Anterior innervation of the proximal tibiofibular joint.

Mucoid cysts compressing the common peroneal nerve have been reported. Whether these cysts are schwannoma or are synovial in nature is the subject of controversy in the medical literature. To contribute to this debate, the present study was designed to detail the anterior innervation of the proximal tibiofibular joint. We dissected 10 knees of five fresh cadavers after staining the tibiofibular joint under fluoroscopic guidance. Through a lateral approach near the fibular head, the common peroneal nerve was isolated then dissected distally to determine whether it or its branches ramified over the proximal tibiofibular joint. In all 10 legs, only one collateral branch was observed on the common peroneal nerve proximal to its terminal division. This collateral sent a branch to the proximal tibiofibular joint before penetrating the tibialis anterior muscle. The articular branch coursed in a superior and posterior direction approximately 1 cm to attain the tibiofibular joint. In no specimen did the deep or superficial peroneal nerves send a twig to the tibiofibular joint. This study confirms and clarifies prior descriptions of the innervation of the anterior aspect of the proximal tibiofibular joint. It clarifies the mechanisms of compression of the common peroneal nerve by synovial cysts that originate from the proximal tibiofibular joint and provides anatomical landmarks that should facilitate complete resection of these cysts.

Does the motor branch of the long head of the triceps brachii arise from the radial nerve? An anatomic and electromyographic study.

Anatomy textbooks say that the motor branch of the long head of the triceps brachii (LHT) arises from the radial nerve. Some clinical observations of traumatic injuries of the axillary nerve with associated paralysis of the LHT have suggested that the motor branch of the LHT may arise from the axillary nerve. This anatomic study was performed, using both cadaver anatomical dissections and a surgical study, to determine the exact origin of the motor branch of the LHT. From the adult cadaver specimens (group I), 20 posterior cords were dissected from 10 subjects (eight embalmed, two fresh) using 3.5x magnification. The axillary nerve was followed from its onset to the posteromedial part of the surgical neck of the humerus and the radial nerve. We looked for the origin of the proximal branch of the LHT by a meticulous double anterior and posterior dissection. From the surgical group (group II), 15 posterior cords were dissected from 15 patients suffering from a C5-C6 injured paralysis, without paralysis of the LHT. During the surgical procedure, we looked for the origins of the motor branch of the LHT with a nerve stimulator. In group I, the motor branch of the LHT arose in 13 cases from the axillary nerve near its origin, in five cases from the terminal division of the posterior cord itself, and in two cases from the posterior cord 10 mm before its terminal division into the radial and axillary nerves. In no case did we find the motor branch of the LHT arising from the radial nerve. In eight cases, we found some accessory branches that arose near the principal branch. In group II, the motor branch of the LHT arose in 11 cases from the axillary nerve near its origin and in four cases from the terminal division of the posterior cord itself. The motor branch of the LHT never originated from the radial nerve. In four cases, we found some accessory branches that arose near the principal branch of the LHT. These results reveal that the motor branch of the LHT seems to originate most often from the axillary nerve. This contribution could be relevant for surgical treatment of traumatic nerve injuries.

[Botulinum toxin A and musculoskeletal pain]. / Toxine botulique A et douleurs musculosquelettiques.

INTRODUCTION: Relaxant muscle properties and pain relieve effectiveness in neurological spasmodic disorders of botulinum toxin A (BTXA) suggested its relevance to relieve musculoskeletal pain. The aim of this article was to collect literature data and to assess the different analgesia indications of BTXA proposed in the treatment of musculoskeletal pains. METHOD: The international literature was carried out with the Medline data bank using keywords toxin and pain. Only clinical trials have been analysed. RESULTS: Three hundred and seventeen articles were collected and 12 clinical trials were retained. They are focused on 4 chronic diseases, neck pain, tennis elbow, Piriformis syndrome and low back pain. Results of the 6 chronic neck pain studies are contradictory and emphasize the difficulty to display a satisfactory analgesia effect of BTXA in this indication. Results of the studies concerning other indications (tennis elbow, Piriformis syndrome and low back pain) seem to be more effective and clinically pertinent. DISCUSSION: Analgesia BTXA effect seems to be conditioned by the presence of an objective muscular spasm or stringy disease inducing musculoskeletal pain. CONCLUSION: The first data concerning use of BTXA to treat musculoskeletal pains are few and are worth specifying by other studies.

[Pinctada margaritifera nacre (mother-of-pearl): physico-chemical and biomechanical properties, and in vitro cytocompatibility]. / La nacre Pinctada margaritifera: caractérisation physico-chimique, propriétés biomécaniques et cytocompatibilité in vitro.

PURPOSE OF THE STUDY: Pinctada maxima nacre (mother-of-pearl) has been recently proposed as a bone substitute. The purpose of this work was to assess the in vitro cytocompatibility of Pinctada margaritifera nacre and its physico-chemical and biomechanical properties. MATERIAL AND METHODS: The cytocompatiblity was assessed in contact with human osteoprogenetic cells. Attachment was measured at one hour and three hours by determining N-acetyl-beta-D-hexosaminidase activity. Proliferation was monitored by measuring metabolic activity with the MTT test. Cell morphology was studied under scanning electron microscopy and cell differentiation was assessed by immunocytochemistry monitoring of the synthesis of type I collagen and osteocalcin. Diffraction x-ray and scanning electron microscopy was used to study the physico-chemical structure. Two samples taken from the inner part of the shell and two other samples from the outer part of the shell were tested for resistance under compression and to calculate the Young module. RESULTS: The results showed that osteoprogenetic cells attached to the nacre (2/3 of the plastic control), proliferated according to a standard pattern (increased metabolic activity followed by a plateau then decreased activity), synthetized type I collagen and osteocalcin, and presented a morphology analogous to control cells cultured on the plastic culture wells. The diffraction spectrum of the crystalline structure corresponded to crystallized calcium carbonate in the form of calcite (CaCO(3)) for the outer part and in the form of aragonite for the inner part. The Young module was 46.1 Gpa and resistance to rupture was 185 Mpa. CONCLUSION: Pinctada margaritifera nacre is cytocompatible in vitro with mechanical properties very similar to cortical bone.

Study of correlation between intradiscal pressure and magnetic resonance imaging data in evaluation of disc degeneration. Therapeutic issue with percutaneous nucleotomy.

Intradiscal pressure and volume measurements using discomanometry were correlated to features of degeneration noted with magnetic resonance (MR) imaging in 36 discs in patients scheduled for percutaneous nucleotomy. Discomanometric data (intradiscal pressure and degree of pressure loss at 0 and 60 seconds after intradiscal infusion, area under the pressure curve, and discal volume) were not correlated with the MR data (degree of disc height loss and degree of signal intensity loss on T2-weighted images). Results of nucleotomy were strongly correlated with discomanometric data but not with the studied MR factors. Discomanometry by evaluating the physical status of discs, may predict results of percutaneous nucleotomy and consequently play a major role in patients selection.

[Foraminal lumbar hernia. Diagnostic and therapeutic aspects (apropos of 40 cases)]. / Hernies foraminales lombaires. Aspects diagnostiques et thérapeutiques (à propos de 40 cas).

This study was based upon a retrospective analysis of 40 case-histories of foraminal lombar disc herniations. Patients presented an isolated femoral neuralgia 3 times out of 4, were males twice out of 3 and were about fifty. Computed Tomographic Scanning oriented precisely the diagnosis for half the cases but only suggested it for the other 50 per cent. Computed Tomographic Scanning of lumbar discography was executed 5 times and confirmed the foraminal lumbar disc herniation. MRI executed 18 times confirmed the foraminal lumbar disc herniation by sagittal, axial and frontal-oblique views. 7 patients recovered with medical treatment. 4 patients with a subligamentous lumbar disc herniation recovered with percutaneous treatment. 29 patients underwent surgical treatment. The classical intervertebral foramina approach by complete facetectomy and arthrodesis was replaced by more conservative technics regarding bony structures: extraforaminal lumbar disc herniation was removed by paraspinal approach, whereas foraminal lumbar disc herniation was removed by a combined approach associating an interlaminar approach with a paraspinal one.

An anatomic and dynamic study of the greater occipital nerve (n. of Arnold). Applications to the treatment of Arnold's neuralgia.

This study concerns the posterior ramus of the second cervical spinal n., or greater occipital of Arnold. By means of dissections in formalin embalmed cadavers, an attempt was made to define its winding course and to locate it in relation to clinical or radiographic landmarks, so as to provide a guide for infiltration of the nerve with local anesthetic. At the same time a dynamic study was made to elucidate the relations of the nerve to adjacent structures during the different movements of the neck. This allowed us to propose clinical tests of nerve involvement and to reveal the zones where the nerve is anatomically vulnerable.

[Radiologic change of cartilage of the pelvis and the upper end of the femur during growth. Application to the surveillance of scolioses]. / Etude de l'évolution radiologique des cartilages du bassin et de l'extrémité supérieure du fémur pendant la croissance. Application à la surveillance des scolioses.

We retrospectively studied the radiographic documents of seventy girls with bony age varying from nine to eighteen years old and divided in nine equal groups and seventy boys with bony age from ten to nineteen years old. We analyzed the AP pelvic X ray of each child focusing on cartilages and ossification centers of both pelvic bone and upper femoral extremity. The purpose of this study was to assess the dates of apparition and ossification of these ossification centers and the dates of fusion of cartilages. The iliac ossification center (epiphysaris nucleus ilii) appears lately at bony age of thirteen years and half for girls and fourteen years and half for boys. The triradiate cartilage closes the earliest from its medial to its lateral portion before the apparition of the iliac ossification center. This closing date corresponds to the beginning of growth acceleration. Therefore, the period of growth acceleration can be identified by an accurate analyse of the triradiate cartilage closure on a single AP pelvic X ray.

The neurocentral vertebral cartilage: anatomy, physiology and physiopathology.

The neurocentral cartilage (NCC) described by Schmorl was an intermediate cartilage has aroused discussion among numerous authors as to its role, its age of closure and its possible involvment in the genesis of scoliosis. The authors have attempted to define these problems on the basis of a histologic study of 20 vertebral specimens of different ages and a scanographic study of 25 children. The NCC remains open until adolescence and even beyond, but its maximal activity is probably around 5-6 years. Part of its function is to ensure growth of the posterior arch. Finally, the scanograms of scoliosis show the NCC to be more widely open on the concave side, as if this remained active for a longer period.

Anatomy of the lumbar radicular canal.

The radicular canal is defined as the lateral part of the spinal canal containing the spinal nerve root from its point of emergence through the dural envelope up to and including the intervertebral foramen. The radicular canal, resembling a hollow hemicylinder opened towards the midline, can be divided into three parts, i.e. retrodiscal, parapedicular (the lateral recess per se) and foraminal. The different walls of the canal (notably those of the lateral recess) are described. A review of the main types of roentgenographic exploration of the radicular canal are presented based on these anatomical findings. Finally, this static description of the typical lumbar radicular canal and its variations according to the lumbar or sacral level under consideration is followed by a presentation of the modifications which arise in the upright position and during extension and flexion of the lumbar spine.

An approach to the functional anatomy of the sacroiliac joints in vivo.

This first part of this paper is a review of the literature on the functional anatomy of the sacroiliac joint followed by a preliminary biomechanical study of the fresh post mortem pelvis. The latter was done in order to determine the coefficients of the screw matrix and the position of the instantaneous centers of rotation during the symmetrical movements of nutation and contranutation simulated in the biomechanics laboratory. The main part of this work deals with the spatial analysis in vivo of the relative displacements of the iliac bones with respect to the sacrum in the course of dissymmetrical movements of the pelvis. In the different phases of movement, the roentgenographic observation of the position of the bony components with respect to a three-dimensional orthonormal reference system required the use of material based on the principles of photogrammetry. This technique was used to achieve spatial reconstruction of the data recovered from a series of orthogonal x-ray films of the sacroiliac joints. Data retrieval was carried out on a digital table linked to a computer with a graphic terminal so that the information could be displayed in the form of rectangular coordinates of defined points on the bone. Owing to the limited amplitude of articular displacement, a statistical study was required to retrieve the coordinates from the projection of these points on the X-ray film with an estimated threshold of significance of 0.1 and an error of +/- 0.1 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

[Scanography and chemonucleolysis of herniated discs. Value and limitations in 20 cases]. / Scanographie et chémonucléolyse des hernies discales. Intérêts et limites. A propos de 20 cas.

Scanography explorations were conducted before and after chemonucleolysis in 20 patients with sciatica from herniated discs. The scanner can improve the selection of patients for this new type of medical treatment by detecting adverse factors: stenosed discs, excluded hernias, narrow canals, stenosis of the lateral recesses. The diagnostic precision of scanography can be demonstrated by comparison of results with those obtained by discography. Following chemonucleolysis, however, intravenous injection of a contrast medium and a high resolution programme are necessary to obtain specific information from scanography.