Dr Henderson) and osteopathic manipulative medicine (Dr Heinking) at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois, and from Advocate Illinois Masonic Medical Center in Downers Grove, Illinois (Dr Parker). At the time of submission, Dr Parker was an osteopathic medical student at the Midwestern University/Chicago College of Osteopathic Medicine
| | - Justine Parker
- From the departments of physiology (Dr Henderson) and osteopathic manipulative medicine (Dr Heinking) at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois, and from Advocate Illinois Masonic Medical Center in Downers Grove, Illinois (Dr Parker). At the time of submission, Dr Parker was an osteopathic medical student at the Midwestern University/Chicago College of Osteopathic Medicine
| | - Kurt P Heinking
- From the departments of physiology (Dr Henderson) and osteopathic manipulative medicine (Dr Heinking) at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois, and from Advocate Illinois Masonic Medical Center in Downers Grove, Illinois (Dr Parker). At the time of submission, Dr Parker was an osteopathic medical student at the Midwestern University/Chicago College of Osteopathic Medicine
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Rehmani R, Endo Y, Bauman P, Hamilton W, Potter H, Adler R. Lower Extremity Injury Patterns in Elite Ballet Dancers: Ultrasound/MRI Imaging Features and an Institutional Overview of Therapeutic Ultrasound Guided Percutaneous Interventions. HSS J 2015; 11:258-77. [PMID: 26788031 PMCID: PMC4712185 DOI: 10.1007/s11420-015-9442-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 03/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands. QUESTIONS/PURPOSES The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases. METHODS Online searches were performed using the search criteria of "ballet biomechanics" and "ballet injuries." The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals. RESULTS Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who "time is money". CONCLUSION Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.
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Affiliation(s)
- Razia Rehmani
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yoshimi Endo
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Phillip Bauman
- />Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA
| | - William Hamilton
- />Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA
| | - Hollis Potter
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Ronald Adler
- />Hospital for Joint Diseases, New York University, New York, NY USA
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Abstract
Traumatic injuries to the extremities are common in athletic competitions. The practitioner providing coverage of sporting events must be prepared to diagnose and provide initial treatment of these injuries. A thorough history and physical examination should result in a provisional diagnosis. Many injuries will require subsequent radiographs or orthopedic consultation. Limb threatening emergencies are rare but must be promptly recognized and referred to a hospital. Early treatment can protect athletes from further injury and may hasten their return to competition. Some athletes with extremity trauma can return to the contest, but this decision must be made on an individual basis.
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Affiliation(s)
- Daniel C Wascher
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA,
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Abstract
The aim of the study was to identify specific factors that affect the outcome in patients with long thoracic mononeuropathy. The authors reviewed all medical records of patients with long thoracic mononeuropathy from the archive of the electromyography service over the past 16 years. Age, sex, occupation, pain at onset, symptom duration, neuropathy causes and side, and electromyography findings were collected. The outcome was evaluated by performing standard telephone interviews consisting of 9 queries about use limitations in the affected upper limb. If no limitation existed, the recovery was considered complete. If partial limitations only affected the upper limb in performing 5 or fewer of 9 specific activities, the outcome was considered good; if limitations affected more than 5 activities, the outcome was considered poor. The authors performed a multivariate logistic regression to calculate the association between good outcome or full recovery and poor outcome with demographic, clinical, and electromyography findings. Forty-one patients were included (mean±SD age, 39±14 years; 68.3% men). Causes were shoulder-arm overuse or trauma in 19 patients, iatrogenic in 5, idiopathic in 9, and inflammatory in 8. Twenty-seven patients had a good outcome and full recovery and 14 had a poor outcome. No patient underwent surgery. Age, sex, occupation, pain at onset, symptom duration, neuropathy side, and electromyography findings were not predictive of the outcome. The probability of full recovery and good outcome was 7.5 times greater in long thoracic mononeuropathy secondary to idiopathic or inflammatory causes compared with other etiologies.
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Affiliation(s)
- Mauro Mondelli
- Electromyography Service, Local Health Unit 7, University of Siena, Siena, Italy.
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Affiliation(s)
- Terence Babwah
- a Sport Medicine and Injury Rehabilitation Clinic, Centre of Excellence , Macoya , Trinidad & Tobago
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Babwah T. Common peroneal neuropathy related to cryotherapy and compression in a footballer. Res Sports Med 2011; 19:66-71. [PMID: 21253977 DOI: 10.1080/15438627.2011.536043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This report describes the effect of excessive cooling with ice, and compression with a plastic wrap on the common peroneal nerve (CPN) for 90 minutes in a professional footballer, which led to a common peroneal nerve palsy and a resulting footdrop. It highlights the need to be cautious with regards to the duration and frequency of icing as well as the choice of anchoring material when applying ice to injured areas that have superficial nerves passing nearby. Full recovery of the CPN function occurred in this athlete after five weeks. The major causes of footdrop and common causes of common peroneal neuropathy are discussed.
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Affiliation(s)
- Terence Babwah
- Sport Medicine and Injury Rehabilitation Clinic, Centre of Excellence, Macoya, Trinidad & Tobago.
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Toussaint CP, Perry EC, Pisansky MT, Anderson DE. What's new in the diagnosis and treatment of peripheral nerve entrapment neuropathies. Neurol Clin 2011; 28:979-1004. [PMID: 20816274 DOI: 10.1016/j.ncl.2010.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Entrapment neuropathies can be common conditions with the potential to cause significant disability. Correct diagnosis is essential for proper management. This article is a review of recent developments related to diagnosis and treatment of various common and uncommon nerve entrapment disorders. When combined with classical peripheral nerve examination techniques, innovations in imaging modalities have led to more reliable diagnoses. Moreover, innovations in conservative and surgical techniques have been controversial as to their effects on patient outcome, but randomized controlled trials have provided important information regarding common operative techniques. Treatment strategies for painful peripheral neuropathies are also reviewed.
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Affiliation(s)
- Charles P Toussaint
- Department of Neurological Surgery, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA
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