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Pirri C, Pirri N, Macchi V, Porzionato A, De Caro R, Stecco C. Ultrasound Imaging of Thoracolumbar Fascia: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1090. [PMID: 39064519 PMCID: PMC11279050 DOI: 10.3390/medicina60071090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
Over the past decade, there has been a notable increase in research focused on ultrasound imaging of thoracolumbar fascia (TLF). Nevertheless, published papers' results about the application of US imaging in TLF examination are still sparse. Background and Objevtives: Hence, this systematic review was performed aiming to firstly investigate the use and the methodology of ultrasound imaging to assess pathologic and healthy TLF. Secondarily, we aim to assess intra- and inter-observer reproducibility of US imaging in TLF assessment. Materials and Methods: The search was done on PubMed and Web of Science database from inception to April 2024. Furthermore, the references of included papers were thoroughly checked to find eligible publications. The MeSH keywords used were: "Thoracolumbar fascia", "Ultrasound Imaging", "Ultrasound", "Ultrasonography", and "Ultrasound examination". Results: Studies were aimed primarily at TLF diagnosis, treatment monitoring, or evaluating movement-related changes, underscoring the diverse clinical applications. The US parameters assessed included TLF thickness, echogenicity, stiffness, deformation, shear strain, and displacement, providing comprehensive insights into TLF features. Conclusions: Advanced US imaging holds promise as a reliable tool in musculoskeletal assessment, offering insights into TLF pathology/disfunction, treatment outcomes, and movement dynamics.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padua, 35122 Padova, Italy;
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
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Noten K, van Amstel R. From Muscle-Bone Concept to the ArthroMyoFascial Complex: A Pragmatic Anatomical Concept for Physiotherapy and Manual Therapy. Life (Basel) 2024; 14:799. [PMID: 39063554 PMCID: PMC11278034 DOI: 10.3390/life14070799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND In physiotherapy, the classic muscle-bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle-bone concept. METHOD This study is a narrative review and ultrasound observation. RESULTS Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle-bone concept within the larger ArthroMyoFascial complex. CONCLUSION The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle-bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation.
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Affiliation(s)
- Karl Noten
- Fysio Science Department, Fysio Physics Group, 3401 IJsselstein, The Netherlands;
| | - Robbert van Amstel
- Fysio Science Department, Fysio Physics Group, 3401 IJsselstein, The Netherlands;
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
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Bordoni B. Diaphragm and chronic neck pain: Letter to editor. Musculoskelet Sci Pract 2024; 71:102932. [PMID: 38520878 DOI: 10.1016/j.msksp.2024.102932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Bruno Bordoni
- Department of Cardiology, Foundation Don Carlo Gnocchi IRCCS, Institute of Hospitalization and Care, 20100, Milan, Italy.
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Ando F, Terashima T, Takahashi H, Kurita H, Takayama A, Endo Y. Trunk Muscle Thickness During Supine and Crawling Exercises. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2023; 16:1103-1112. [PMID: 38288071 PMCID: PMC10824310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
The purpose of this study was to measure and validate trunk muscle thickness while performing the Heel Off (HO-ex) and Bird Dog exercises (BD-ex), which are hip extension exercises in the supine position. Thirty-one healthy young males who provided informed consent were included in the study. The thicknesses of the right trunk muscles (lumbar multifidus (LM), erector spinae (ES), external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) were measured using an ultrasound machine. Measurements were taken under four random conditions: supine, HO-ex, crawling on all fours, and BD-ex. One-way analysis of variance and Friedman tests were performed to determine the differences between the conditions for each muscle thickness. LM was significantly thicker in the HO-ex. ES was significantly thicker in HO-ex than in supine, and in BD-ex than in supine, HO-ex, or crawling on all fours. EO was significantly thicker in the supine position than in HO-ex, crawling on all fours. IO was significantly thicker in the HO-ex than in the supine position. TrA was significantly thicker in HO-ex, crawling on all fours, and BD-ex than in the supine position, with no significant difference between HO-ex, crawling on all fours, and BD-ex. The results of this study suggest that HO-ex is more advantageous than BD-ex in stimulating contraction of the multifidus and IO muscles, and that HO-ex can stimulate contraction of the TrA to the same degree as BD-ex.
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Affiliation(s)
- Fumiya Ando
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Otawara-shi, Tochigi 324-8501, JAPAN
| | - Tsubasa Terashima
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Otawara-shi, Tochigi 324-8501, JAPAN
| | - Hiroto Takahashi
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Otawara-shi, Tochigi 324-8501, JAPAN
| | - Honoka Kurita
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Otawara-shi, Tochigi 324-8501, JAPAN
| | - Ayaka Takayama
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Otawara-shi, Tochigi 324-8501, JAPAN
| | - Yoshiaki Endo
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Otawara-shi, Tochigi 324-8501, JAPAN
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Haupt S, Cornaz F, Falkowski AL, Farshad M, Widmer J. The biomechanical consequence of posterior interventions at the thoracolumbar spine on the passively stabilized flexed posture. J Biomech 2023; 153:111599. [PMID: 37137272 DOI: 10.1016/j.jbiomech.2023.111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
In the flexed end-of-range position (e.g., during slumped sitting), the trunk is passively stabilized. Little is known about the biomechanical consequence of posterior approaches on passive stabilization. The aim of this study is to investigate the effect of posterior surgical interventions on local and distant spinal regions. While being fixed at the pelvis, five human torsos were passively flexed. The change in spinal angulation at Th4, Th12, L4 and S1 was measured after level-wise longitudinal incisions of the thoracolumbar fascia, the paraspinal muscles, horizontal incisions of the inter- & supraspinous ligaments (ISL/SSL) and horizontal incision of the thoracolumbar fascia and the paraspinal muscles. Lumbar angulation (Th12-S1) was increased by 0.3° for fascia, 0.5° for muscle and 0.8° for ISL/SSL-incisions per lumbar level. The effect of level-wise incisions at the lumbar spine was 1.4, 3.5 and 2.6 times greater compared to thoracic interventions for fascia, muscle and ISL/SSL respectively. The combined midline interventions at the lumbar spine were associated with 2.2° extension of the thoracic spine. Horizontal incision of the fascia increased spinal angulation by 0.3°, while horizontal muscle incision resulted in a collapse of 4/5 specimens. The thoracolumbar fascia, the paraspinal muscle and the ISL/SSL are important passive stabilizers for the trunk in the flexed end-of-range position. Lumbar interventions needed for approaches to the spine have a larger effect on spinal posture than thoracic interventions and the increase of spinal angulation at the level of the intervention is partially compensated at the neighboring spinal regions.
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Affiliation(s)
- Samuel Haupt
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Frédéric Cornaz
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Spine Biomechanics, Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Anna L Falkowski
- Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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Alver S, Bahadir C, Tahta AC, Cetinkal A, Gölboyu BE, Erdogan C, Ekinci M. The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: a randomized controlled trial. BMC Anesthesiol 2022; 22:394. [PMID: 36536307 PMCID: PMC9761987 DOI: 10.1186/s12871-022-01943-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Quadratus lumborum block (QLB) is a fascial plane block. There is no randomized study on the efficacy of QLB for lumbar surgery. We evaluated the efficacy of QLB for postoperative pain management and patient satisfaction after lumbar disc herniation surgery (LDHS). METHODS Sixty patients with ASA score I-II planned for LDHS under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the control group (n = 30). QLB was performed with 30 ml 0.25% bupivacaine in the QLB group. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/ kg tramadol IV was administered as rescue analgesia. RESULTS There was a reduction in the median static NRS at 0 h and 2 h with QLB compared to the control group (p < 0.05). There was no difference in the resting NRS at any other time point up to 24 h. The median dynamic NRS was significantly lower at 0, 2, 4, 8, and 16 h in the QLB group (p < 0.05). The need for rescue analgesia was significantly lower in the QLB group. The incidence of nausea was significantly higher in the control group. The postoperative patient satisfaction was significantly higher in the QLB group (p < 0.05). CONCLUSION We found that the QLB is effective for pain control following LDHS.
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Affiliation(s)
- Selcuk Alver
- grid.411781.a0000 0004 0471 9346Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Ciftci Bahadir
- grid.411781.a0000 0004 0471 9346Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Ali Can Tahta
- grid.411781.a0000 0004 0471 9346Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Cetinkal
- grid.411781.a0000 0004 0471 9346Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey
| | - Birzat Emre Gölboyu
- grid.411795.f0000 0004 0454 9420Department of Anesthesiology, Katip Çelebi University, Izmir, Turkey
| | - Cem Erdogan
- grid.411781.a0000 0004 0471 9346Department of Anesthesiology and Reanimation, Istanbul Medipol University, Istanbul, Turkey
| | - Mursel Ekinci
- Department of Anesthesiology and Reanimation, Bursa State Hospital, Bursa, Turkey
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Biomechanical considerations of the posterior surgical approach to the lumbar spine. Spine J 2022; 22:2066-2071. [PMID: 35964832 DOI: 10.1016/j.spinee.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effect of the posterior midline approach to the lumbar spine, relevance of inter- and supraspinous ligament (ISL&SSL) sparing, and potential of different wound closure techniques are largely unknown despite their common use. PURPOSE The aim of this study was to quantify the effect of the posterior approach, ISL&SSL resection, and different suture techniques. STUDY DESIGN Biomechanical cadaveric study. METHODS Five fresh frozen human torsi were stabilized at the pelvis in the erect position. The torsi were passively loaded into the forward bending position and the sagittal angulation of the sacrum, L4 and T12 were measured after a level-wise posterior surgical approach from L5/S1 to T12/L1 and after a level-wise ISL&SSL dissection of the same sequence. The measurements were repeated after the surgical closure of the thoracolumbar fascia with and without suturing the fascia to the spinous processes. RESULTS Passive spinal flexion was increased by 0.8±0.3° with every spinal level accessed by the posterior approach. With each additional ISL&SSL resection, a total increase of 1.6±0.4° was recorded. Suturing of the thoracolumbar fascia reduced this loss of resistance against lumbar flexion by 70%. If the ISL&SSL were resected, fascial closure reduced the lumbar flexion by 40% only. In both settings, suturing the fascia to the spinous processes did not result in a significantly different result (p=.523 and p=.730 respectively). CONCLUSION Each level accessed by a posterior midline approach is directly related to a loss of resistance against passive spinal flexion. Additional resection of ISL&SSL multiplies it by a factor of two. CLINICAL SIGNIFICANCE The surgical closure of the thoracolumbar fascia can reduce the above mentioned loss of resistance partially. Suturing the fascia to the spinal processes does not result in improved passive stability.
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Weber P, Klingler W, Schleip R, Weber N, Joisten C. The Influence of a Single Instrument-Assisted Manual Therapy (IAMT) for the Lower Back on the Structural and Functional Properties of the Dorsal Myofascial Chain in Female Soccer Players: A Randomised, Placebo-Controlled Trial. J Clin Med 2022; 11:jcm11237110. [PMID: 36498690 PMCID: PMC9736370 DOI: 10.3390/jcm11237110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/26/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Instrument-assisted manual therapy (IAMT) is indicated to improve flexibility, reduce pain, and induce hyperaemia locally and along myofascial chains. The underlying effects are largely unclear. This randomised, placebo-controlled pilot study aimed to gain first insights into these effects, primarily on the structural level, through ultrasonography. Methods: 67 healthy female soccer players aged 20.9 (±3.9) years were examined after right lumbar intervention (IAMT: intervention group (IG), heat application: comparison group (CG), pressure-less placebo: placebo group (PG)). Ultrasonography (absolute movement and shear motion), flexibility tests (passive straight leg raise test (PSLR), lumbar and thoracic double inclinometry), and superficial skin temperature were recorded before (t0), immediately (t1) and 45 min after the intervention (t2). Results: IAMT decreased the absolute mobility of the superficial lamina and its shear motion to the superficial fascia compared with the PG (t1; p < 0.05). PSLR improved in the IG compared with the CG (t2) and PG (t1, t2; p < 0.05). The temperature increased in the IG and CG compared with the PG (t1, t2) and in the CG compared with the IG (t1; p < 0.05). Conclusion: IAMT of the lumbar back briefly reduces absolute mobility of the superficial lamina and its shear motion to the superficial fascia, improves flexibility, and increases the temperature.
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Affiliation(s)
- Patrick Weber
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
- PANOVIA Medical Cooperative Society, 50354 Hürth, Germany
- Correspondence:
| | - Werner Klingler
- Anaesthesiology, SRH Hospitals Sigmaringen, 72488 Sigmaringen, Germany
- Experimental Anaesthesiology, Ulm University, 89081 Ulm, Germany
- Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Robert Schleip
- Conservative and Rehabilitative Orthopaedics, Department of Sport and Health Sciences, Technical University of Munich, 80809 Munich, Germany
- Department for Medical Professions, Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Nadine Weber
- PANOVIA Medical Cooperative Society, 50354 Hürth, Germany
| | - Christine Joisten
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, German Sport University Cologne, 50933 Cologne, Germany
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Brandl A, Bartsch K, James H, Miller ME, Schleip R. Influence of Rolfing Structural Integration on Active Range of Motion: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11195878. [PMID: 36233746 PMCID: PMC9570915 DOI: 10.3390/jcm11195878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Recent work has investigated significant force transmission between the components of myofascial chains. Misalignments in the body due to fascial thickening and shortening can therefore lead to complex compensatory patterns. For the treatment of such nonlinear cause−effect pathology, comprehensive neuromusculoskeletal therapy such as the Rolf Method of Structural Integration (SI) could be targeted. Methods: A total of 727 subjects were retrospectively screened from the medical records of an SI practice over a 23-year period. A total of 383 subjects who had completed 10 basic SI sessions met eligibility criteria and were assessed for active range of motion (AROM) of the shoulder and hip before and after SI treatment. Results: Shoulder flexion, external and internal rotation, and hip flexion improved significantly (all p < 0.0001) after 10 SI sessions. Left shoulder flexion and external rotation of both shoulders increased more in men than in women (p < 0.0001) but were not affected by age. Conclusions: An SI intervention could produce multiple changes in the components of myofascial chains that could help maintain upright posture in humans and reduce inadequate compensatory patterns. SI may also affect differently the outcome of some AROM parameters in women and men.
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Affiliation(s)
- Andreas Brandl
- Department of Sports Medicine, Faculty for Psychology and Human Movement Science, Institute for Human Movement Science, University of Hamburg, 20148 Hamburg, Germany
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Osteopathic Research Institute, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Katja Bartsch
- Department of Sport Science and Sports, Friedrich-Alexander University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Helen James
- Department of Physical Therapy, California State University, Fresno, CA 93740, USA
| | - Marilyn E. Miller
- Department of Physical Therapy, University of St. Augustine for Health Sciences at San Diego, San Diego, CA 92069, USA
| | - Robert Schleip
- Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
- Conservative and Rehabilitative Orthopedics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
- Correspondence: ; Tel.: +49-89-289-24561
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Abd Elmaksoud OSM, Elansary SEM, Fahmy NG, Hussien RM. A Comparative Study between Postoperative Analgesia of Fascia Iliaca Compartment Block and Anterior Quadratus Lumborum Block in Proximal Femur Fracture. Anesthesiol Res Pract 2022; 2022:3465537. [PMID: 35620036 PMCID: PMC9130016 DOI: 10.1155/2022/3465537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/18/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Elderly patients with various comorbidities are more likely to suffer from proximal femur fractures. It is also a painful fracture, and poor pain management can have serious physiological and psychological consequences, such as acute delirium. Purpose. The aim of this study is to compare the efficacy of ultrasound-guided transmuscular (anterior) quadratus lumborum block (QLB) versus infrainguinal fascia iliaca compartment block (FICB) in proximal femur fractures for postoperative analgesia. Patient-reported pain on the visual analogue scale (VAS), analgesic demand, and ambulation were the key factors. Patients and Methods. This prospective, randomised trial was done after receiving approval from the institute' study ethical committee. In this study, ultrasound-guided infrainguinal fascia iliaca compartment block was compared to ultrasound-guided anterior quadratus lumborum block using 50 ml of bupivacaine 0.25%, with a maximum dose of 2.5 mg/kg at the end of surgery after spinal anaesthesia in 128 patients (64 patients in each group). Nalbuphine was given as rescue analgesia if VAS >3. Our 1st outcome was the first rescue analgesia and total analgesic consumption in the 1st 24 hours; the 2nd outcome was the time patients started to ambulate. Results. Postoperative pain perception was substantially greater in the FICB group starting from 30 min (P value 0.022) till 24 hours (P value <0.001), and they received a considerably larger total narcotic dose (14.1 ± 3.5) than patients in the QLB group (7.9 ± 3.4), P value (<0.001 ∗ ). The time required to achieve first rescue analgesia was much less in the FICB group (8.5 ± 2.2) compared to the QLB group (14.1 ± 4.5), P value (<0.001 ∗ ), and they took much longer to ambulate (22.3 ± 4.8) when compared to the QLB group (20.1 ± 4.6), P value (0.011 ∗ ). Hypotension (1.6%) was detected mainly in the QLB group, whereas poor fascial separation (1.6%) was observed only in the FICB group. There were no significant differences in complications between both the FICB and QLB groups. Conclusion. Patients receiving postoperative anterior QL block for proximal femur fracture demonstrated delayed first rescue analgesia and lower total nalbuphine consumption with early ambulation than patients who received FICB.
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Affiliation(s)
- O. S. M. Abd Elmaksoud
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - S. E. M. Elansary
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N. G. Fahmy
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R. M. Hussien
- Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Snoeck O, Beyer B, Rooze M, Feipel V. Anatomical study of paratenons and fascia lata connections in the posteromedial knee region. Surg Radiol Anat 2022; 44:821-827. [PMID: 35316382 DOI: 10.1007/s00276-022-02927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the last decade, fascia research increased significantly in various aspects such as anatomical and biomechanical features related to epimuscular force transmission. METHODS The present anatomic study focuses on macroscopic observations of the potential gracilis and semitendinosus paratenons, as well as fascial surroundings connections in the posteromedial knee region on 17 lower-limbs dissections. RESULTS The gracilis and semitendinosus expansions and paratenons were observed in all specimen and further connections with the fascia lata and crural fascia were demonstrated. Contrary to the previously described expansions connected to the tendons, we observed that the expansions were the edges of the paratenon tunnel and that the paratenon structure surrounded the overall muscle. Both paratenons of gracilis and semitendinosus were connected to the crural fascia and, respectively, to the sartorius fascia (part of the fascia lata), to the semimembranosus and the fascia lata. Furthermore, numerous connections between the fascia lata and the neighboring structures in the posteromedial knee region are described. DISCUSSION-CONCLUSION The present study describes for the first time gracilis and semitendinosus paratenons and other surrounding fascial connections. Such macroscopic observations may represent a new basis for further characterization of the myofascial pathway of epimuscular force transmission in the knee region.
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Affiliation(s)
- Olivier Snoeck
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium. .,Laboratory for Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Benoît Beyer
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Laboratory for Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marcel Rooze
- Laboratory for Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Véronique Feipel
- Laboratory for Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
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12
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Chin KJ, Versyck B, Elsharkawy H, Rojas Gomez MF, Sala-Blanch X, Reina MA. Anatomical basis of fascial plane blocks. Reg Anesth Pain Med 2021; 46:581-599. [PMID: 34145071 DOI: 10.1136/rapm-2021-102506] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 11/04/2022]
Abstract
Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space ("plane") between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatomical concepts relevant to FPBs, with a focus on blocks of the torso. Fascia, in this context, refers to any sheet of connective tissue that encloses or separates muscles and internal organs. The basic composition of fascia is a latticework of collagen fibers filled with a hydrated glycosaminoglycan matrix and infiltrated by adipocytes and fibroblasts; fluid can cross this by diffusion but not bulk flow. The plane between fascial layers is filled with a similar fat-glycosaminoglycan matric and provides gliding and cushioning between structures, as well as a pathway for nerves and vessels. The planes between the various muscle layers of the thorax, abdomen, and paraspinal area close to the thoracic paravertebral space and vertebral canal, are popular targets for ultrasound-guided local anesthetic injection. The pertinent musculofascial anatomy of these regions, together with the nerves involved in somatic and visceral innervation, are summarized. This knowledge will aid not only sonographic identification of landmarks and block performance, but also understanding of the potential pathways and barriers for spread of local anesthetic. It is also critical as the basis for further exploration and refinement of FPBs, with an emphasis on improving their clinical utility, efficacy, and safety.
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Affiliation(s)
- Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Versyck
- Department of Anaesthesia and Pain Medicine, Catharina Ziekenhuis, Eindhoven, North Brabant, The Netherlands.,Department of Anaesthesia and Pain Medicine, AZ Turnhout, Turnhout, Belgium
| | - Hesham Elsharkawy
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Anesthesiology, Case Western Reserve University, MetroHealth Pain and Healing Center, Cleveland, Ohio, USA
| | | | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Miguel A Reina
- Department of Anesthesiology, Madrid-Monteprincipe University Hospital, CEU-San-Pablo University School of Medicine, Madrid, Spain
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Adamietz B, Schönberg SO, Reiser M, Uder M, Frank A, Strecker R, Weiß C, Heiss R. Visualization of the epimysium and fascia thoracolumbalis at the lumbar spine using MRI. Radiologe 2021; 61:49-53. [PMID: 34013397 PMCID: PMC8677649 DOI: 10.1007/s00117-021-00849-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The fascia thoracolumbalis (FTL) is an important component for stabilization and motion control of the lumbar spine. It coordinates the traction forces of the autochthonous muscles of the back (AM) and connects them to the muscles of the abdominal wall, shoulder, and buttocks. OBJECTIVES The aim of our study was to describe the assessment of the normal FTL and epimysium of the AM in MRI and to identify patterns associated with pathological changes in the lumbar spine. MATERIAL AND METHODS A total of 33 patients were retrospectively evaluated: 15 patients had no pathology at the lumbar spine; six patients had previous hemilaminectomy, three had spondylodesis, two had ventrolisthesis, and seven had scoliosis. The thickness of the FTL and EM was measured, and the adhesion of both structures was assessed. RESULTS The fascial thickness at the levels of the lumbar vertebral bodies LVB 3 was 1.8, of LVB 4 it was 2.0, of LVB 5 it was 2.1, and at the sacral vertebra SVB 1 it was 1.8 mm. Fascial adhesions together with thickening of the EM occurred at the level of LVB 4 in 36% of the cases independently of the underlying disorder. Only thickening of the EM was seen in 48% of cases at the level of SVB 1. By contrast, adhesion of the FTL without epimysial changes occurred in 36% of cases at the level of LVB 3. CONCLUSION Thickening and adhesions at the EM and FTL occurred both postoperatively and in the case of scoliosis. Furthermore, lipomatous and muscular herniation could be detected in the FTL postoperatively. Epimysial and fascial alterations may be imaging manifestations of chronic myofascial back pain and should be included in radiological assessments.
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Affiliation(s)
- Boris Adamietz
- Radiologisches Zentrum für Diagnostik und Therapie München, Oberföhringer Str. 2, 81679 Munich, Germany
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan O. Schönberg
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Maximilian Reiser
- Radiologisches Zentrum für Diagnostik und Therapie München, Oberföhringer Str. 2, 81679 Munich, Germany
- Radiologische Klinik und Poliklinik, LMU-Klinikum, Munich, Germany
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Frank
- Neurochirurgische Praxis in München, Munich, Germany
| | | | - Christel Weiß
- Abteilung für Medizinische Statistik und Biomathematik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
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Zanfini BA, Biancone M, Famele M, Catarci S, Lavalle R, Frassanito L, Piersanti A, Olivieri C, Lanzone A, Draisci R, Draisci G. Comparison of ropivacaine plasma concentration after posterior Quadratus Lumborum Block in Cesarean Section with ropivacaine with epinephrine vs plane. Minerva Anestesiol 2021; 87:979-986. [PMID: 33938678 DOI: 10.23736/s0375-9393.21.15354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The posterior Quadratus Lumborum Block (pQLB) has been used in postoperative pain management after Cesarean Section (CS). However, clinicians have no data about pQLB safety in pregnants, at increased risk of local anesthetic systemic toxicity (LAST). The purpose of the present study was to explore the efficacy and the safety of adding epinephrine to ropivacaine for bilateral pQLB vs. bilateral pQLB performed with ropivacaine alone in CS. METHODS in this prospective trial 52 pregnants, ASA 2 physiological status, were consecutively allocated to one of 2 groups, e-pQLB and pQLB; e-pQLB group received 0.375% ropivacaine+100 mcg epinephrine, 20 ml each side; pQLB received 0.375% ropivacaine alone, 20 ml each side. The primary and secondary outcomes were to evaluate if the adjunct of epinephrine to ropivacaine increases efficacy and safety of pQLB, respectively. RESULTS Authors found in e-pQLB group vs. p-QLB group: a total mean morphine consumption statistically lower during the first 24 postoperative hours (5.08±3.12, vs 9.11±4.67 SD mg, p=0.0002); NRS values statistically lower at 6 hours from block, both at rest (1,73±1,88 SD vs. 2,88±2,53, p=0.03) and with movement (3,03±1,98 SD vs. 4,23±2,87, p=0.04); a longer time between block and the first opioid request (5.92±2.48 vs 3.78±2.68 SD hrs, p< 0.003); venous ropivacaine concentrations significantly lower at any time of samples but at 120 minutes. CONCLUSIONS Adding epinephrine to ropivacaine increases efficacy and duration of pQLB. Moreover it increases block safety, reducing peak and mean venous ropivacaine concentration.
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Affiliation(s)
- Bruno A Zanfini
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
| | - Matteo Biancone
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Famele
- National Institute of Health, National Center for Chemicals, Cosmetic Products and Consumer Health Protection, Rome, Italy
| | - Stefano Catarci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Lavalle
- National Institute of Health, National Center for Chemicals, Cosmetic Products and Consumer Health Protection, Rome, Italy
| | - Luciano Frassanito
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Piersanti
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Olivieri
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Rosa Draisci
- National Institute of Health, National Center for Chemicals, Cosmetic Products and Consumer Health Protection, Rome, Italy
| | - Gaetano Draisci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
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Lohr C, Medina-Porqueres I. Immediate effects of myofascial release on neuromechanical characteristics in female and male patients with low back pain and healthy controls as assessed by tensiomyography. A controlled matched-pair study. Clin Biomech (Bristol, Avon) 2021; 84:105351. [PMID: 33848704 DOI: 10.1016/j.clinbiomech.2021.105351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/04/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low back pain (LBP) is a major health issue in most industrialised countries. Lumbodorsal fascia has been advocated as a potential source of pain in the lumbopelvic region. Myofascial release constitutes a manual therapeutic approach focussing on the restoration of altered soft tissue function. No previous study has focused on quantifying neuromechanical effects of myofascial release on LBP patients through tensiomyography. The purpose of this study was to quantify immediate neuromechanical alterations of myofascial release on patients with LBP and healthy controls through tensiomyography parameters. METHODS The participants' (n = 30) bilateral lumbar erector spinae muscles were assessed via tensiomyography before and after a 6-min myofascial release treatment of the lumbodorsal fascia to evaluate the muscles' mechanical characteristics. Subjects with LBP (n = 15) were eligible to partake if they reported having had LBP for most days in the past 12 weeks. Muscle displacement (Dm [mm]), velocity of contraction (Vc [mm/s]), and lateral symmetry (Ls [%]) were assessed through tensiomyography testing. FINDINGS Statistical analyses revealed a significant increase for velocity of contraction in the right (p = .021) and left (p = .041) lumbar erector spinae for the subjects with LBP but not for the healthy controls (both p > .14). INTERPRETATION We suggested that myofascial release alters neuromechanical characteristics in subjects with LBP. Tensiomyography may be implemented in clinical settings to monitor intervention effects of the myofascial system, especially the tensiomyography parameter velocity of contraction.
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Affiliation(s)
- Christine Lohr
- Department of Sports and Exercise Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.
| | - Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain.
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Saadawi M, Layera S, Aliste J, Bravo D, Leurcharusmee P, Tran DQ. Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks. J Clin Anesth 2020; 68:110063. [PMID: 33032124 DOI: 10.1016/j.jclinane.2020.110063] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/28/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE This narrative review discusses the anatomy, mechanism of action, techniques, pharmacology, indications, complications and substitutes for erector spinae plane (ESP) blocks. INTERVENTIONS The Medline, Embase and Google Scholar databases (inception-last week of April 2020) were searched. For indications and alternative blocks, a systematic analysis of the available evidence was carried out. In order to highlight the best evidence available, only randomized trials with prospective registration, blinded assessment and sample size justification were retained for analysis. MAIN RESULTS The collective body of anatomical studies suggests that ESP block may work through a combination of different mechanisms (e.g., local anesthetic spread to the thoracic paravertebral space, epidural space, and dorsal ramus). Compared to control, the available evidence suggests that ESP block results in decreased postoperative pain and opioid requirement for a wide array of thoracic and abdominal surgical interventions. Erector spinae plane blocks and thoracic paravertebral blocks seem to provide comparable benefits for thoracoscopic and breast cancer surgery when performed with a similar number of injections. Currently, ESP blocks should be favored over intercostal blocks since, at best, the latter provide similar analgesia to ESP blocks despite requiring multiple-level injections. CONCLUSIONS In recent years, ESP blocks have become the topic of considerable clinical interest. Future trials are required to investigate their optimal technique, dose of local anesthetic and perineural adjuvants. Moreover, additional investigation should compare ESP blocks with robust multimodal analgesic regimens as well as truncal blocks such as thoracic epidural block, midpoint transverse process to pleura block, PECS block, quadratus lumborum block, and transversus abdominis plane block.
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Affiliation(s)
- Mohammed Saadawi
- St. Mary's Hospital, Department of Anesthesiology, McGill University, 3830 Ave Lacombe, Montreal H3T-1M5, Quebec, Canada
| | - Sebastián Layera
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Julián Aliste
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Daniela Bravo
- Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Office B222 second floor, sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Prangmalee Leurcharusmee
- Maharaj Nakorn Chiang Mai Hospital, Department of Anaesthesiology, Chiang Mai University, 110 Intawarorot Street, Chiang Mai 50200, Thailand
| | - De Q Tran
- St. Mary's Hospital, Department of Anesthesiology, McGill University, 3830 Ave Lacombe, Montreal H3T-1M5, Quebec, Canada.
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17
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Farag E, Seif J, Kolli S. Quadratus lumborum block versus transversus abdominal plane block - The Debate is Still Going on. Editorial. J Clin Anesth 2020; 66:109969. [PMID: 32645565 DOI: 10.1016/j.jclinane.2020.109969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022]
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18
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Lohr C, Schmidt T, Braumann KM, Reer R, Medina-Porqueres I. Sex-Based Differences in Tensiomyography as Assessed in the Lower Erector Spinae of Healthy Participants: An Observational Study. Sports Health 2020; 12:341-346. [PMID: 32511080 DOI: 10.1177/1941738120917932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although there is mounting evidence on sex-linked differences in paraspinal muscle function, it is unknown whether sex-based variations in mechanical and contractile characteristics of the lumbar erector spinae (LES) can be monitored noninvasively in healthy participants at rest using tensiomyography (TMG). HYPOTHESIS Sex-specific effects in muscle displacement (Dm) and velocity of muscle deformation (Vd) will be observed via TMG assessed in the LES. STUDY DESIGN Observational study. LEVEL OF EVIDENCE Level 3. METHODS LES response was measured in a relaxed state in 40 healthy adults (20 females). Possible differences between the conditions were investigated using mixed-model analyses of variance. Two-stage hierarchical linear regression analyses were performed to predict the outcome of TMG Dm and Vd based on participant sex. RESULTS There were significant main effects of sex with large effect sizes for both TMG parameters, resulting from lower mean values in women compared with men (Dm, P < 0.01; Vd, P < 0.01). In contrast, neither the main effect of side (left vs right LES) nor the interaction between the side and sex reached significance (all P > 0.3). Introducing the sex variable in stage 2 of the regression analyses significantly improved the prediction of the TMG parameters (all ∆R2 ≥ 0.18; all P < 0.01; all f2 ≥ 0.29). CONCLUSION Sex-based differences in muscle stiffness and contractile characteristics could be observed by TMG on LES muscles in healthy individuals at rest. The data suggest that these disparities are not exclusively attributable to anthropometric measures but may be linked to intrinsic sex-based differences in skeletal muscle characteristics. CLINICAL RELEVANCE We recommend implementing TMG in a clinical setting using the obtained results as a basis to factor for the patient's biological sex when assessing effects of therapeutic/exercise regimens aiming at the optimization of myofascial tissue regeneration and performance.
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Affiliation(s)
- Christine Lohr
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Tobias Schmidt
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.,Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.,Osteopathie Schule Deutschland (OSD) Hamburg, Hamburg, Germany
| | - Klaus-Michael Braumann
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Rüdiger Reer
- Department of Sports Medicine, Institute for Human Movement Science, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
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19
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Posteromedial quadratus lumborum block versus transversus abdominal plane block for postoperative analgesia following laparoscopic colorectal surgery: A randomized controlled trial. J Clin Anesth 2020; 62:109716. [DOI: 10.1016/j.jclinane.2020.109716] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/09/2019] [Accepted: 01/11/2020] [Indexed: 11/19/2022]
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20
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Weber P, Graf C, Klingler W, Weber N, Schleip R. The feasibility and impact of instrument-assisted manual therapy (IAMT) for the lower back on the structural and functional properties of the lumbar area in female soccer players: a randomised, placebo-controlled pilot study design. Pilot Feasibility Stud 2020; 6:47. [PMID: 32322406 PMCID: PMC7164264 DOI: 10.1186/s40814-020-00592-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Myofascial (self-)treatments, such as foam rollers to therapeutic instruments in manual therapy, are utilized increasingly in prevention and therapy in healthy people, athletes, and patients suffering from chronic back pain. However, there is limited knowledge about the effectiveness of treatment and the underlying mechanisms of myofascial therapies, especially for instrument-assisted manual therapy (IAMT). Therefore, this pilot study will investigate the feasibility and impact of IAMT for the lumbar area compared with heat application and placebo treatment as a basis for calculating the sample size for further full studies. The primary outcomes will be a critical analysis of the feasibility of the measurement protocol in terms of time economy and expressiveness and of the short- and long-term effects on shear motion of the single tissue layers of the lower back obtained through ultrasound imaging. Secondary outcomes will include thickness and compressibility of the lumbar structures and flexibility of the dorsal structures, indentometry, and superficial skin temperature. METHODS A minimum of 60 healthy, competitive 15-35-year-old female soccer players will be recruited and randomised into three groups. Short-term effects of IAMT on thoracolumbar structures will be compared with heat application and pressure-less placebo treatment. Long-term effects in the IAMT group will be tested after nine further interventions over a 5-week period (2×/week) and compared with the placebo group, which will not receive further treatments but will serve as a control. Intermediate and final testing of both groups will occur in weeks three and five. DISCUSSION This pilot study will assess the feasibility and the impact of IAMT for the lower back particularly by examining the structural and functional properties of myofascial tissue using diagnostic ultrasound. These outcomes could evaluate the feasibility of the measurements used, shall build a basis for sample size calculation of further full studies, and might generate a greater understanding of myofascial therapies, especially IAMT, for the lower back and its benefits. If this approach proves to be practicable, next steps will be further full studies with soccer players, other sports, and patients with low back pain. TRIAL REGISTRATION German Clinical Trials Register (DRKS00012252) 20.06.2018; retrospectively registered.
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Affiliation(s)
- Patrick Weber
- Department Movement and Health Promotion, German Sport University Cologne, Cologne, Germany
| | - Christine Graf
- Department Movement and Health Promotion, German Sport University Cologne, Cologne, Germany
| | - Werner Klingler
- Anaesthesiology, SRH Hospitals Sigmaringen, Sigmaringen, Germany
- Experimental Anaesthesiology, Ulm University, Germany, Ulm, Germany
- Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Nadine Weber
- Department Cardiology, Aachen University, Aachen, Germany
| | - Robert Schleip
- Conservative and Rehabilitative Orthopaedics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Sports Medicine and Health Promotion, Friedrich-Schiller University Jena, Jena, Germany
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Stouthandel MEJ, Vanhove C, Devriendt W, De Bock S, Debbaut C, Vangestel C, Van Hoof T. Biomechanical comparison of Thiel embalmed and fresh frozen nerve tissue. Anat Sci Int 2020; 95:399-407. [PMID: 32144646 DOI: 10.1007/s12565-020-00535-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/24/2020] [Indexed: 12/13/2022]
Abstract
The aim of this study was to determine the effect of Thiel embalming on the biomechanical properties of nerve tissue, to validate the use of Thiel embalmed bodies as a reliable model system for obtaining biomechanical data to supplement neurodynamic models, for anesthesiological and neurosurgical training and for future preclinical test set-ups involving nerve tissue. Upon the arrival of a body at the anatomy department, a fresh median nerve was harvested, the harvest site was sutured and following the Thiel embalming procedure the Thiel embalmed median nerve of the opposing wrist was harvested. Micro CT was performed to establish the cross-sectional area and biomechanical tensile testing was performed to compare the Young's modulus/elasticity of fresh frozen and Thiel embalmed nerves. Thiel embalming did not cause a significant difference in elasticity when comparing Thiel embalmed and fresh frozen specimens. A correlation was found between the cross-sectional area of Thiel embalmed nerve specimens and their Young's modulus. Thiel embalming does not significantly alter the elasticity of nerve tissue compared to fresh frozen nerve tissue. Similar shapes were observed when comparing the stress/strain curves of both specimen types. This indicates that Thiel embalmed nerve tissue is a viable alternative for using fresh frozen specimens when investigating biomechanical principles/mechanisms. Some specimens showed a reversed trend in Young's modulus that could be related to slight differences in embalming outcome, so caution is advised when Thiel embalmed specimens are used to obtain raw numerical data for direct application in the clinic.
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Affiliation(s)
- Michael E J Stouthandel
- Department of Human Structure and Repair, Ghent University, Radiotherapy Park, Entrance 98, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Christian Vanhove
- Infinity Lab, Ghent University, Building P8, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Wouter Devriendt
- Agfa Healthcare, 150 Royall Street (Second Floor), Canton, Massachusetts, 02021, USA
| | - Sander De Bock
- IBiTech-bioMMeda, Ghent University, Block B, Entrance 36, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Charlotte Debbaut
- Infinity Lab, Ghent University, Building P8, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Carl Vangestel
- Directorate Taxonomy and Phylogeny, Royal Belgian Institute of Natural Sciences, 1000, Brussels, Belgium.,Terrestrial Ecology Unit, Biology Department, Ghent University, 9000, Ghent, Belgium
| | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, Radiotherapy Park, Entrance 98, C. Heymanslaan 10, 9000, Ghent, Belgium
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Verma K, Malawat A, Jethava D, Jethava DD. Comparison of transversus abdominis plane block and quadratus lumborum block for post-caesarean section analgesia: A randomised clinical trial. Indian J Anaesth 2019; 63:820-826. [PMID: 31649394 PMCID: PMC6798627 DOI: 10.4103/ija.ija_61_19] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 08/11/2019] [Indexed: 02/04/2023] Open
Abstract
Background and Aims: Effective post-operative analgesia after caesarean section (CS) is important because it facilitates early amelioration, ambulation and expedites breastfeeding. Quadratus lumborum (QL) block is an interfascial block providing effective visceral and somatic analgesia. We conducted this study to compare the analgesic efficacy of QL block and transversus abdominis plane (TAP) block after CS. Methods: In this single hospital-based, prospective double-blind study, 60 patients scheduled for an elective CS between December 2018 and January 2019 were randomised to receive ultrasound-guided TAP block (n = 30) or QL block (n = 30) bilaterally with 0.2% ropivacaine postoperatively. The primary objective was to measure the time for rescue analgesic requirement and secondary objectives included the total number of analgesic dose required over a period of 72 hours and severity of post-operative pain assessment via visual analogue scale (VAS) score at rest and with movement. Statistical analysis was done using SPSS version 21. Data were compared using the Chi-square test and students' t-test. Results: Time for rescue analgesic requirement was higher in the QL group than the TAP group (mean ± SD: 68.77 ± 1.74 h vs. 13.3 ± 1.21 h) (P < 0.001). The QL group had significantly less analgesic demand (P < 0.001) at 2, 4, 6, 12, 24, 36, 48 and 72 h post-CS. The VAS at rest and movement was significantly reduced in the QL group at all times. Conclusion: The QL block provided prolonged and effective analgesia in comparison to TAP block up to 72 hours post-CS.
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Affiliation(s)
- Kalpana Verma
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Aman Malawat
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Durga Jethava
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
| | - Dharam Das Jethava
- Department of Anaesthesiology, Critical Care and Pain Management, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
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Pirri C, Todros S, Fede C, Pianigiani S, Fan C, Foti C, Stecco C, Pavan P. Inter‐rater reliability and variability of ultrasound measurements of abdominal muscles and fasciae thickness. Clin Anat 2019; 32:948-960. [DOI: 10.1002/ca.23435] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/27/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Carmelo Pirri
- Physical and Rehabilitation Medicine, University of Rome “Tor Vergata” Rome Italy
| | - Silvia Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials University of Padova Italy
| | - Caterina Fede
- Department of Neuroscience University of Padova Padova Italy
| | - Silvia Pianigiani
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials University of Padova Italy
| | - Chenglei Fan
- Department of Neuroscience University of Padova Padova Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, University of Rome “Tor Vergata” Rome Italy
| | - Carla Stecco
- Department of Neuroscience University of Padova Padova Italy
| | - Piero Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials University of Padova Italy
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Goto T, Sakai T, Sato N, Katoh S, Sairyo K. An Adolescent Athlete with Low Back Pain Associated with Spina Bifida Occulta at the Thoracolumbar Junction : A Case Report. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:199-200. [PMID: 31064941 DOI: 10.2152/jmi.66.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Spina bifida occulta (SBO) is a common malformation of lamina of the spine, most commonly occurring in the sacrum or lower lumbar spine. Athletes with anatomical abnormalities such as SBO may be vulnerable to discoordination of muscles and/or skeletal structures. CASE REPORT We present a case of a 15- year-old male adolescent who presented with persistent low back pain (LBP) associated with SBO at T11-L1 that had been overlooked for several years. He participated in karate as a top-level competitor at the nationallevel, but the LBP interfered with his play. Dynamic X-ray films showed limited range of motion (ROM) in his lower lumbar spine (L3-S1). Instead, the thoracolumbar junction compensated for the lack of ROM in the lumbar spine,enabling trunk flexion and extension. To restore normal coordination, he was treated with a 2-week rehabilitation program including flexibility and core conditioning for the trunk to improve coordination of spinal movement. Two weeks later, his LBP resolved. CONCLUSION These results suggest that evaluation of the coordination of the muscles and skeletal structures has an important role in the treatment of cases with an anatomical abnormality such as SBO. J.Med.Invest.66:199-200, February, 2019.
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Affiliation(s)
- Tsuyoshi Goto
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute ofBiomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Nori Sato
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Shinsuke Katoh
- Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute ofBiomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Abstract
A review of anatomy, potential mechanisms of action, and techniques and summary of clinical evidence for quadratus lumborum block.
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Song L, Huang D, Li Y. Posteromedial quadratus lumborum block provides successful analgesia after laparoscopic rectal cancer surgery. J Clin Anesth 2018; 55:28-30. [PMID: 30594095 DOI: 10.1016/j.jclinane.2018.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Linlin Song
- Department of Anesthesiology, Peking University First Hospital, No. 15 Xishiku Street, Xicheng District, 100034 Beijing, China.
| | - Da Huang
- Department of Anesthesiology, Peking University First Hospital, No. 15 Xishiku Street, Xicheng District, 100034 Beijing, China
| | - Yuting Li
- Department of Anesthesiology, Peking University First Hospital, No. 15 Xishiku Street, Xicheng District, 100034 Beijing, China
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Blain M, Bedretdinova D, Bellin MF, Rocher L, Gagey O, Soubeyrand M, Creze M. Influence of thoracolumbar fascia stretching on lumbar back muscle stiffness: A supersonic shear wave elastography approach. Clin Anat 2018; 32:73-80. [DOI: 10.1002/ca.23266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/03/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Maxime Blain
- Radiology Department; Bicêtre Hospital; APHP France
| | - Dina Bedretdinova
- Centre de recherche en Epidémiologie et Santé des Populations; CESP, INSERM, Université Paris-Saclay; le Kremlin-Bicêtre France
| | - Marie-France Bellin
- Radiology Department; Bicêtre Hospital; APHP France
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités; IR4M, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
| | - Laurence Rocher
- Radiology Department; Bicêtre Hospital; APHP France
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités; IR4M, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
| | - Olivier Gagey
- Orthopedy Department; Bicêtre Hospital; APHP France
- Complexité, Innovations, Activités Motrices et Sportives, CIAMS (EA4532); Univ Paris-Sud, Université Paris-Saclay; Orsay France
| | | | - Maud Creze
- Radiology Department; Bicêtre Hospital; APHP France
- Imagerie par Résonance Magnétique Médicale et Multi-Modalités; IR4M, CNRS, Univ Paris-Sud, Université Paris-Saclay; Orsay France
- Complexité, Innovations, Activités Motrices et Sportives, CIAMS (EA4532); Univ Paris-Sud, Université Paris-Saclay; Orsay France
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Tamura T, Yokota S, Ito S, Shibata Y, Nishiwaki K. Local anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study. J Anesth 2018; 33:26-32. [DOI: 10.1007/s00540-018-2578-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/28/2018] [Indexed: 02/07/2023]
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FAN CHENGLEI, FEDE CATERINA, GAUDREAULT NATHALY, PORZIONATO ANDREA, MACCHI VERONICA, DE CARO RAFFAELE, Stecco C. Anatomical and functional relationships between external abdominal oblique muscle and posterior layer of thoracolumbar fascia. Clin Anat 2018; 31:1092-1098. [DOI: 10.1002/ca.23248] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 12/15/2022]
Affiliation(s)
- CHENGLEI FAN
- Institute of Human Anatomy, Department of Neurosciences; University of Padova; Via Gabelli 65, 35127, Padova Italy
| | - CATERINA FEDE
- Institute of Human Anatomy, Department of Neurosciences; University of Padova; Via Gabelli 65, 35127, Padova Italy
| | - NATHALY GAUDREAULT
- School of Rehabilitation, Faculty of Medicine and Health Sciences; University of Sherbrooke; 3001, 12e Avenue Nord, Sherbrooke, J1H 5N4 Canada
| | - ANDREA PORZIONATO
- Institute of Human Anatomy, Department of Neurosciences; University of Padova; Via Gabelli 65, 35127, Padova Italy
| | - VERONICA MACCHI
- Institute of Human Anatomy, Department of Neurosciences; University of Padova; Via Gabelli 65, 35127, Padova Italy
| | - RAFFAELE DE CARO
- Institute of Human Anatomy, Department of Neurosciences; University of Padova; Via Gabelli 65, 35127, Padova Italy
| | - Carla Stecco
- Institute of Human Anatomy, Department of Neurosciences; University of Padova; Via Gabelli 65, 35127, Padova Italy
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Nelson-Wong E, Glinka M, Noguchi M, Langevin H, Badger GJ, Callaghan JP. Acute Surgical Injury Alters the Tensile Properties of Thoracolumbar Fascia in a Porcine Model. J Biomech Eng 2018; 140:2683659. [PMID: 30029246 PMCID: PMC6993774 DOI: 10.1115/1.4040452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/20/2018] [Indexed: 11/08/2022]
Abstract
Recent work utilizing ultrasound imaging demonstrated that individuals with low back pain (LBP) have increased thickness and decreased mobility of the thoracolumbar fascia (TLF), an indication that the TLF may play a role in LBP. This study used a porcine injury model (microsurgically induced local injury)-shown to produce similar results to those observed in humans with LBP-to test the hypothesis that TLF mechanical properties may also be altered in patients with LBP. Perimuscular TLF tissue was harvested from the noninjured side of vertebral level L3-4 in pigs randomized into either control (n = 5) or injured (n = 5) groups. All samples were tested with a displacement-controlled biaxial testing system using the following protocol: cyclic loading/unloading and stress relaxation tests at 25%, 35%, and then 45% of their resting length. Tissue anisotropy was also explored by comparing responses to loading in longitudinal and transverse orientations. Tissues from injured pigs were found to have greater stretch-stretch ratio moduli (measure of tissue stiffness), less energy dissipation, and less stress decay compared to tissues from control pigs. Responses across these variables also depended on loading orientation. CLINICAL SIGNIFICANCE these findings suggest that a focal TLF injury can produce impairments in tissue mechanical properties away from the injured area itself. This could contribute to some of the functional abnormalities observed in human LBP.
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Affiliation(s)
- Erika Nelson-Wong
- School of Physical Therapy,
Regis University,
3333 Regis Boulevard G4,
Denver, CO 80221
e-mail:
| | - Michal Glinka
- Faculty of Applied Health Sciences,
University of Waterloo,
200 University Avenue West,
Waterloo, ON N2 L 3G1, Canada
e-mail:
| | - Mamiko Noguchi
- Faculty of Applied Health Sciences,
University of Waterloo,
200 University Avenue West,
Waterloo, ON N2 L 3G1, Canada
e-mail:
| | - Helene Langevin
- Osher Center for Integrative Medicine
at Harvard Medical School and
Brigham and Women's Hospital,
75 Francis Street,
Boston, MA 02115
e-mail:
| | - Gary J. Badger
- Department of Medical Biostatistics,
College of Medicine,
University of Vermont,
Burlington, VT 05405
e-mail:
| | - Jack P. Callaghan
- Faculty of Applied Health Sciences,
University of Waterloo,
200 University Avenue West,
Waterloo, ON N2 L 3G1, Canada
e-mail:
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Creze M, Soubeyrand M, Nyangoh Timoh K, Gagey O. Organization of the fascia and aponeurosis in the lumbar paraspinal compartment. Surg Radiol Anat 2018; 40:1231-1242. [PMID: 30171298 DOI: 10.1007/s00276-018-2087-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/31/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE The thoracolumbar fascia (TLF) and the erector spinae aponeurosis (ESA) play significant roles in the biomechanics of the spine and could be a source of low back pain. Attachment, collagen fiber direction, size and biomechanical properties of the TLF have been well documented. However, questions remain about the attachment of the TLF and ESA in relation to adjoining tissues in the lumbosacral region. Moreover, quantitative data in relation to the ESA have rarely been examined. The aim of this study was to further investigate the anatomical features of the TLF and ESA and to determine the attachments and sliding areas of the paraspinal compartment through dissection. MATERIALS AND METHODS In 10 fresh cadavers (6 females, 4 males, mean age: 77 ± 10 years), we determined (1) the gross anatomy of the ESA and the TLF (attachments and sliding areas) and (2) the structure of the ESA and the TLF (thickness, width, orientation of collagen fibers). The pennation angle between the axis of the ES muscle fibers and the axis of the collagen fibers of the ESA were also measured. RESULTS The TLF is an irregular dense connective tissue with a mean thickness of 0.95 mm. The distance between the spinous processes line and the site where the neurovascular bundles pierced the TLF, depending on the vertebral level, ranged from 29 mm at L1 to 75 mm at L3. The ESA constituted a band of regular longitudinally oriented connective fibers (mean thickness: 1.85 mm). Muscles fibers of the ES were strongly diagonally attached to the ESA (mean pennation angle 8° for the iliocostalis and 14° for the longissimus). To a lesser extent, the superficial multifidi were attached to the ESA at the lumbar level close to the midline and at the sacral level. CONCLUSION The ESA, at twice the thickness of the pTLF, was the thickest dense connective tissue of the paraspinal compartment. The ESA and the TLF circumscribed subcompartments and sliding areas between the TFL and the lumbar paraspinal muscles, between the ES and the multifidus, and between the longissimus and the iliocostalis.
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Affiliation(s)
- Maud Creze
- Radiology Department, Bicêtre Hospital, APHP, 78 avenue du Général Leclerc, 94270, Le Kremlin-Bicetre, France.
- Laboratory "Complexité, Innovations, Activités Motrices et Sportives", CIAMS (EA4532), University Paris-Sud, University Paris-Saclay, Orsay, France.
| | - Marc Soubeyrand
- Orthopedic Department, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | - Krystel Nyangoh Timoh
- Obstetrics and Gynecology Department, Rennes Hospital, University Rennes 1, Rennes, France
| | - Olivier Gagey
- Laboratory "Complexité, Innovations, Activités Motrices et Sportives", CIAMS (EA4532), University Paris-Sud, University Paris-Saclay, Orsay, France
- Orthopedic Department, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
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Cadaveric Evaluation of Different Approaches for Quadratus Lumborum Blocks. Pain Res Manag 2018; 2018:2368930. [PMID: 29991972 PMCID: PMC6016158 DOI: 10.1155/2018/2368930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/06/2018] [Accepted: 05/20/2018] [Indexed: 11/17/2022]
Abstract
Background A quadratus lumborum (QL) block is an abdominal truncal block technique that primarily provides analgesia and anaesthesia to the abdominal wall. This cadaveric study was undertaken to compare the dye spread between different needle approaches for ultrasound-guided QL blocks in soft-embalmed cadavers. Methods After randomization, an experienced anesthesiologist performed two lateral, three posterior, and five alternative QL blocks on the left or right sides of five cadavers. The target injection point for the alternative approach was the lumbar interfascial triangle, same as that of conventional posterior QL block, with a different needle trajectory. For each block, 20 ml of dye solution was injected. The lumbar region and abdominal flank were dissected. Results Ten blocks were successfully performed. Regardless of the approach used, the middle thoracolumbar fascia was deeply stained in all blocks, but the anterior layer was less stained. The alternative approach was more associated with spread of injectate to the transversus abdominis and transversalis fascia plane. Despite accurate needle placement, all lateral QL blocks were associated with a certain amount of intramuscular or subcutaneous infiltration. Two posterior QL blocks showed a deeply stained posterior thoracolumbar fascia, and one of them was associated with obvious subcutaneous staining. The subcostal, iliohypogastric, and ilioinguinal nerves were mostly involved, but the thoracic paravertebral space and lumbar plexus were not affected in all blocks. Conclusions The alternative approach for QL blocks was able to achieve a comparable extent when compared to the conventional approach.
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Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection. Reg Anesth Pain Med 2018; 43:372-377. [DOI: 10.1097/aap.0000000000000735] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Lohr C, Braumann KM, Reer R, Schroeder J, Schmidt T. Reliability of tensiomyography and myotonometry in detecting mechanical and contractile characteristics of the lumbar erector spinae in healthy volunteers. Eur J Appl Physiol 2018; 118:1349-1359. [DOI: 10.1007/s00421-018-3867-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/13/2018] [Indexed: 11/30/2022]
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Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block. Eur J Anaesthesiol 2017; 34:587-595. [DOI: 10.1097/eja.0000000000000680] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Nagar VR, Hooper TL, Dedrick GS, Brismée JM, McGalliard MK, Sizer PS. The Effect of Current Low Back Pain on Volitional Preemptive Abdominal Activation During a Loaded Forward Reach Activity. PM R 2016; 9:127-135. [PMID: 27390055 DOI: 10.1016/j.pmrj.2016.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND A volitional preemptive abdominal contraction (VPAC) supports trunk stability during functional activity. Pain-free individuals can sustain VPAC during function, but such has not been reported for individuals with current low back pain (cLBP). OBJECTIVE To examine whether cLBP affects VPAC performance during a loaded forward reach (LFR) task. DESIGN Observational crossover study. SETTING Laboratory. PARTICIPANTS A total of 18 controls and 17 subjects with cLBP with pain ratings of 1/10 to 4/10 on a visual analog scale. INTERVENTIONS Transverse abdominis (TrA) thickness measurements were recorded by blinded researchers from M-mode ultrasound imaging during 4 conditions: (1) quiet standing without abdominal drawing-in maneuver (ADIM); (2) quiet standing with ADIM; (3) LFR without ADIM; and (4) LFR with ADIM. A physical therapist with 29 years of experience collected historical and examination data. MAIN OUTCOME MEASURES TrA muscle thickness (mm). RESULTS A 2 (group) × 2 (contraction) × 2 (reach) analysis of variance demonstrated a significant group × contraction interaction (F [1, 31] = 4.499, P = .04) where ADIM produced greater TrA thickness increases in PLBP subjects (2.18 mm) versus controls (1.36 mm). We observed a significant main effect for reach (F [1, 31] = 14.989, P < .001), where LFR activity produced a greater TrA thickness (6.15 ± 2.48 mm) versus quiet standing (5.30 ± 2.12 mm). CONCLUSIONS Subjects with cLBP demonstrated a greater increase in TrA activation during ADIM versus controls.
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Affiliation(s)
- Vittal R Nagar
- Center for Rehabilitation Research, SAHS, Texas Tech University Health Sciences Center, Lubbock, TX; Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY(∗)
| | - Troy L Hooper
- Center for Rehabilitation Research, SAHS, Texas Tech University Health Sciences Center, Lubbock, TX(†)
| | - Gregory S Dedrick
- Doctor of Physical Therapy Program, Campbell University, Buies Creek, NC(‡)
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, SAHS, Texas Tech University Health Sciences Center, Lubbock, TX(§)
| | - Michael K McGalliard
- Center for Rehabilitation Research, SAHS, Texas Tech University Health Sciences Center, Lubbock, TX; Doctor of Physical Therapy Program, Harding University, Searcy, AR(¶)
| | - Phillip S Sizer
- Center for Rehabilitation Research, SAHS, Texas Tech University Health Sciences Center, 3601 4th St., Stop 6280, Lubbock, TX 79430-6280(#).
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Elsharkawy H. Quadratus lumborum block with paramedian sagittal oblique (subcostal) approach. Anaesthesia 2016; 71:241-2. [PMID: 26750418 DOI: 10.1111/anae.13371] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery. Reg Anesth Pain Med 2016; 41:757-762. [DOI: 10.1097/aap.0000000000000495] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Currently, the exact role of telocytes within fascial structures is unknown. The morphology, distribution and behaviour of fascial telocytes as well as the mutual relationship between telocytes and other cellular fascia constituents should be definitely a subject of further studies. It will contribute to better understanding of the role of the fascial system in health and diseases, may shed light on the regeneration potential of these tissues and may help to find targets for future treatments for locomotor disorders, including fascial diseases. Last but not least, confirmation of the presence of telocytes within fascia may contribute to optimise the use of fascia as a graft material.
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Chen YH, Chai HM, Yang JL, Lin YJ, Wang SF. Reliability and Validity of Transversus Abdominis Measurement at the Posterior Muscle-Fascia Junction with Ultrasonography in Asymptomatic Participants. J Manipulative Physiol Ther 2015; 38:581-6. [DOI: 10.1016/j.jmpt.2014.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 12/02/2014] [Accepted: 12/06/2014] [Indexed: 01/14/2023]
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Van de Velde J, Bogaert S, Vandemaele P, Huysse W, Achten E, Leijnse J, De Neve W, Van Hoof T. Brachial plexus 3D reconstruction from MRI with dissection validation: a baseline study for clinical applications. Surg Radiol Anat 2015; 38:229-36. [DOI: 10.1007/s00276-015-1549-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/17/2015] [Indexed: 02/01/2023]
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Vleeming A, Schuenke MD, Danneels L, Willard FH. The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia. J Anat 2014; 225:447-62. [PMID: 25139243 DOI: 10.1111/joa.12227] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 11/30/2022] Open
Abstract
The thoracolumbar fascia (TLF) consists of aponeurotic and fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF's paraspinal muscular compartment (PMC) alters load transfer between the TLF's posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incremental PMC pressure, fascial tension is primarily transferred to the PLF. In cadaveric axial sections, paraspinal muscles were replaced with inflatable tubes to simulate paraspinal muscle contraction. At each inflation increment, tension was created in the CTrA to simulate contraction of the deep abdominal muscles. Fluoroscopic images and load cells captured changes in the size, shape and tension of the PMC due to inflation, with and without tension to the CTrA. In the absence of PMC pressure, increasing tension on the CTrA resulted in anterior and lateral movement of the PMC. PMC inflation in the absence of tension to the CTrA resulted in a small increase in the PMC perimeter and a larger posterior displacement. Combining PMC inflation and tension to the CTrA resulted in an incremental increase in PLF tension without significantly altering tension in the MLF. Paraspinal muscle contraction leads to posterior displacement of the PLF. When expansion is combined with abdominal muscle contraction, the CTrA and internal oblique transfers tension almost exclusively to the PLF, thereby girdling the paraspinal muscles. The lateral border of the PMC is restrained from displacement to maintain integrity. Posterior movement of the PMC represents an increase of the PLF extension moment arm. Dysfunctional paraspinal muscles would reduce the posterior displacement of the PLF and increase the compliance of the lateral border. The resulting change in PMC geometry could diminish any effects of increased tension of the CTrA. This study reveals a co-dependent mechanism involving balanced tension between deep abdominal and lumbar spinal muscles, which are linked through the aponeurotic components of the TLF. This implies the existence of a point of equal tension between the paraspinal muscles and the transversus abdominis and internal oblique muscles, acting through the CTrA.
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Affiliation(s)
- A Vleeming
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME, USA; Department of Rehabilitation Sciences and Physiotherapy, University of Ghent, Ghent, Belgium
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Van de Velde J, Vercauteren T, De Gersem W, Wouters J, Vandecasteele K, Vuye P, Vanpachtenbeke F, D’Herde K, Kerckaert I, De Neve W, Van Hoof T. Reliability and accuracy assessment of radiation therapy oncology group-endorsed guidelines for brachial plexus contouring. Strahlenther Onkol 2014; 190:628-32, 634-5. [DOI: 10.1007/s00066-014-0657-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/11/2014] [Indexed: 12/25/2022]
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Cuesta-Vargas AI, González-Sánchez M. Ability to discriminate between healthy and low back pain sufferers using ultrasound during maximum lumbar extension. Arch Phys Med Rehabil 2014; 95:1093-9. [PMID: 24534298 DOI: 10.1016/j.apmr.2014.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the ability to discriminate between healthy individuals and individuals with chronic nonspecific low back pain (CNLBP) by measuring the relation between patient-reported outcomes and objective clinical outcome measures of the erector spinae (ES) muscles using an ultrasound during maximal isometric lumbar extension. DESIGN Cross-sectional study with screening and diagnostic tests with no blinded comparison. SETTING University laboratory. PARTICIPANTS Healthy individuals (n=33) and individuals with CNLBP (n=33). INTERVENTIONS Each subject performed an isometric lumbar extension. With the variables measured, a discriminate analysis was performed using a value ≥ 6 in the Roland and Morris disability questionnaire (RMDQ) as the grouping variable. Then, a logistic regression with the functional and architectural variables was performed. A new index was obtained from each subject value input in the discriminate multivariate analysis. MAIN OUTCOME MEASURES Morphologic muscle variables of the ES muscle were measured through ultrasound images. The reliability of the measures was calculated through intraclass correlation coefficients (ICCs). The relation between patient-reported outcomes and objective clinical outcome measures was analyzed using a discriminate function from standardized values of the variables and an analysis of the reliability of the ultrasound measurement. RESULTS The reliability tests show an ICC value >.95 for morphologic and functional variables. The independent variables included in the analysis explained 42% (P=.003) of the dependent variable variance. CONCLUSIONS The relation between objective variables (electromyography, thickness, pennation angle) and a subjective variable (RMDQ ≥ 6) and the capacity of this relation to identify CNLBP within a group of healthy subjects is moderate. These results should be considered by clinicians when treating this type of patient in clinical practice.
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Affiliation(s)
- Antonio I Cuesta-Vargas
- IBIMA, Department of Physiotherapy, Faculty of Health Sciences, Andalucia Tech, University of Malaga, Malaga, Spain; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Manuel González-Sánchez
- IBIMA, Department of Physiotherapy, Faculty of Health Sciences, Andalucia Tech, University of Malaga, Malaga, Spain
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Effect of recurrent low back pain history on volitional pre-emptive abdominal activation during a loaded functional reach activity. Spine (Phila Pa 1976) 2014; 39:E89-96. [PMID: 24153166 DOI: 10.1097/brs.0000000000000091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A 2 (group) × 2 (abdominal contraction) × 2 (reach activity) crossover mixed design with repeated measures for contraction and activity examined the effects of a loaded (4.6 kg) forward-reach activity and abdominal drawing-in maneuver (ADIM) on transversus abdominis (TrA) contraction in subjects with nonspecific low back pain (NSLBP) history versus controls. OBJECTIVE We measured TrA contraction during a loaded forward-reach activity while using the ADIM and examined if a NSLBP history affects TrA activity. SUMMARY OF BACKGROUND DATA The ADIM supports trunk stability during function. Clinicians incorporate ADIM during patients' functional tasks. Pain-free individuals can sustain ADIM during function, such as forward-reach. However, this has not been tested in those with a NSLBP history. METHODS Eighteen normal subjects and 18 subjects with a history of NSLBP participated. A blinded investigator recorded M-mode ultrasound imaging measurements of TrA thickness (mm) during 4 conditions as follows: (1) quiet standing without ADIM; (2) quiet standing with ADIM; (3) loaded forward-reach without ADIM; and (4) loaded forward-reach with ADIM. RESULTS A mixed analysis of variance demonstrated a significant main effect for group (F [1, 34] = 5.404, P = 0.026; ), where TrA thickness was greater for NSLBP history (7.41 + 2.34 mm) versus controls (5.9 + 2.46 mm). A significant main effect was observed for abdominal contraction (F [1, 34] = 49.57, P < 0.0001; ), where TrA thickness was greater during ADIM (7.47 + 2.7 mm) versus without ADIM (5.84, 1.92 m). A significant main effect was observed for forward-reach activity (F [1, 34] = 12.79, P = 0.001; ), where TrA thickness was greater during a loaded forward-reach (7.04 + 2.6 mm) versus quiet standing (6.2 + 2.4 mm). There were no significant interactions. CONCLUSION Individuals can use a volitional pre-emptive ADIM for trunk protection during loaded forward-reach, potentially reducing injury risk. A NSLBP history increases TrA activation during ADIM, suggesting an enhanced protective role. LEVEL OF EVIDENCE 2.
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King HH. Abdominal Muscles Are the Front Side of the Low Back. J Osteopath Med 2014. [DOI: 10.7556/jaoa.2014.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hollis H. King
- University of Wisconsin School of Medicine and Public Health, Madison
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Van de Velde J, Audenaert E, Speleers B, Vercauteren T, Mulliez T, Vandemaele P, Achten E, Kerckaert I, D'Herde K, De Neve W, Van Hoof T. An anatomically validated brachial plexus contouring method for intensity modulated radiation therapy planning. Int J Radiat Oncol Biol Phys 2013; 87:802-8. [PMID: 24138919 DOI: 10.1016/j.ijrobp.2013.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/17/2013] [Accepted: 08/02/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop contouring guidelines for the brachial plexus (BP) using anatomically validated cadaver datasets. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to obtain detailed visualizations of the BP region, with the goal of achieving maximal inclusion of the actual BP in a small contoured volume while also accommodating for anatomic variations. METHODS AND MATERIALS CT and MRI were obtained for 8 cadavers positioned for intensity modulated radiation therapy. 3-dimensional reconstructions of soft tissue (from MRI) and bone (from CT) were combined to create 8 separate enhanced CT project files. Dissection of the corresponding cadavers anatomically validated the reconstructions created. Seven enhanced CT project files were then automatically fitted, separately in different regions, to obtain a single dataset of superimposed BP regions that incorporated anatomic variations. From this dataset, improved BP contouring guidelines were developed. These guidelines were then applied to the 7 original CT project files and also to 1 additional file, left out from the superimposing procedure. The percentage of BP inclusion was compared with the published guidelines. RESULTS The anatomic validation procedure showed a high level of conformity for the BP regions examined between the 3-dimensional reconstructions generated and the dissected counterparts. Accurate and detailed BP contouring guidelines were developed, which provided corresponding guidance for each level in a clinical dataset. An average margin of 4.7 mm around the anatomically validated BP contour is sufficient to accommodate for anatomic variations. Using the new guidelines, 100% inclusion of the BP was achieved, compared with a mean inclusion of 37.75% when published guidelines were applied. CONCLUSION Improved guidelines for BP delineation were developed using combined MRI and CT imaging with validation by anatomic dissection.
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Affiliation(s)
- Joris Van de Velde
- Department of Anatomy, Ghent University, Ghent, Belgium; Department of Radiotherapy, Ghent University, Ghent, Belgium.
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Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc 2013; 6:281-91. [PMID: 23940419 PMCID: PMC3731110 DOI: 10.2147/jmdh.s45443] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The article explains the scientific reasons for the diaphragm muscle being an important crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the mouth. Like many structures in the human body, the diaphragm muscle has more than one function, and has links throughout the body, and provides the network necessary for breathing. To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing. The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction.
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Affiliation(s)
- Bruno Bordoni
- Rehabilitation Cardiology Institute of Hospitalization and Care with Scientific Address, S Maria Nascente Don Carlo Gnocchi Foundation
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What is 'fascia'? A review of different nomenclatures. J Bodyw Mov Ther 2012; 16:496-502. [PMID: 23036881 DOI: 10.1016/j.jbmt.2012.08.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 02/08/2023]
Abstract
There are many different definitions of fascia. Here the three most common nomenclatures are compared, including that of the Federative International Committee on Anatomical Terminology (1998), the definition included in the latest British edition of Gray's Anatomy (2008) and the newer and more comprehensive terminology suggested at the last international Fascia Research Congress (2012). This review covers which tissues are included and excluded in each of these nomenclatures. The advantages and disadvantages of each terminology system are suggested and related to different fields of application, ranging from histology, tissue repair, to muscular force transmission and proprioception. Interdisciplinary communication involving professionals of different fields is also discussed.
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