Accessory Muscle Research Articles

Accessory Flexor Carpi Ulnaris Muscle in Humans: A Rare Anatomical Case with Clinical Considerations.

Anatomical variations of the forearm flexor muscles are occasionally encountered. Though usually observed incidentally during autopsies or imaging studies, they may at times cause concern due to associated clinical symptoms. This report presents a case of unilateral accessory flexor carpi ulnaris (AFCU) muscle observed in a human male cadaver aged 78 years. During routine cadaveric dissection, an anomalous AFCU muscle was observed in the left forearm of a human male cadaver aged 78 years. Standard institutional guidelines pertaining to the use of human cadaver for teaching and research were followed. A thorough literature review about the flexor carpi ulnaris (FCU) through the PubMed, Embase and Google scholar databases was undertaken, using the keywords - accessory flexor carpi ulnaris muscle, aberrant flexor carpi ulnaris muscle and anatomical variation of flexor carpi ulnaris muscle. Relevant gross anatomical findings were recorded and photographed. AFCU was identified on the medial aspect of the distal third of the left forearm. The AFCU was found originating from the ante-brachial fascia and the fascia covering the FCU on the left forearm, forming a small separate belly deep to the main muscle. It terminated as a thin tendon running alongside the hypothenar muscles and attached distally to the base of the proximal phalanx of the little finger. The AFCU was found to be innervated by a branch of the ulnar nerve. Awareness about the rare AFCU muscle is clinically important as a possible cause of ulnar nerve compression but also as a possible graft in reconstruction surgeries.

Accessory respiratory muscles performance among people with spinal cord injury while singing songs with different musical parameters.

People with spinal cord injury (SCI) experience respiratory dysfunctions which include hypersecretions, bronchospasm, and respiratory muscles weakness. Singing therapy has been implemented as part of respiratory muscle training (RMT) to improve their muscle strength. Singing different types and genres of songs may elicit specific recruitment of respiratory muscles, attributed to the variation of the songs' characteristics including tempo, pitch, and rhythmic complexity. This study aims to determine the effect of singing songs with different characteristics on the accessory respiratory muscle performance among people with SCI. Thirteen male SCI participants of ASIA A and B (C4 -T11) were recruited. Respiratory muscle signals were retrieved by placing two mechanomyography (MMG) sensors on the sternocleidomastoid (SCM) and rectus abdominis (RA) muscles. Eight music experts categorized several songs into four categories based on their pitch, tempo, and rhythmic complexity. Each participant sang one song from each category. Findings showed statistically significant difference in RA and SCM responses among all categories (P < 0.01). The SCM muscle is most active while singing high pitch songs. While the RA is most active during slow tempo and easy rhythmic complexity. This shows that different accessory respiratory muscle is activated by people with SCI while singing songs with different characteristics. Clinicians could benefit from this knowledge while prescribing singing therapy or exercise among people with SCI in the future.

Accessory Extraocular Muscle: A Rare Cause of Strabismus.

Teaching point: Accessory extraocular muscles are rare intraorbital congenital structures that can cause diplopia and restrictive strabismus.

Ab. No. 125 Effect of Repetitive Transcranial Magnetic Stimulation Along With Conventional Physiotherapy Treatment on Sleep Parameters Using Polysomnography: A Sleep Study in Individuals With Sleep Apnea: A Single Case Study

Introduction: The purpose is to find the effectiveness of rTMS along with conventional physiotherapy on polysomnography (PSG)-sleep analysis in individuals with sleep apnea. The study attempts to widen the horizons of the physiotherapy profession in the field of sleep apnea. The improved quality of sleep may improve various domains of the quality of life of affected individuals. Methods: Study design is a case report of an individual with sleep apnea. A 45-year-old male has been diagnosed with sleep apnea for 4 years and has been using a CPAP device for the last 5 months. The patient had excessive daytime sleepiness, loud snoring, and difficulty wearing a CPAP mask at night. The physical examination showed obesity (BMI – 25.5 kg/m2), an inappropriate breathing pattern (more mouth breathing instead of nasal breathing), and tightness of accessory respiratory muscles (scalene, trapezius, pectoral, and sternocleidomastoid) on palpation. Then the patient was intervened with rTMS along with conventional physiotherapy for 5 sessions a week for the duration of 3 weeks. Pre- and post-objective assessment were done using polysomnography and subjective assessment were done using Pittsburgh Sleep Quality Index (PSQI). Results: Significant reduction in apnea-hypopnea index (AHI) was observed after the intervention. Sleep disturbance also decreased during the night and PSQI score also decreased from 8 to 6. Conclusion: The study concluded that rTMS, along with conventional physiotherapy, was found to be an effective treatment and can be used for management of sleep apnea.

Structured respiratory physiotherapy protocol for resolution of atelectasis in pediatric intensive care

Children are at higher risk of atelectasis due to their anatomical and physiological particularities. Several physiotherapy techniques are used to treat atelectasis, but only four studies cite methods in pediatric patients undergoing Invasive Mechanical Ventilation (IMV). The objective of this study was to evaluate the Structured Respiratory Physiotherapy Protocol (SRPP) for airway clearance and lung reexpansion for infants on IMV with atelectasis. This is a prospective study including 30 infants (mean ± standard deviation age 8.9 ± 8.0 months; weight 7.5 ± 3.0 kg; BMI 15.8 ± 1.6 kg/cm2 and IMV duration 7.7 ± 4.3 days). The sample was randomized into a Control Group (CG), which received routine physiotherapy, and an Intervention Group (IG), submitted to SRPP (postural drainage, mechanical thoracic vibration, manual hyperinflation, stretching of the accessory respiratory muscles, and functional positioning). Both groups were evaluated before and after physiotherapy for respiratory effort using the Wood Downes Score (WD) and pulmonary aeration using lung ultrasonography (Lung Ultrasound Score ‒ LUS). The outcome of the intervention was evaluated by the magnitude of the effect by the Hedges' g test [(small (0.2 < Hedges' g < 0.5), moderate (0.5 < Hedges' g < 0.8) and large (Hedges' g > 0.8) effects]. There were large within-group effects on the reduction of WD in the CG after intervention in both the CG (Hedges' g = -1.53) and IG (Hedges' g = -2.2). There was a moderate effect on LUS reduction in the CG (Hedges' g = -0.64) and a large effect on IG (Hedges' g = -1.88). This study has shown that the SRPP appears to be safe and may be effective in improving airway clearance and lung reexpansion in children on IMV with atelectasis.

Clinical Evaluation of Dyspnoea in Obstructive Lung Disease – Progressing from Psychometrics to Physiology

Dyspnoea is a common symptom that afflicts persons with myriad medical conditions. Among sufferers of lung disorders such as chronic obstructive pulmonary disease, dyspnoea, together with effort intolerance, are the major complaints. Dyspnoea is a marker of disease severity and adverse prognosis of chronic obstructive pulmonary disease, and the need for symptom alleviation in improving health status is ever-present, but the quantification of this symptom is challenging in clinical practice, and is mostly limited to the use of questionnaires and self-reports currently. Numerous psychometric tools have been developed to measure the severity of dyspnoea clinically, but their utility is vitiated by the complexity and multidimensional nature of the symptom. The lack of a universally accepted and accurate measurement tool is likely to hinder future progress in developing novel treatments for relieving dyspnoea. Physiological measurements have been used to complement or supplant psychometric evaluation of dyspnoea but simple stationary lung function tests do not correlate sufficiently well with dyspnoea severity in patients with chronic obstructive pulmonary disease, while complex exercise testing is impractical or limited to specialized research labs. In recent years, the use of non-invasive surface electromyography of the diaphragm and/or accessory muscles of respiration is gaining attention as a promising physiological assessment of dyspnoea with potential for widespread clinical applications. Although substantial technological gaps still exist between bench and bedside, the current interest, as evidenced by the number of med-tech collaborations in surface respiratory electromyography, appears to be well justified. This review aims to summarize the past and present methodologies as well as future developments in evaluating and quantifying dyspnoea, especially in patients with chronic obstructive pulmonary disease.

Prevalence, evaluation, and clinical implications of a reticular tunnel formed by uncharacteristic distal fibers of the abductor pollicis longus

IntroductionVariations in muscles of the pollex are common, and some can elicit significant clinical implications. The abductor pollicis longus (APL) frequently exhibits non-typical morphologies; however, descriptions of uncharacteristic distal fibers from APL (APLudf) that form a reticular tunnel around the tendons of extensor carpi radialis longus (ECRL) and brevis (ECRB) are scarce in current literature. The objective of this study is to investigate the prevalence of APLudf with concurrent report of in situ and cross-sectional gross imaging. MethodsThe distal aspect of 110 APL muscles was examined for APLudf and reticular tunnel formation. Reticular tunnel length was measured over the long axis of the underlying ECRL tendon, and APLudf pennation angle was recorded. Characteristic APL and APLudf examples were photographed in situ, and one example of APLudf was cross-sectioned to show the bony attachment of the atypical fibers in relation to contiguous anatomy. A unique finding of an APLudf accessory tendon inserting onto an accessory abductor pollicis brevis muscle was removed, splayed, and photographed. ResultsAPLudf were present in 65 (59.1%) of upper limbs. The APLudf originated from a free origin over the ECRL and ECRB tendons and a fixed origin from the lateral margin of the distal radius and inserted onto the main APL tendon or an accessory tendon, creating a distinct reticular tunnel around the ECRL and ECRL with a mean length of 20.25 ± 5.55 mm (range = 11.09 mm–36.09 mm) and 12.99° ± 1.44° pennation. All APL muscles displayed one main tendon and at least one accessory tendon which originated solely from APLudf on 43 (39.1%) of the specimens. ConclusionsThe present study suggests the prevalence of APLudf is 59.1% and often occurs bilaterally. The restriction of intersecting movements within the APLudf reticular tunnel could cause ECRL and ECRB tendon inflammation (i.e., intersection syndrome), directly affect respective functions (e.g., radial extension of the wrist, abduction and extension of the thumb), and complicate surgical management in the region. This report may inform educators and healthcare providers when deliberating diagnosis, treatment, and healing of associated forearm, wrist, and pollex conditions.

Popliteal Artery-Related Pathologies in Athletes—A Primer for Musculoskeletal Radiologists

AbstractVascular complications in athletes are common and mimic musculoskeletal injuries such as muscle sprains, fractures, and cartilage abnormalities. They include traumatic vascular injuries and more subtle pathologies like entrapment syndromes, pseudoaneurysms, arterial occlusions, and venous thrombosis. Such vascular complications may be occult on imaging and can be difficult for a musculoskeletal radiologist to diagnose, resulting in a lack of timely diagnosis and potentially limb-threatening consequences. Although the final diagnosis may require multidisciplinary input from orthopaedic, sports and exercise medicine, and vascular and interventional radiology inputs, a musculoskeletal radiologist with prior knowledge of such conditions can be the first to diagnose such conditions aiding the athlete's performance. A musculoskeletal radiologist should pay due attention to anatomical courses of vascular channels and look for potential causes of vascular compression, aberrant myotendinous bands, accessory muscles, etc., before concluding a computed tomography (CT) or magnetic resonance imaging (MRI) as normal. Doppler ultrasound, CT, or MR angiography are commonly employed techniques for primary evaluation, whereas digital subtraction angiography is generally reserved for troubleshooting as advanced dynamic imaging.

Variations of accessory thoracic muscles identified in the ethnically diverse whole-body donation population in Northern California.

Accessory thoracic muscles in humans are relatively common and it is important to draw awareness to their variable presentations and potential clinical implications owing to their close association with the axilla. Here we report four cases of accessory thoracic muscle variations identified in the ethnically diverse whole- -body donation population in Northern California (4 out of 48 donors, 8.3%). Of these, combined presentations of thoracic accessory muscles were observed in two of the donors, one involving bilateral axillary arches and a pectoralis quartus on the left and the other a unilateral axillary arch on the left and bilateral pairs of pectoral fascicles. In the former, the proximal ends of the left axillary arch and pectoralis quartus joined to form a common aponeurosis which inserted onto the deep tendon of the pectoralis major; in the latter, the pectoral fascicles originated from the surface of the ribs and inserted into the deep surface of the pectoralis major muscle. In the other two donors, unilateral axillary arches were observed. Our observations illustrate that accessory thoracic muscles, in isolated as well as combined forms, are commonplace in the general population. We also describe the proposed embryonic origins of these accessory muscles, which may reflect their frequent occurrence, and potential clinical implications of these muscles, as discussed in literature.

A very rare case of the accessory palmaris longus muscle and clinical significance.

The palmaris longus muscle is located in the forearm region. It morphological variability was noted during standard anatomical dissection of the upper limb. The muscle was characterized by a normal course, i.e. originating from the medial humeral epicondyle and inserting to the palmaris aponeurosis, but a small additional tendon attached to the flexor retinaculum was observed in its distal part. An accessory palmaris longus muscle was also observed nearby. Interestingly, this accessory muscle was reversed, and the first part was not muscular, but tendinous, represented by two tendons originating from the common muscular mass attached to the medial epicondyle of the humerus; these later connected together, creating one muscle belly distally attached to the flexor retinaculum. This additional structure was innervated by a neural branch from the median nerve and the ulnar artery was responsible for blood supply. The course of the median nerve is also clinically important, because before entering the carpal tunnel, it was located directly under the accessory palmaris longus muscle. In turn, the ulnar artery passed through a special hole created by the flexor digiti minimi brevis and flexor retinaculum, before passing under the palmaris brevis muscle.

The Therapeutic Role of Inspiratory Muscle Training in The Management of Asthma: A Narrative Review.

Asthma is a disorder of the airways characterized by chronic airway inflammation, hyperresponsiveness, and variable recurring airway obstruction. Treatment options for asthma include pharmacological strategies, while non-pharmacological strategies are limited. Established pharmacological approaches to treating asthma may cause unwanted side effects and do not always afford adequate protection against asthma, possibly due to an individual's variable response to medications. A potential non-pharmacological intervention that is most available and cost-effective is inspiratory muscle training (IMT), which is a technique targeted at increasing the strength and endurance of the diaphragm and accessory muscles of inspiration. Studies examining the impact of IMT on asthma have reported increases in inspiratory muscle strength, and a reduction in the perception of dyspnea and medication use. However, due to the limited number and discordant methods between studies more evidence is required to elucidate in asthmatics the efficacy of IMT on inspiratory muscle endurance, exercise capacity, asthma control, symptoms, quality of life, as well as adolescents with differing severities of asthma. Large randomized controlled trials would be a significant step forward in clarifying the effectiveness of IMT in asthmatics. While IMT may have favorable effects on inspiratory muscle strength, dyspnea and medication use, the current evidence that IMT is an effective treatment for asthma is inconclusive.

Absence of musculocutaneous nerve associated with the presence of an accessory head of the biceps brachii muscle: report of a bilateral case and its clinical implications

The anatomical variants of the biceps brachii muscle (BBM) are frequent, mostly unilaterally than bilaterally, and are associated with supernumerary muscle bellies, the total absence of the muscle or one of its heads, and variations in the points of origin and insertion. In the same way, the variants of the musculocutaneous nerve (MCN) can include alterations in its course, number of branches, or anatomical relations, whereas its absence is considered an atypical variation. The aim of this work was to report the absence of musculocutaneous nerve associated with the presence of one accessory head of the biceps brachii muscle. Dissection of a female cadaver, fixed in 10% buffered formaldehyde, which did not present previous surgeries in the studied area was performed. Variations were noted in both upper limbs related to accessory muscle bellies and change in innervation. Anatomical relations of muscles and nerves were determined by following proximal to distal ends, relation, vascularization, and innervation pattern. The absence of MCN associated with the presence of one accessory head of the BBM were found bilaterally. These anatomical variations are atypical. Clinically, these variations can produce compressive symptoms that could generate confusing diagnostics and conduce to unnecessary procedures on the arm, inducing iatrogenic actions.

Pemberian Inhalasi Minyak Kayu Putih Untuk Memperbaiki Pola Napas Tidak Efektif Pada Anak Dengan Bronkitis

&lt;p&gt;&lt;em&gt;There are 1.6 million persons who have bronchitis in Indonesia. Coughing, wheezing, sputum buildup, and shortness of breath are common symptoms. We must be mindful of the efficiency of breathing patterns when considering these symptoms. The goal of this study was to identify inefficient breathing techniques used by nurses to provide bronchitis-stricken An. A with nursing care. An. A is the focus of this case study in a scientific journal, and the study's findings include cough and runny nose, RR 32 beats per minute, additional rhonchi noises, SPO2 92%, body temperature 36.8 oC, and pulse 100 beats per minute. Airway control using eucalyptus oil inhalation was the intervention that was used. The major treatment for An's respiratory pattern issues was a straightforward inhalation of eucalyptus oil, and the findings of the case study were achieved following nursing care for airway management for three consecutive days. Increased inspiratory pressure, moderately decreased dyspnea, moderately decreased use of accessory muscles, decreased orthopnea, moderately decreased nasal breathing, improved respiratory rate, and improved respiratory depth are all signs that A can be substantially resolved. This demonstrates how eucalyptus oil can help bronchitis patients breathe more easily.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;strong&gt;&lt;em&gt;Keyword: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;children, bronchitis, ineffective breathing pattern, simple inhalation&lt;/em&gt;&lt;br /&gt;&lt;/strong&gt;&lt;/p&gt;

Effect of tone normalizing massage on stiffness of accessory inspiratory muscles in patients with COPD

The aim of this study was to evaluate the effect of medical massage on inspiratory accessory muscle function and sensory sensitivity in patients with chronic obstructive pulmonary disease. The participants were divided into two groups: group II (22 patients with COPD in the stable period), and group II (II: 17 participants with no respiratory disorders). Each group was subjected to a series of five massages. The treatment was performed for the sternocleidomastoid, levator scapulae, and the descending part of the trapezius muscle. The parameters of muscle frequency and stiffness were measured using a Myoton Pro Digital device. The compression sensitivity was measured using a Force algometer. The results obtained showed significant differences in the stiffness parameters of the muscles studied between the groups, which indicates a positive effect of massage on muscle function in patients with COPD. The greatest significant differences were found in the patient’s sensitivity parameters. The application of the massage series significantly improved the parameters of frequency and decreased stiffness of inspiratory accessory muscles in patients with COPD compared to the group of healthy participants. This massage is an effective method to normalize muscle tone and thus improve the functional status of patients with COPD.

A case report on multiple accessory muscles and nerve variations in upper limb

During routine dissection of formalin fixed cadavers, the brachial plexus and other upper limb structures were observed for variations. In 65-year-old male cadaver, bilateral upper limb neuromuscular variations were identified. On the left side, median nerve had three roots (one medial and two lateral) and biceps brachii had an additional head which was originating from the mid shaft of humerus and joined with the main muscle at the lower third of arm, and was innervated by musculocutaneous nerve. On the right side, the brachioradialis muscle had an accessory head which took origin from the lateral side of humerus near deltoid tuberosity and joined with main tendon in the lower part of the forearm, and was innervated by radial nerve. The association of nerve variations and accessory muscles is clinically significant. As accessory muscle may lead to nerve or artery entrapment in the limb and is likely to cause palsy or ischemia, knowledge about the neuromuscular variations is clinically significant.

A cadaveric case study of the fibulo calcaneus internus muscle as a rare accessory muscle of calf region

The fibulocalcaneus (peroneocalcaneus) Internus (FCI) muscle which is also called as Peroneo calcaneus Internus (PCI) muscle (of MacAlister) is a rare variation of calf muscle with a low prevalence of &amp;#60;1%-3% in cadaveric dissection and imaging studies. The FCI arises from the posterior-medial aspect of the distal 1/3 of the fibula, descends posterior and lateral to the flexor hallucis longus (FHL) muscle. It than traverses the tarsal tunnel inferior to the sustentaculum tali of the Calcaneus, and get inserted into the plantar surface of the calcaneus. However, controversy exists concerning the exact location of the insertion site of FCI muscle. Recently the insertion of the FCI muscle has been described as distal to the coronoid fossa, a small depression between the anterior tuberosity and the anterior apex of the sustentaculum tali of the calcaneus. However, chronological descriptions described the FCI as inserting into either the sustentaculum tali itself or a small tubercle on the medical surface of the calcaneus distal to the sustentaculum tali. During routine dissection for under graduate students, about 56-year old Indian male, a Fibulocalcaneus (peroneocalcaneus) Internus (FCI) muscle was identified, which originated from the posterior medial surface of distal third of the fibula and tendon merges with 2 slip of flexor digitorum longus and get inserted on base of distal phalanx of second toe. Knowledge of the FCI muscle is important due its involvement with various ankle pathologies, including predisposing individuals to tarsal tunnel syndrome, FHL tenosynovitis, and posterior ankle impingement and pain. The FCI muscle is one of the least common muscular variants associated with the ankle joint, and it has been implicated in posterior ankle pain and impingement. This muscle is often confused with the flexor digitorum accessorius longus (FDAL) muscle. Additionally, this study describes ways to differentiate between the FCI and FDAL muscles in the lower leg. Radiologists and clinicians should be aware of this anomalous muscle when considering various diagnoses, interpreting radiographs, and pursuing surgical involvement to reduce symptoms of posterior ankle region.

Anatomical Features of Patients with Recurrent Dislocation of the Peroneal Tendons

Category: Hindfoot; Sports Introduction/Purpose: The occurrence of peroneal tendon dislocation (PTD) may be influenced by anatomical variations in the peroneal muscles and ankle lateral malleolus. One such factor is peroneal groove crowding, which can result from increased muscle and tendons bulk within the peroneal tendon sheath. Another potential factor is the shape of the retromalleolar groove, which determines the inherent stability of the tendons in the groove. This study aims to examine the anatomical variations of the retromalleolar groove and peroneal muscles in patients with and without recurrent PTD (RPTD) using magnetic resonance imaging (MRI) and computed tomography (CT). Methods: This study included 30 patients (30 ankles) with recurrent PTD who underwent both MRI and CT before surgery (PD group) and 30 age- and sex-matched patients (control (CN) group) who underwent MRI and CT. The imaging was reviewed at the level of the tibial plafond (TP level) and the center slice between the TP and the fibula tip (CS level). CT images were used to assess the appearance of a malleolar groove (convex, concave, or flat) and the posterior tilting angle of the fibula. MRI images were used to assess the appearance of accessory peroneal muscles, height of the peroneus brevis muscle belly, and volume of the peroneal muscle and tendons. Low-lying muscle belly (LLMB) of the PB was defined as when the musculotendinous junction extended beyond the tip. The Mann-Whitney U test was used to compare continuous variables, and Fisher’s exact test was used to compare nominal variables. Results: There were no differences in the appearance of the malleolar groove, posterior tilting angle of the fibula, or accessory peroneal muscles at the TP and CS levels between the PD and CN groups. However, the peroneal muscle ratio was significantly higher in the PD group than in the CN group at both levels (both p&lt; 0.001). The peroneal tendons ratio was not significantly different between the groups at both levels. The height of the peroneus brevis muscle belly was significantly lower in the PD group than in the CN group (p=0.001). LLMB of the PB was identified in 19 patients (63.3%) in the PD group and in eight patients (26.7%) in the CN group (p=0.009). Conclusion: The findings of this study suggest that LLMB of the PB and the peroneal muscle ratio are significantly related to RPTD, whereas retromalleolar bony morphology is not. Therefore, maintaining proper volume in the peroneal tunnel is more important than the groove shape. Reduction of the muscle belly of the peroneus brevis during RPTD surgery may help prevent peroneal tendon dislocation.

Assessment of Respiratory Functions, Activities of Daily Living, and Quality of Life of the Post-mechanical Ventilated Patients

Background: The fundamental goal of mechanical ventilation is to restore and improve respiratory functions and relieve respiratory distress, thus permitting lungs and airways to heal in acute and chronic respiratory failure conditions. Associated post-mechanical ventilation complications may increase the chance of re-intubation, poor quality of life, hospital stay and hospital costs, and so on. Objective: To assess the respiratory functions, activities of daily living, and quality of life of the post-mechanical ventilated patients. Methods: Using a purposive sampling technique, 72 patients after 24 h of weaning from the ventilator were enrolled in the study. Their socio-demographic profile, respiratory functions, activities of daily living, and quality of life were assessed using validated tools. Results: The mean respiratory rate per minute and oxygen saturation were 21.69 ± 4.10 and 93.58 ± 3.73, respectively. A total of 58.9% of the patients had dyspnea, 18.1% had abnormal breathing sound, 22.3% were using accessory muscles during breathing, 20.9% had pain during breathing, and 18.1% had cough with sputum production after extubation. Three fourth of the patients had complete dependency (75%) to perform activities of daily living. More than half (59.8%) of the patients had good quality of life scores as per the SF-36 item scale. Conclusion: There is a need to plan nursing interventions for patients in order to decrease post-mechanical ventilation complications.

Intermediate Accessory Papillary Muscle: An Anatomic Variant of Interest for Transcatheter Edge-to-Edge Mitral Valve Repair.

Intermediate Accessory Papillary Muscle: An Anatomic Variant of Interest for Transcatheter Edge-to-Edge Mitral Valve Repair.

Normal and Aberrant Muscle Tissue Healing, Learning from Health and Disease

Human skeletal muscle exhibits remarkable plasticity, being responsive to chemical, mechanical, metabolic, and inflammatory stress. When the homeostatic disturbance is below a threshold of significant damage, the muscle responds by modifying metabolic activity, cell size/shape, and structure, thereby normalizing cellular function. If the disturbance causes significant damage, skeletal muscle, along with a precisely choreographed response from the immune system, can regenerate. Very few pathological conditions inhibit these adaptive responses in muscle. Yet, from these few conditions, we can learn a great deal. Working with the immune system, normal muscle healing can inform disease treatments, and the disease pathology informs our understanding of normal muscle healing. Here we use Duchenne Muscular Dystrophy (DMD) as a model of failed muscle adaptation/regeneration to attempt to understand normal muscle healing, why it sometimes fails, and how normal muscle response might be applied to understand and treat DMD.