The fenrou zhijian theory in The Inner Canon of Huangdi and the stratified treatment of painful bi syndrome of meridian tendons / 中国针灸

The fenrou zhijian is defined as potential gap between different layers in the three-dimensional network structure formed by the twelve meridian tendons. Various pathological changes of the meridian tendons lead to the adhesion and closure of fenrou zhijian, causing abnormal mechanical conduction of the meridian tendon system, which in turn leads to painful bi syndrome of meridian tendons. As such, restarting the fenrou zhijian is the key to acupuncture treatment for painful bi syndrome of meridian tendons. Under the guidance of musculoskeletal ultrasound, the level and the angle of needle insertion of acupuncture at fenrou zhijian could be accurately controlled, the efficacy of acupuncture is improved.

Avaliação ultrassonográfica dos tendões flexores dos membros anteriores em equinos de vaquejada na microrregião do Alto Médio Gurgueia, Sul do Piauí, Brasil / Ultrasound evaluation of the flexor tendons of the forelimbs in horses in vaquejada horses in the Alto Médio Gurgueia, South of Piauí, Brazil

Objetivou-se com este estudo demonstrar a influência do tipo de treinamento sobre as medidas dos tendões flexores palmares em equinos de vaquejada que correm à direita do boi na microrregião do Alto Médio Gurgueia, Sul do Piauí, Brasil. Foram utilizados oito animais, da raça quarto de milha e seus mestiços, de diferentes idades, peso e sexo, selecionados e questionados sobre o tempo que exerciam a atividade de vaquejada e o tipo de treinamento a qual eram submetidos, que refere-se a maneira como praticavam a prova correndo de que lado do boi, em uma prova de vaquejada no município de Cristino Castro, Sul do Piauí, Brasil, onde os participantes eram provenientes de diferentes haras da Microrregião do Alto Médio Gurgueia, Sul do Piauí, Brasil. Em cada animal foi realizada ultrassonografia das zonas IB, IIB e IIIB dos tendões flexores digital superficial (TFDS) e digital profundo (TFDP), obtendo-se as medidas dos diâmetros médio lateral (DML) e dorso palmar (DDP) através do plano transverso em cada uma das diferentes zonas. Os dados foram submetidos a análise estatística (ANOVA), utilizando-se o teste t a nível de significância de (p<0,05), observando-se que não houve diferença significativa entre as medidas avaliadas. De acordo com os resultados obtidos, cavalos atletas que correm a direita do boi não apresentam diferença significativa nos diâmetros médio lateral e dorso palmar dos tendões flexores entre os antímeros direito e esquerdo do membro torácico.

The objective of this study was to demonstrate the influence of the type of training on the measurements of the palmar flexor tendons in vaquejada horses that run to the right of the ox in the microregion of the Alto Médio Gurgueia, South of Piauí, Brazil. Eight animals of the quarter-mile breed and their crossbreed, of different ages, weight and sex, were selected and asked about the time they were engaged in the activity of the vaquejada and the type of training they were submitted to as they practiced running on which side of the ox, in a vaquejada test in the municipality of Cristino Castro, South of Piauí, Brazil, where the participants came from different farms of the microregion of the Alto Médio Gurgueia, South of Piauí, Brazil. The ultrasonography of the IB, IIB and IIIB zones of the superficial digital (TFDS) and deep digital flexor tendons (TFDP) were performed in each animal, obtaining the measurements of the lateral diameters (DML) and palmar dorsum (DDP) through the transverse plane in each of the different zones. Data were submitted to statistical analysis (ANOVA), using the t test at the significance level of (p <0.05), observing that there was no significant difference between the measures evaluated. According to the results, horses for vaquejada athletes do not present significant difference in the lateral diameters and palmar dorsum of the flexor tendons between the right and left thoracic limb antimeres.

Avaliação ultrassonográfica dos tendões flexores dos membros anteriores em equinos de vaquejada na microrregião do Alto Médio Gurgueia, Sul do Piauí, Brasil / Ultrasound evaluation of the flexor tendons of the forelimbs in horses in vaquejada horses in theAlto Médio Gurgueia, South of Piauí, Brazil

Objetivou-se com este estudo demonstrar a influência do tipo de treinamento sobre as medidas dos tendões flexores palmares em equinos de vaquejada que correm à direita do boi na microrregião do Alto Médio Gurgueia, Sul do Piauí, Brasil. Foram utilizados oito animais, da raça quarto de milha e seus mestiços, de diferentes idades, peso e sexo, selecionados e questionados sobre o tempo que exerciam a atividade de vaquejada e o tipo de treinamento a qual eram submetidos, que refere-se a maneira como praticavam a prova correndo de que lado do boi, em uma prova de vaquejada no município de Cristino Castro, Sul do Piauí, Brasil, onde os participantes eram provenientes de diferentes haras da Microrregião do Alto Médio Gurgueia, Sul do Piauí, Brasil. Em cada animal foi realizada ultrassonografia das zonas IB, IIB e IIIB dos tendões flexores digital superficial (TFDS) e digital profundo (TFDP), obtendo-se as medidas dos diâmetros médio lateral (DML) e dorso palmar (DDP) através do plano transverso em cada uma das diferentes zonas. Os dados foram submetidos a análise estatística (ANOVA), utilizando-se o teste t a nível de significância de (p<0,05), observando-se que não houve diferença significativa entre as medidas avaliadas. De acordo com os resultados obtidos, cavalos atletas que correm a direita do boi não apresentam diferença significativa nos diâmetros médio lateral e dorso palmar dos tendões flexores entre os antímeros direito e esquerdo do membro torácico.

The objective of this study was to demonstrate the influence of the type of training on the measurements of the palmar flexor tendons in vaquejada horses that run to the right of the ox in the microregion of the Alto Médio Gurgueia, South of Piauí, Brazil. Eight animals of the quarter-mile breed and their crossbreed, of different ages, weight and sex, were selected and asked about the time they were engaged in the activity of the vaquejada and the type of training they were submitted to as they practiced running on which side of the ox, in a vaquejada test in the municipality of Cristino Castro, South of Piauí, Brazil, where the participants came from different farms of the microregion of the Alto Médio Gurgueia, South of Piauí, Brazil. The ultrasonography of the IB, IIB and IIIB zones of the superficial digital (TFDS) and deep digital flexor tendons (TFDP) were performed in each animal, obtaining the measurements of the lateral diameters (DML) and palmar dorsum (DDP) through the transverse plane in each of the different zones. Data were submitted to statistical analysis (ANOVA), using the t test at the significance level of (p <0.05), observing that there was no significant difference between the measures evaluated. According to the results, horses for vaquejada athletes do not present significant difference in the lateral diameters and palmar dorsum of the flexor tendons between the right and left thoracic limb antimeres.

Difference of musculoskeletal ultrasound imaging of focus of knee joint tendon between patients with knee osteoarthritis and healthy subjects / 中国针灸

OBJECTIVE@#To observe the imaging features of focus of knee joint tendon in patients with knee osteoarthritis (KOA) by musculoskeletal ultrasound (MSUS) technique.@*METHODS@#One hundred KOA patients and 100 healthy subjects were included. All the KOA patients were palpated by the sequence of foot @*RESULTS@#The top-5 focus of knee tendon of KOA patients were located in medial inferior patella, medial tibial condyle, inferior patella, Zusanlici and Hedingci. The thickness of ligaments and tendons in extension and flexion positions in KOA patients were thicker than that in healthy subjects (@*CONCLUSION@#The focus of knee joint tendon in KOA patients shows significantly thickened musculoskeletal imaging features.

Acoustic Radiation Force Impulse (ARFI) elastography imaging of equine distal forelimb flexor structures / [Elastografia Acoustic Radiation Force Impulse (ARFI) das estruturas flexoras da porção distal do membro torácico de equinos]

This study set out to determine normal values for acoustic radiation force impulse (ARFI) elastography of the superficial digital flexor tendon, deep digital flexor tendon, accessory ligament of the deep digital flexor tendon and suspensory ligament in horses. Twenty-four horses were submitted to conventional sonographic assessment and elastography imaging (quantitative ARFI method) of distal forelimb tendons and ligaments at nine anatomical regions. Elastograms depicted tendons and ligaments in orange to red tones consistent with greater stiffness. Shear wave velocity was higher in the longitudinal compared to the cross-sectional plane but did not differ significantly between the left and right forelimbs. The suspensory ligament was stiffer compared to remaining structures in the cross-sectional plane. Ligaments were stiffer than tendons and the deep digital flexor tendon was stiffer than the superficial digital flexor tendon in the longitudinal plane. Target structures were stiffer in male compared to female horses and stiffness tended to increase with age. ARFI elastography proved to be a feasible and reproducible imaging modality for assessment of distal forelimb tendons and ligaments in horses. Qualitative features derived from stiffness quantification in these structures can be applied to horses with musculoskeletal disorders, as well as to other animal species.(AU)

Este trabalho objetivou estabelecer valores de referência por meio da elastografia ARFI ("Acoustic Radiation Force Impulse") do tendão flexor digital superficial, tendão flexor digital profundo, ligamento acessório inferior e ligamento suspensor do boleto em equinos hígidos. Vinte e quatro equinos foram submetidos aos exames ultrassonográfico e elastográfico (método ARFI quantitativo) dos tendões e ligamentos da porção distal do membro torácico, em nove regiões anatômicas diferentes. Os elastogramas mostraram tendões e ligamentos de coloração alaranjada a vermelha, que representam maior rigidez. Não houve diferenças em relação ao membro avaliado; as velocidades de cisalhamento foram maiores nos planos longitudinais. No plano transversal, os ligamentos suspensores foram mais rígidos em comparação aos demais. No plano longitudinal, os ligamentos mostraram-se mais rígidos que os tendões, e o tendão flexor digital profundo, mais rígido que o tendão flexor digital superficial. As estruturas mostraram-se mais rígidas nos machos, e houve uma tendência à maior rigidez em animais mais velhos. A elastografia ARFI comprovou ser um método viável e reprodutível para avaliação dos tendões e ligamentos dos membros torácicos de equinos. As características qualitativas obtidas a partir da rigidez dessas estruturas podem ser utilizadas para testes em equinos com distúrbios musculoesqueléticos e também em outras espécies animais.(AU)

Is there something new regarding triceps brachii muscle insertion?

Abstract Purpose: Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. Methods: Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. Results: A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. Conclusion: Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.

Precisión de los cirujanos artroscopistas al medir por ecografía estructuras tendinosas sin tener experiencia previa en la utilización de este método / Precision of arthroscopic surgeons using ultrasound for the first time to measure tendon structures

Resumen: Antecedentes: Se evalúa la precisión de un grupo de cirujanos artroscopistas sin experiencia en la utilización de la ecografía al medir estructuras tendinosas en el hombro y la cadera. Métodos: Participaron 22 alumnos y tres profesores en un curso de formación teórico-práctico de un día de duración. Se realizaron dos tandas de mediciones, donde cada alumno identificó el eje menor, el mayor y el área de sección transversal (AST) del tendón del bíceps, el grosor del supraespinoso y el eje menor, mayor y el AST del psoas-ilíaco. Se establecieron como valores de referencia las medias de las dos mediciones realizadas por cada uno de los profesores del curso. Resultados: Evaluando las dos mediciones realizadas por los alumnos en cada una de las estructuras, no se logró una correlación significativa en ninguno de los casos, obteniendo siempre una p > 0.05. Salvo en la medición del AST del bíceps, donde de manera significativa se realizó una infraestimación; en el resto de las siete mediciones hubo una marcada tendencia a sobredimensionar las estructuras tanto en la primera como en la segunda medición, siendo esto altamente significativo (p < 0.05). Conclusiones: La ecografía es un método útil para identificar estructuras por parte de los cirujanos artroscopistas. Sin embargo, la marcada tendencia a sobredimensionarlas con respecto a los valores tomados como referencia hace pensar que la realización de cursos de capacitación y la práctica diaria son indispensables para perfeccionar la utilización del método.

Abstract: Background: The precision of a group of arthroscopic surgeons using ultrasound for the first time was assessed when measuring shoulder and hip tendon structures. Methods: Twenty-two students and 3 professors participated in a one-day theoretical-practical course. Two measurement rounds were conducted, during which each student identified the greater and lesser axes and the cross-sectional area of the biceps tendon, the supraspinous depth, as well as the lesser and greater axes and the cross-sectional area of the iliac psoas. The mean of the two measurements made by each of the course professors was considered as the reference value. Results: When the 2 measurements made by each of the students of each of the structures were assessed, no significant correlation was found in any of the cases, with a p > 0.05. With the exception of the cross-sectional area of the biceps, where there was a significant undersizing of the structure, in the remaining 7 measurements a marked trend to oversize the structures was seen in both the first and second measurements, with a high statistical significance (p < 0.05). Conclusions: Ultrasound is a useful method through which arthroscopic surgeons can identify structures. However, the marked trend to oversize structures compared to the reference values leads to think that the training courses and the daily practice are essential to improve the method.

Evaluation of the Effusion within Biceps Long Head Tendon Sheath Using Ultrasonography

BACKGROUND: Many shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath. METHODS: A consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score. RESULTS: The effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 +/- 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease. CONCLUSIONS: The effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.

Prediction of the presence of plantaris tendon through examination of palmaris longus tendon: is there a link? / Predicción de la presencia del tendón del músculo plantar mediante el examen del tendón del músculo palmar largo: ¿hay una relación?

The purpose of this study was to investigate the relationship between palmaris longus (PL) and plantaris (P) tendons and test the clinical usefulness of symmetry patterns between these tendons in Turkish population. This prospective study comprised a total of 240 adult patients (120 men and 120 women) who were admitted to our outpatient clinic with bilateral knee complaints that required bilateral knee MR examination during two years. Standard test (Schaefer's test, oppose the thumb to the little finger while flexing the wrist) was used to assess the presence of the PL tendon both with inspection and palpation. Knee MRI was used to determine the presence of P muscle belly on both sides. We have analyzed symmetric distribution pattern using Mc-Nemar test. The PL was absent unilaterally in 34 subjects (14.2%), while it was absent bilaterally in 17 subjects (7.1%). The P was absent unilaterally in 51 subjects (21.3%), while it was absent bilaterally in 10 subjects (4.2%). If PL was absent in one hand, the chance of having an ipsilateral P tendon was 70.6%. If PL was present in one hand, the chance of having an ipsilateral P tendon was 87.6%. The Mc-Nemar test for symmetry yielded a p value of 0.841 for ipsilateral PL and P muscles. A clear-cut link between Palmaris longus and plantaris tendons could not be demonstrated in this study. Both muscles show different variations independent from each other.

El propósito de este estudio fue investigar la relación entre los tendones del músculo palmar largo (MPL ) y músculo plantar (MP) y poner a prueba la utilidad clínica de los patrones de simetría entre estos tendones de la población turca. Estudio prospectivo realizado sobre 240 pacientes adultos (120 hombres y 120 mujeres) que ingresaron en la clínica por síntomas de dolor en la rodilla bilateralmente, quienes requerían un examen de RM de rodilla durante dos años. Se utilizó la prueba estándar (prueba de Schaefer, se oponen el pulgar hasta el dedo mínimo, mientras se flexiona la muñeca) para evaluar la presencia del tendón MPL tanto con la inspección y palpación. La RM de la rodilla se utilizó para determinar la presencia de vientre muscular plantar en ambos lados. Se analizó el patrón de distribución simétrica mediante la prueba de McNemar. El tendón del MPL estuvo ausente de manera unilateral en 34 pacientes (14,2%) y bilateralmente en 17 pacientes (7,1%). El tendón del MP estuvo ausente de manera unilateral en 51 pacientes ( 21,3 %) mientras que bilateralmente no estaba en 10 pacientes (4,2%). Si el tendón del MPL estuvo ausente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue del 70,6 %. Si el tendón del MPL estaba presente en un lado, la probabilidad de tener un tendón del MP ipsilateral fue 87,6%. La prueba de McNemar - simetría produjo un valor p de 0,841 para los músculos PL y P ipsilaterales. Una relación directa claro entre los tendones de los músculos PL y P no se pudo demostrar en este estudio. Ambos músculos muestran diferentes variaciones independiente uno del otro.

Espessamento do tendão muscular na oftalmopatia de Graves / Muscle tendon enlargment in Graves´ophthalmopathy

OBJETIVO: Estudar a frequência do espessamento do tendão muscular em pacientes com oftalmopatia de Graves buscando estabelecer correlações com as diferentes formas clínicas da doença. A diversidade clínica e laboratorial na oftalmopatia de Graves pode levar à confusão quanto ao diagnóstico, conduta e prognóstico. Os achados radiológicos variam desde o aumento isolado do tecido adiposo até o espessamento da musculatura extraocular, caracteristicamente poupando os tendões. Em 2004,no entanto, Ben Simon descreveu o espessamento do tendão muscular na oftalmopatia de Graves. MÉTODOS: Foram avaliados 20 pacientes, de ambos os sexos, com idades entre 20 e 80 anos, com formas clínicas designadas como :forma benigna (retração palpebral),forma intermediária (diplopia na posição primária do olhar) e forma maligna ou infiltrativa (sinais de comprometimento do nervo óptico).Todos os pacientes foram submetidos à tomografias computadorizadas de órbita. Os pacientes estavam eutiroideanos, há pelo menos um ano. Os padrões tomográficos foram estudados e divididos em dois grupos: com e sem espessamento dos tendões da musculatura extraocular. RESULTADOS: Uma relação estatisticamente significativa entre espessamento do tendão e a forma clínica intermediária foi encontrada (p <0,012). CONCLUSÃO: O espessamento do tendão extraocular, encontrado em 30 por cento dos pacientes com oftalmopatia de Graves, relaciona-se positivamente com a forma intermediária da doença, caracterizada pela presença de diplopia e que constitui um achado de grande valor clínico.

PURPOSE: The aim is therefore to study the frequency of tendon enlargment in Graves' ophthalmopathy, seeking to estabilish its clinical correlations. Clinical and laboratory diversity in Graves' Ophthalmopathy sometimes may mislead its diagnosis. Radiological findings are more reliable for the diagnosis of Graves' Ophthalmopathy. Since then, a number of patterns have been described. Extraocular muscle involvement in this pathology is considered as always sparing the tendons. In 2004, Ben Simon described extraocular muscles tendon enlargment in some patients with diplopia in Graves' orbitopathy. METHODS: 20 patients, aged between 20 and 80 years, of both sexes, designated as benign (eyelid retraction), intermediate(diplopia in primary sight position) and malignant or infiltrative(signs of optic nerve compromise) forms were evaluated by orbital tomography. All patients had already been euthyroidean for at least one year. Tomographic patterns were studied and divided into two groups: with or without extraocular muscle tendons enlargment. RESULTS: Statistically significant relationship was found between tendon enlargment and intermediate form (p<0.012). CONCLUSION: Extraocular tendon involvement present in 30 percent of the patients with Graves' ophthalmopathy, and is positively correlated to intermediary form of the disease, characterized by diplopia, a very important clinical landmark.

Inferior extensor retinaculum of the human ankle; its medial and lateral attachments and arrangement of structures deep to it

The attachments and arrangement of the inferior extensor retinaculum were studied through surface anatomy and radiological examinations for ten adult healthy persons in addition to dissection of its region in fourteen human lower limbs, obtained from anatomy department, Zagazig university. The results were correlated together and analyzed. It was shown that the retinaculum was Y shaped. Its stem was attached to the antero-superior aspect of the calcaneus. while its two limbs extended medially. The upper limb was attached to the medial malleolus, while the lower one was attached to the medial cuneiform in addition to its continuation with the plantar aponeurosis. The long muscle tendons in front of the ankle were found to split the retinaculum into superficial and deep layers, except that of tibialis anterior that passed superficial to the main fibers of the retinaculum. The neuro-vascular bundle [represented by the anterior tibial vessels and nerve] was found to pass in a special compartment deep to the retinaculum; lying at a deeper level than that of the surrounding tendons. This compartment was roofed by the retinaculum while its floor was formed by the fascia overlying the talus. The relations between the present morphological findings and the previous results were discussed and also correlated with some clinical conditions