Accessory Muscle Research Articles

The Position of Leaning Forward to Reduce Breathing of COPD Patients: Literature Review

COPD patients often experience shortness of breath as a result of inflammation in the lungs that develops in the long term. COPD is generally characterized by difficulty breathing, coughing with phlegm, and wheezing or wheezing. In this condition, the patient often finds a comfortable position to reduce shortness of breath. The aim of this study was to look at appropriate and effective interventions in reducing spasms in COPD patients. This literature study was created by analyzing scientific articles, at least in retrospective research from 2012 to 2020 and in English. Data obtained from databases include Pubmed, CINAHL, Scopus, Proquest and Google Scholar with the keywords position for breathing in COPD, position forward lean trunk for short breathing in COPD, and best position for COPD. The results of this literature obtained 5 articles that match the inclusion and exclusion criteria. The results have been found that the forward leaning position is effective in reducing shortness of breath in COPD patients because of the involvement of the respiratory accessory muscles so that the pulmonary ventilation process is good.

Prevalence of pulmonary arterial hypertension in severe chronic obstructive pulmonary disease patients attending tertiary care centre Ernakulam

Background: Chronic obstructive pulmonary disease (COPD) is an irreversible bronchial inflammation of lung airways and parenchyma. Various factors play an important role in occurrence and severity of pulmonary arterial hypertension (PAH), a common in severe COPD. The objective of the study is to know the proportion of PAH in patients with severe COPD and to find the association between various factors.Methods: 180 cases of severe COPD patients admitted in Government Medical College Ernakulum from January 2019-December 2019, were enrolled into this cross-sectional descriptive study. Subject’s history, clinical examination, anthropometric measurements, vitals, Arterial Blood Gas (ABG) analysis were done.Results: Among 180 subjects, 148 (82.22%) had mild PAH, 22 (12.22%) subjects had moderate PAH and 10 (5.56%) had severe PAH. Use of accessory muscle was the most elicited sign in the study with 174 (96.67%). 170 (94.44%) had cough and 169 (93.89%) had breathlessness which were the most reported symptoms. Demographic variables and clinical features had no significant mean pulmonary artery pressure (mPAP) association. Grade 3 PAH groups were elder than others, which was statistically significant (p<0.047). FEV1, Oxygen Saturation and ejection fraction were lowest in grade 3 PAH subjects. Respiratory rate, hemoglobin, PCV, tricuspid velocity, PaCO2 were highest in grade 3 PAH subjects being statistically significant (p<0.0001).Conclusions: In our study, majority of severe COPD patients had mild PAH. There was an independent correlation between respiratory rate, hemoglobin, PCV, tricuspid regurgitant velocity and PaCO2 with severity of PAH.

Atypical Causes of Dyspnea: A Review of Neuromuscular and Chest Wall Disorders that Compromise Ventilation.

Dyspnea is a common presenting symptom among patients with cardiopulmonary diseases. However, several neuromuscular and chest wall conditions are often overlooked and under-recognized causes of dyspnea. These disorders frequently adversely affect the structure and function of the ventilatory pump (diaphragm, accessory muscles of ventilation) and can precipitate respiratory failure despite normal lung parenchyma. Weakened musculature impairs clearance of airway secretions leading to aspiration and pneumonia, further compromising respiratory function. Radiologists should be aware of the pathophysiology and imaging manifestations of these conditions and might suggest them to be causes of dyspnea which otherwise may not have been considered by referring clinicians.

18F-FDG uptake in accessory respiratory muscles shows the respiratory effort of patients with pleuroparenchymal fibroelastosis.

Patients with pleuroparenchymal fibroelastosis (PPFE) have severe breathlessness even with mild hypoxaemia. In patients with PPFE, accessory respiratory muscles, such as the sternocleidomastoid muscles, are used to maintain ventilation. An intense 18F‐fluorodeoxyglucose uptake in accessory respiratory muscles using positron emission tomography/computed tomography reflects the strong respiratory effort of patients with PPFE.

Topographical anatomy of the annulus of Zinn

The anatomy and even existence of a common tendinous origin of the extraocular eye muscles, or annulus of Zinn, has widely been debated in anatomical literature. This study explored the anatomical origins of the recti muscles, their course into the orbit and the dural connections of the common tendinous origin with the skull base. Twenty orbits of ten adult human cadavers were dissected. The orbital apex and its dural connections were photographed. Histological examination of apical specimens was performed. In all cadavers, extraocular muscles were observed to have a common tendinous origin at the orbital apex, continuous with dural connections extending into the skull base. Accessory slips of the medial rectus were observed across all cadavers. Dual heads of the lateral rectus were observed in fourteen orbits of seven cadavers. The origin of the levator palpebrae superioris appeared to be contiguous with the superior rectus at the common tendinous origin in all but one cadaver. These results support the existence of a common tendinous origin of the extraocular muscles, that is continuous with the skull base dura. In addition, they support the existence of variations in orbital anatomy including dual or accessory muscle slips of the extraocular muscles.

A Comparison of Consumer Responses Using Paper and Digital Ballots for Eating Quality Assessment of Beef Steaks

A consumer study was conducted to determine whether consumers scored beef palatability traits differently on paper versus digital ballots. Beef subprimals representing 4 treatments with inherent variation in eating quality were collected: USDA Select eye of round aged 7 d postmortem, USDA Select strip loin aged 7 d postmortem, USDA Choice tenderloin aged 21 d postmortem, and USDA Prime strip loin aged 21 d postmortem. Accessory muscles, external fat, and connective tissue were removed from subprimals. Muscles were fabricated into 2.5-cm steaks and further divided into 2 equal halves for consumer testing. Consumers (n = 360) evaluated 8 samples divided into 2 blocks representing the 2 ballot types. Within each ballot block, Select longissimus lumborum samples were always served in the first and fifth position, followed by the remaining 3 treatments served in a randomized order among the latter 3 positions. Consumers rated each steak sample for tenderness, juiciness, flavor liking, and overall liking from 0 to 100 on either a paper or a digital ballot and then rated the paired steak halves on the opposite ballot during the second block of sample testing. Ballot type influenced (P < 0.02) all traits, as consumers scored traits greater (P < 0.05) on paper compared with digital ballots, regardless of treatment. The magnitude of differences between ballot types was much smaller than the magnitude of differences between cut treatments, which also differed (P < 0.01). The smallest margin between ballot type was observed for tenderness (1.8 points); juiciness, flavor liking, and overall liking all differed by 3.4 points. Independent studies could and have utilized digital ballots without concern, as consumers sorted samples by treatment in the current study similarly, regardless of ballot type. However, researchers should consider ballot type for their sensory studies, especially if data will be added to a collective data set.

Could We Predict Respiratory Failure in Amyotrophic Lateral Sclerosis?

Introduction: Respiratory complications are important in the prognosis of amyotrophic lateral sclerosis (ALS). The aim of this study was to determine the electrophysiological findings that may predict respiratory failure. Methods: According to the Awaji electrodiagnostic criteria, 30 patients with ALS who were diagnosed with definite or probable ALS without respiratory failure were included in the study. Nerve conduction studies, needle electromyography (EMG), and single-breath count tests were performed in all patients. In addition, the pulmonary function tests, swallowing EMG, and arterial blood gas analysis of the patients were recorded and evaluated. The patients were followed until respiratory failure developed. Results: As a result of 18 months of follow-up, 26 of 30 patients developed respiratory failure. When the contribution of the accessory respiratory muscles to the respiratory effort before the development of respiratory failure was evaluated clinically and electrophysiologically, it was observed that the most common muscles involved in the respiratory effort were sternocleidomastoid (SCM), trapezius, and rectus abdominis. Before the development of respiratory failure, the latest neurogenic EMG findings were seen in the SCM (50% cases), trapezius (20% cases), and thoracic paraspinal muscles (17% of cases), respectively. It was thought that this finding could be an important early electrophysiologic marker in predicting the development of respiratory failure in ALS cases. Conclusions: To sum up, the presence of neurogenic changes in certain muscles in needle EMG and demonstration of the contribution of certain accessory respiratory muscles in respiration can be used as an electrophysiological marker to predict the development of respiratory failure.

Assessment of noninvasive ventilation in patients with acute severe asthma

Background Despite improvements in asthma medication, intubation is deemed necessary in severe asthma with its complications. Noninvasive ventilation (NIV) is an evolving method to manage acute respiratory failure in those patients. However, the effect of NIV is unclear, and there are debates regarding its safety. Aims To evaluate the role of NIV in patients with acute severe asthma and to assess predictors for its use in those patients. Patients and methods In a prospective interventional study, 90 patients with acute asthma were divided into two groups: medical one and NIV group. The outcomes were the improvement in forced expiratory volume in the first second, as well as clinical and respiratory parameters. Results The respiratory rate showed a significant improvement after 6 h (16.6±3.7 breath/min), and also the heart rate (95.8±11.3 beat/min) and arterial partial pressure of oxygen (88.09±20.2). The time needed to alleviate accessory muscle use was shorter in the NIV group (1.93±0.3 vs. 3.07±0.4 h in the other group). The need for endotracheal intubation and invasive mechanical ventilation was more with group 1. There was no mortality in any group of our study. Conclusion NIV group demonstrated clinical improvement regarding the grade of dyspnea and accelerating the time needed for the absence of accessory muscle usage in acute severe asthma. NIV also has a significant benefit in improving oxygenation, lowering the intubation rate, and shortening the length of hospital and ICU stay in comparison with conventional medical therapy.

A Quasi Experimental Study to Evaluate the Effectiveness Of Pursed Lip Breathing Exercise on Reduction of Dyspnea Among Chronic Obstructive Pulmonary Disease Patients in Selected Hospital in Panipat, Haryana

Chronic Obstructive Pulmonary Disease (COPD) is a progressiveinflammatory disease characterized by chronic obstruction in the peripheral bronchus and pulmonary emphysema. The disease is disabling with symptoms such as chronic cough, phlegm, wheezing, shortness of breath and increased infections of the respiratory passage. Changes in the lungs result in mucus hyper secretion, dysfunction of the cilia, airflow limitation and hyper inflation of the lungs, gas exchange abnormalities, pulmonary hypertension and cor pulmonale. Persons with COPD are greatly under estimated because the disease is usually not diagnosed until it is moderately advanced .Patients usually seek medical help when they have an acute respiratory infection, with dyspnea being the main concern. Dyspnea is often progressive, and initially occurs with exertion, gradually interferes with daily activities and in late stages dyspnea may be present at rest also. The person becomes more of a chest breather, relying on the intercostals and accessory muscles rather than effective abdominal breathing.The objective of the study was, to assess the breathing pattern before and after pursed Lip breathing exercise among chronic obstructive pulmonary disease patients in control and experimental group. To evaluate the effectiveness of Pursed lip breathing exercise on the reduction of Dsypnea among chronic obstructive pulmonary disease patients in experimental group. To find out the association between the breathing pattern with selected demographic variables in the control and experimental group.

Translated article] Tarsal tunnel syndrome: Clinical-imaging analysis of a case series

BackgroundRetrospective review of patients with a diagnosis of Tarsal Tunnel Syndrome (TTS) treated surgically. MethodsRetrospective series of patients with diagnosis of TTS operated between 2005 and 2020 in the same center. Variables such as age, sex, side, affected nerve or branch, classification, type of imaging study, biopsy result, infection rate, recurrence rate, sequelae, among others, were analyzed. ResultsWe included 8 men and 2 women with an average age of 47 years (range 34−67) and an average follow-up of 62.2 months (range 2–149). All cases were related to intrinsic compression. The most frequent cause was the presence of cyst (40%) followed by perineural adhesions (20%). The posterior tibial nerve was the most affected (50%) and 30% the medial plantar branch. Ultrasound (70%) and MRI (50%) were the most requested studies. There were no cases of postoperative infection. There were 3 patients who presented recurrence of the lesion requiring a new surgery. ConclusionsTTS is a neuropathy involving the posterior tibial nerve or some of its branches. In general, it is caused by compression of the nerve by different structures such as accessory muscles and ganglions, among others. The diagnosis is eminently clinical, supported by imaging studies. Surgical treatment presents better results when the cause is an intrinsic compression, although variable recurrence rates are described.

Clinical features and flexible laryngoscopy results laryngomalacia in hospitalized children at the respiratory department of chldren’s hospital 1, Ho Chi Minh City

Objective: To describe the presentation, diagnosis, and treatment children with endoscpically confirmed laryngomalacia in hospitalized at the respiratory department of children’s hospital 1. Methods: Prospective case series children with endoscpically confirmed laryngomalacia dunring 1-year period 05/2020 to 05/2021. We included all 34 children under 2 years old with endoscpically confirmed laryngomalacia without prior documentation of the diagnosis. Results: 34 children had a confirmed diagnosis of laryngomalacia and were thus included (1.8:1 male to female sex ratio; mean age, 3 months, age range, 0-6 months). Twenty- three children (67,6%) presented with stridor, 34 (100%) with pulmonary rales, 33 (97,1%) with using accessory respiratory muscles. Type 1 laryngomalacia was the most commoly encountered (29,4%). Most with severe laryngomalacia (52,9%) needed medical treatments in our study. GERD and pneumonia are theo two common comorbidities in our study. Medical comorbidites were associated with severe laryngomalacia. Conclusions: Early diagnosis of laryngomalacia by typical clinical presentations and flexible fiberoptic laryngoscopy may improve the disease severity and outcomes of laryngomalacia patients. Besides, evaluating and treating the comorbidities are also important.

The Clinical Relevance of the Accessory Peroneus Quartus in a Male Division I Collegiate Track Athlete

A healthy 20-year-old Division I track athlete participated in out-of-season practice and experienced inflammation on mid-lateral aspect of his right calcaneus. The patient modified his weekly training program, and a magnetic resonance imaging revealed the presence of an accessory peroneus quartus. This muscle is present in around 5.2% of the population. The pathological symptoms cause pain, snapping, and synovitis. Literature shows a higher prevalence of the accessory peroneus quartus muscle in males of European/American descent and in the right lower leg. Symptoms include peroneal tears, decrease in range of motion, and pain of the ankle and foot.

A Rare Case of Flexor Digitorum Accessorius Longus Muscle Presenting as Tarsal Tunnel Syndrome.

Tarsal tunnel syndrome (TTS) is a relatively uncommon nerve entrapment neuropathy. Many pathologies are reported as possible causes for TTS. The diagnosis of TTS can be difficult and often missed. We present a rare case of TTS due to an accessory flexor digitorum longus muscle. Together with a high index of suspicion, MRI is the investigation of choice in making the diagnosis. These patients are best managed with excision or transposition of the flexor digitorum accessorius longus (FDAL) and neurolysis of the posterior tibial nerve and its branches.

Comparison of the acute response of morning and evening outdoor exercise to oxygen saturation (SpO2) after aerobic activity

The condition of O2 in the morning is different from the night because the process of photosynthesis occurs in plants. Plants absorb CO2 in the morning and release CO2 at night. Exercise affects the frequency of breathing which results in an increase in the mass of accessory muscles of respiration so that the uptake of O2 in the lungs increases. O2 is taken up by the blood through the lungs and binds to Hb. O2 that diffuses into the lungs and binds to Hb, affects the value of the body's oxygen saturation (SpO2). This study aims to compare the acute response of morning and evening outdoor exercise to oxygen saturation (SpO2) after aerobic activity. This type of research is a quasiexperimental pretest-posttest with a cross-over design. The subjects were 32 athletes who were divided into 2 groups. Measurement of oxygen saturation using a pulse oximeter. The data analysis technique used the statistical package for social science (SPSS 16.0). The results of the oxygen saturation analysis before morning and evening outdoor exercise showed no significant difference (p>0.05). Oxygen saturation after morning and evening outdoor exercise showed no significant difference (p>0.05). The results of this study concluded that there is no difference in oxygen saturation before outdoor exercise in the morning and evening. There is no difference in oxygen saturation after morning and evening outdoor exercise.

Comparative effectiveness of oral dexamethasone vs. oral prednisolone for acute exacerbation of asthma: A randomized control trial.

Background:Acute exacerbation of asthma is a common condition leading to emergency visits. Prednisolone is a commonly prescribed drug in the standard management of acute exacerbation of asthma along with other drugs. This study was planned to see the efficacy of oral dexamethasone when compared with oral prednisolone in the management of acute exacerbation of asthma.Methods:A single-center pilot study in the form of randomized control trial was done by recruiting children aged 2–14 years diagnosed with acute asthma exacerbation with mild to moderate severity. A total of 88 patients received oral dexamethasone (0.3 mg/kg) in two doses 24 h apart, which was compared with 87 patients who received oral prednisolone (1 mg/kg) in two divided doses 12 h apart for 5 days. The patients were assessed at the time of admission (zero hour), at 4th hour, and on the 5th day by various parameters such as respiratory rate, use of accessory muscles, Pediatric Respiratory Assessment Measure (PRAM) score, peak expiratory flow rate (PEFR), 6-h admission stay, and rate of hospital admission.Results:Baseline demographic profile, clinical characteristics, comorbidities, indoor pollution, and use of Metered Dose Inhaler (MDI) among the two study groups were comparable. Six-hour emergency stay and rate of admission were significantly lower in the dexamethasone group (P < 0.05). Improvement in PRAM score, PEFR, use of accessory muscles, and respiratory rate was also better in dexamethasone group at the 4th hour and 5th day (P < 0.05). In addition, oral dexamethasone was shown to have less incidence of vomiting/gastritis than prednisolone (P < 0.05).Conclusion:Oral dexamethasone can be considered a reliable and better option as compared with prednisolone due to its faster action and minimal side effects.

Impacto das instruções verbais na contração do assoalho pélvico no puerpério imediato

Abstract Introduction: Pregnancy predisposes the emergence of pelvic floor dysfunctions (PFD), postpartum being the opportune moment to assess these muscles. Objective: To investigate the effect of instructions and verbal feedback on the contraction capacity of pelvic floor muscles (PFM) in postpartum women. Methods: Quasi-experimental study with 109 women in the immediate vaginal postpartum at a reference maternity hospital in Fortaleza, Ceará state, Brazil. PFM were visually inspected using the visual contraction scale (0 = no visible contraction; 1 = weak visible contraction; 2 = visible contraction with perineal elevation), in addition to observing the use of accessory muscles and movements. Assessments occurred in consecutive moments: 1 - PFM contraction at a verbal command; 2 - contraction after instructions on structure, function and correct contraction; and 3 - contraction after feedback on the use of accessory muscles and reinforcement of correct contraction. Cochran’s Q test and a 5% significance level were used to compare the outcomes between different moments. Results: At the first assessment, 15.6% of the postpartum women did not exhibit visible PFM contraction (grade 0). Of these, 70.5% changed their contraction grade after instructions and feedback. At the end, 45.9% of women correctly contracted their PFM with perineal elevation (grade 2) (p &lt; 000.1). The use of accessory muscles (abductors, abdominals and gluteal) declined after instructions and feedback (p &lt; 000.1). Perineal trauma, forceps delivery, previous information and fear of feeling pain were not associated with contraction grade. Conclusion: Instructions and verbal feedback are useful tools for correct PMF contraction in the immediate postpartum.

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases.

The postmortem diagnosis of drowning death and understanding the mechanisms leading to drowning require a comprehensive judgment based on numerous morphological findings in order to determine the pathogenesis and epidemiological characteristics of the findings. Effortful breathing during the drowning process can result in intramuscular hemorrhage in respiratory and accessory respiratory muscles. However, the characteristics of this phenomenon have not been investigated. We analyzed the epidemiological characteristics of 145 cases diagnosed as drowning, in which hemorrhage, not due to trauma, was found in the respiratory muscles and accessory respiratory muscles. Hemorrhage was observed in 31.7% of these cases, and the incidence did not differ by gender or drowning location. The frequency of hemorrhage was significantly higher in months with a mean temperature below 20°C than in months above 20°C, suggesting a relationship between the occurrence of hemorrhage and low environmental temperature. Moreover, the frequency of hemorrhage was significantly higher in the elderly (aged ≥65 years) compared to those <65 years old. In the elderly, the weakening of muscles due to aging may contribute to the susceptibility for intramuscular hemorrhage. Moreover, these intramuscular hemorrhages do not need to be considered in cases of a potential bleeding tendency due to disease such as cirrhosis or medication such as anticoagulants. Our results indicate that intramuscular hemorrhage in respiratory and accessory respiratory muscles can serve as an additional criterion to differentiate between fatal drowning and other causes of death, as long as no cutaneous or subcutaneous hematomas above the muscles with hemorrhages are observed. In addition, the epidemiological features that such intramuscular hemorrhage is more common in cold environments and in the elderly may provide useful information for the differentiation.

An Erratic Origin of Quadratus Plantae: An Embryological Error

Background: Quadratus plantae (Flexor digitorum accessorius) is one of the plantar muscles of foot . It is present in the second layer of sole. It takes origin from calcaneus and gets inserted into the tendon of flexor digitorum longus. The main function of it is to flex the lateral four toes in any position of the ankle joint by pulling on tendons of the flexor digitorum longus. Its variations like high origin have been implicated in the causation of tarsal tunnel syndrome. Methodology and Results: In routine dissection done on 22 cadavers, we observed a bilateral variant muscle flexor digitorum accessorius longus on both right and left sides in a male cadaver. The modality of choice in diagnosing the accessory muscle is magnetic resonance imaging. Conclusion: The knowledge of this variation would be essential to anatomists, radiologists and also to the foot surgeons while performing posterior ankle endoscopy. KEY WORDS: Flexor digitorum Accessorius longus, Tarsal tunnel syndrome, Posterior ankle endoscopy.

Myotendinous pseudomasses: an imaging review.

A mass or a tumor may not always be an underlying cause for a clinically apparent swelling. A wide range of myotendinous disorders can present as pseudomasses. These include muscle/myofascial hernia, tendon tears, benign hypertrophy, accessory muscles, tendon xanthomas, diffuse myositis, and exertional compartment syndromes. We have briefly reviewed these lesions highlighting their typical radiological findings and have also highlighted the role of different imaging modalities and the role of dynamic imaging. Although rare, radiologists should be aware of these entities to avoid mislabeling a pseudomass as a mass or malignancy and to detect the abnormality in not-so-apparent masses.

Sternalis - Variation of clinical importance

This case report concerns the presence of an accessory anterior thoracic wall muscle during routine dissection in the Department of Anatomy, Vardhman Mahavir Medical College &amp; Safdarjung Hospital, New Delhi. A 59 year old male cadaver was being dissected, when a unilateral accessory muscle was found parallel and lateral to the right margin of sternum. Accidental encounter with Sternalis, one of the many names used to denote this muscle, made it apparent that such anatomical variations is not uncommon. A descriptive knowledge of such common anatomical variations is both essential and crucial in realizing that not any human body is alike. Besides theoretical interest &amp; academic curiosity, the implications of these variations is indispensable in diagnostic and surgical disciplines. Keywords: Sternalis, Rectus sternalis, Chest wall, Muscle variation, Human anatomy, Mammography, Rectus sternalis, Anatomical variation, Breast augmentation, Reconstruction, Mammography, Medical education, Sternalis, Chest, Breast, Surgery, Radiography, Mammogram.