Localization of the nerve entry points of thigh adductor muscles by spiral computed tomography: a novel anatomical guide for chemical neurolysis in treating muscle spasticity / Localización de los puntos de entrada del nervio de los músculos aductores del muslo mediante tomografía computarizada espiral: una nueva guía anatómica para la neurolosis química en el tratamiento de la espasticidad muscular

The nerve entry points (NEPs) cannot yet be accurately localized for the treatment of thigh adductor muscles spasticity in chemical neurolysis. The aim of this study was to identify the location and depth of the NEPs of thigh adductor muscles by spiral computed tomography (CT) and bony landmarks. Forty lower limbs of twenty adult cadavers were dissected in supine position. A curved line on skin surface from the tip of greater trochanter of femur to the center of pubic tubercle was designated as the horizontal reference line (H). Another curved line from the tip of great trochanter to the lateral epicondyle of femur was designated as the longitudinal reference line (L). Following dissection, the NEPs were labeled with barium sulfate, and their body surface projection points (P) were determined by spiral CT. Projection of NEP in the opposite direction was designated as P'. The percentage location of the intersections (PH and PL) of P with the H and L and the percentage depth of NEPs were determined with the Syngo system. The PH for the NEP of pectineus, gracilis, adductor longus, adductor brevis and adductor magnus muscles branch were located at 76.41±0.71 %, 93.85±2.07 %, 92.05±2.15 %, 80.75±1.20 % and 88.08±1.09 % of the H, respectively. The PLwere at 1.64±0.04 %, 29.89±1.90 %, 16.06±1.32 %, 11.66±0.11 % and 22.94±0.90 % of the L, respectively. The depth of NEP from P points were at 17.52±0.52 %, 38.38±2.75 %, 20.88±0.79 %, 20.35±0.82 % and 39.52±0.67 % of PP', respectively. These results help to carry out more precise localization of the NEPs. It should provide a novel anatomical guide for improving the efficacy and efficiency of chemical neurolysis in treating thigh adductor muscle spasticity.

Aún no se pueden localizar con precisión los puntos de entrada del nervio (PEN) para el tratamiento de la espasticidad de los músculos aductores del muslo a través de la neurólisis química. El objetivo de este estudio fue identificar la ubicación y la profundidad de los PEN de los músculos aductores del muslo mediante tomografía computarizada espiral (TC) y puntos de referencia óseos. Se disecaron loa miembros inferiores de 20 cadáveres adultos en posición supina. Se trazó una línea curva en la superficie de la piel desdeel ápice del trocánter mayor del fémur hasta el centro del tubérculo púbico y se designó como línea de referencia horizontal (H). Otra línea curva desde el ápice del trocánter mayor hasta el epicóndilo lateral del fémur se designó como línea de referencia longitudinal (L). Después de la disección, los PEN se marcaron con sulfato de bario y sus puntos de proyección de la superficie del cuerpo (P) se determinaron mediante TC helicoidal. La proyección de PEN en la dirección opuesta se designó como P '. El porcentaje de ubicación de las intersecciones (PH y PL) de P con H y L y la profundidad porcentual de los PEN se determinaron con el sistema Syngo. Los PH para los PEN de los músculos pectineus, gracilis, adductor longus, aductor brevis y rama aductora del músculo aductor magnus se localizaron en 76,41±0,71 %, 93,85±2,07 %, 92,05±2,15 %, 80,75±1,20 % y 88,08±1,09 % de H, respectivamente. Los PL estuvieron en 1,64±0,04 %, 29,89±1,90 %, 16,06±1,32 %, 11,66±0,11 % y 22,94±0,90 % de la L, respectivamente. La profundidad de PEN de P puntos fue de 17,52±0,52 %, 38,38±2,75 %, 20,88±0,79 %, 20,35±0,82 % y 39,52±0,67 % de PP ', respectivamente. Estos resultados ayudan a realizar una localización más precisa de los PEN. Se debe proponer una nueva guía anatómica para mejorar la eficacia y la eficiencia de la neurólisis química en el tratamiento de la espasticidad del músculo aductor del muslo.

Revisión anatómica del músculo bíceps femoral del canino / Anatomical review of canine biceps femoris muscle

El músculo bíceps femoral (BF) desempeña un rol fundamental en la biomecánica del miembro pelviano de los caninos, actuando en la flexoextensión de la articulación femorotibiorotuliana y la abducción del miembro. La evaluación correcta de su función es importante en la clínica veterinaria. Existen puntos controversiales entre los autores consultados acerca de la morfología de este músculo. El presente estudio tiene como objetivo discutir las distintas descripciones, reparando en las inserciones, la estructura e inervación del músculo. Se han realizado las disecciones bilaterales en 12 animales. La conservación de las piezas se realizó por inmersión en piletas, con una dilución de formol al 10 por ciento y ácido fenico al 4 por ciento en agua. Se utilizaron diferentes técnicas de abordaje al músculo en cuestión, para obtener distintas observaciones de las estructuras. Se halló que el músculo BF se origina por medio de dos cabezas, como queda implícito en su denominación, una cabeza craneal, más voluminosa y una cabeza caudal más pequeña. La primera originada en el ligamento sacrotuberal y en la superficie lateral de la tuberosidad isquiática. La cabeza caudal, se origina de la tuberosidad isquiática. Estas partes a pesar de hallarse estrechamente unidas se individualizan a nivel de los vientres musculares por medio de una delgada lámina de tejido conectivo que se extiende hasta el tercio distal del músculo. Respecto a la inervación, no se encontraron ramas del nervio glúteo caudal que inerven las partes al músculo.

The biceps femoris (BF) muscle plays a fundamental role in the biomechanics of the canine pelvic limb, acting in flexion ­ extension on knee articulation and abduction of the limb. Correct evaluation plays an important role in veterinary clinic. There are controversial issues among the authors consulted about the morphology of this muscle. The present study aims to discuss the various descriptions proposed for this muscle, considering insertions, structure and innervation. Bilateral dissections of 12 animals were carried out. Pieces conservation was done by immersion in pools with 10 percent formaldehyde and 4 percent carbolic acid in water. Different techniques were used in order to achieve various observations of muscle structures. It was found that BF muscle originates by two heads, as is implicit in its name, a craneal head, bulkier and a smaller caudal head. The first takes origin in the sacrotuberal ligament and the lateral surface of the ischial tuberosity. The caudal head, originates from the ischial tuberosity. These parts are closely linked but they can be identified at the level of the muscle bellies through a thin layer of connective tissue that extends to the distal part of the muscle. Regarding the innervation, we found that no caudal gluteal nerve branches reach this muscle.

anatomical study of the relation between the descending branch of the inferior gluteal artery and the posterior cutaneous nerve of the thigh

The gluteal thigh flap is a myofascio-cutaneous flap receiving its blood supply from a descending branch of the inferior gluteal artery. The superior and inferior myocutaneous gluteal free flaps have been considered as valuable alternatives to the latissimus dorsi or TRAM flap since 1975. The purpose of this study was to gain a better understanding of the anatomical relationship between the posterior cutaneous nerve of the thigh, and the descending branch of the inferior gluteal artery. Twenty four posterior thigh specimens of adult human cadavers were dissected after latex injection of the internal iliac artery. The inferior gluteal artery and the posterior cutaneous nerve of the thigh were carefully dissected. The relation between the descending branch of inferior gluteal artery and the posterior cutaneous nerve of the thigh was studied and photographed. The external diameter and the length of the descending branch of the inferior gluteal artery were measured. The inferior gluteal artery gave off a descending branch that is accompanied by the posterior cutaneous nerve of the thigh. The descending branch was observing in all cadavers dissected. Its average external diameter was 0.3 +/- 0.07mm and it was arising about 7.15 +/- 0.68cm away from the tip of the greater trochanter of the femur. In 5 lower limbs [20.8%] the descending branch was passing medial to the posterior cutaneous nerve of the thigh. In the remaining cadavers the descending branch of the inferior gluteal artery was passing lateral to the posterior cutaneous nerve of the thigh in 19 out of 24 specimens [79.2% of lower limbs]. It was descending below the gluteal fold with the posterior cutaneous nerve of the thigh in a common connective tissue sheath in 21 out of 24 specimens. In all dissected lower limbs, one or two cutaneous branches of the descending branch of inferior gluteal artery and one or two cutaneous nerves were supplying the infragluteal perforator flap. Loop of nerves was found surrounding the inferior gluteal artery and its descending branch in 3 out of 24 lower limbs [12.5%]. Knowledge of the vascular anatomy extends the clinical applicability of the posterior thigh fasciocutaneous flap to patients who might otherwise be excluded because of prior injury or operative procedure

Sciatica due to malignant nerve sheath tumour of sciatic nerve in the thigh.

Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant neoplasm arising from the supportive non-neural component of the peripheral nerves. An unusual case of pain and weakness of the foot and calf muscles due to a giant MPNST of the sciatic nerve in the posterior compartment of the thigh is presented. The patient was already investigated as a case of sciatica due to a lumbar disc disease with a negative magnetic resonance imaging and then unsuccessfully operated elsewhere twice, with a misdiagnosis of tarsal tunnel syndrome. Neurosurgical referral prompted a diagnostic magnetic resonance study of the thigh, revealing the lesion, which was completely excised microsurgically with total relief in the pain and partial improvement in the weakness and sensations in the sole of the foot.

Pentazocine-induced fibrous myopathy and localized neuropathy.

A 47 year-old woman who had a 4-year history of intramuscular pentazocine injections in the lower extremities, developed gradual stiffness and weakness of the lower extremities. The thigh and buttock muscles were "wooden-hard" on palpation. The skin was hard, shiny and hairless. Associated clinical and electrophysiological polyradiculopathy and multiple mononeuropathy of the lower extremities were observed. Imaging studies showed calcification and fibrosis of the involved muscles. Muscle biopsy revealed fibrous myopathy. Caution in longterm usage and early recognition of pentazocine toxicity as a neuromuscular complication are important in order to prevent irreversible drug-induced fibrous myopathy and localized neuropathy.

Lateral femoral cutaneous nerve block for split skin grafting.

Wound with loss of skin needs grafting for early healing and to prevent deformity and disability. For skin grafting lateral femoral cutaneous nerve block can be used as regional anesthesia. The efficacy of 55 lateral femoral cutaneous nerve block was assessed in 52 patients of 10 to 70 years of age. The nerve block was found effective in all cases. 90.91% showed excellent results. The procedure seemed to be easy, safe and less costly for the purpose of skin grafting.

Meralgia paraesthetica.

Forty-four patients of meralgia paraesthetica presented with combination of symptoms mainly of numbness with loss of superficial sensation on the anterolateral aspect of a thigh were selected for the study. They responded well to local infiltration of hydrocortisone acetate and lignocaine hydrochloride which not only helped in diagnosis but also prevented the recurrence of symptoms in majority of cases.

Conduction Studies of the Saphenous Nerve in Normal Subjects and Patients with Femoral Neuropathy

Conduction velocity of the saphenous nerve was studied antidromically. The value in 20 control subjects was 42.22 +/- 4.83 (SD) m/sec. In 7 patients with femoral neuropathy, the sensory nerve conduction in the symptomatic nerves was definitely abnormal : nerve potential was absent in 4 and conduction velocity was slow in 2. In 1 patient, a possible asymptomatic femoral neuropathy was suggested by this test. Conduction velocity of the saphenous nerve can be used as an objective diagnostic aid in femoral neuropathy, saphenous neuropathy and polyneuropathy.