Anterior Nerve Research Articles

Clinical Value Analysis of High-Frequency Ultrasound Combined with Carpal Dorsiflexion Electrophysiological Detection in the Diagnosis of Early Carpal Tunnel Syndrome.

Objective To investigate the clinical value of ultrasound combined with electrophysiological examination in the diagnosis of early carpal tunnel syndrome, we aimed to provide a new EMG (electromyography) method for detecting early carpal tunnel syndrome by exploring the wrist back stretch position and electrophysiological examination. Methods For the 82-lateral wrist (case group) of 62 patients with clinical symptoms or confirmed carpal tunnel syndrome and 40 normal healthy patients, neuroelectrophysiological measurements were performed using a Keypoint6.0 EMG evoked potentiometer, measuring each group twice: conventional position (before compression) and dorsal wrist extension position. The measures for each measurement included DSL, DML, and CAMP. Measure sensory conduction first and then measure motor conduction. The measurements were analyzed in a comprehensive comparative analysis. Combined ultrasound examination, the positive rate of combined ultrasound examination and electrophysiological examination was compared, respectively. Results In the carpal tunnel syndrome (CTS) group, the anterior and posterior median nerve DSL was (4.27 ± 0.73) ms and (4.82 ± 0.65) ms, and SNAP was (13.32 ± 13.68) UV and (12.19 ± 11.04) UV; the median nerve (wrist-bunions) DML was (5.29 ± 1.26) ms and (5.54 ± 1.29) ms, and CMAP was (6.44 ± 2.40) mV and (6.21 ± 2.46) mV. Mid-median DSL and DM in the CTS group L were significantly longer than before compression; median nerve SNAP and CMAP were significantly reduced compared with before compression. Conclusion Electrophysiological testing at the dorsal carpal extension position has high diagnostic value in the diagnosis of mild carpal tunnel syndrome. It helps to improve the diagnostic rate of early carpal tunnel syndrome, while providing a more accurate and effective EMG detection of early carpal tunnel syndrome, and combination examination of neuroelectrophysiology and ultrasound can improve the diagnosis rate of compression peripheral nerve diseases and clarify the site, nature, and scope of compression lesions, which is worthy of clinical application.

Transantral intraseptal sinuous canal

The sinuous canal is an anatomically well-defined intramural canal of the maxillary sinus (MS) folded within the antral walls. Commonly, its first, infraorbital part, courses within the antral roof, while its second, transverse facial part courses below the infraorbital foramen within the anterior antral wall. While retrospective files of patients that were scanned in cone-beam computed tomography (CBCT) for different dental medical purposes were observed randomly, a peculiar variant of the sinuous canal was noticed and further documented. The respective canal origin was far posterior in the infraorbital groove and the canal coursed through the MS embedded within an incomplete oblique septum dividing the antrum into anterosuperior and posteroinferior chambers. Then the sinuous canal continued with the transverse facial segment. As the sinuous canal contains the superior anterior alveolar nerve and artery, major suppliers of the frontal teeth, it is recommended to document in CBCT a possible transantral, and not intramural, course of it, especially when surgical or endoscopic corridors through the MS are planned.

Selective MR neurography-guided anterior femoral cutaneous nerve blocks for diagnosing anterior thigh neuralgia: anatomy, technique, diagnostic performance, and patient-reported experiences.

To evaluate the clinical utility of selective magnetic resonance neurography-(MRN)-guided anterior femoral cutaneous nerve (AFCN) blocks for diagnosing anterior thigh neuralgia. Following institutional review board approval and informed consent, participants with intractable anterior thigh pain and clinically suspected AFCN neuralgia were included. AFCN blocks were performed under MRN guidance using an anterior groin approach along the medial sartorius muscle margin. Outcome variables included AFCN identification on MRN, technical success of perineural drug delivery, rate of AFCN anesthesia, complications, total procedure time, patient-reported procedural experiences, rate of positive diagnostic AFCN blocks, and positive subsequent treatment rate. Eighteen MRN-guided AFCN blocks (six unilateral and six bilateral blocks) were performed in 12 participants (6 women; age, 49 (30-65) years). Successful MRN identified the AFCN, successful perineural drug delivery, and AFCN anesthesia was achieved in all thighs. No complications occurred. The total procedure time was 19 (10-28) min. Patient satisfaction and experience were high without adverse MRI effects. AFCN blocks identified the AFCN as the symptom generator in 16/18 (89%) cases, followed by 14/16 (88%) successful treatments. Our results suggest that selective MR neurography-guided AFCN blocks effectively diagnose anterior femoral cutaneous neuralgia and are well-tolerated.

Transfer of the anterior C3 levator scapulae motor nerve branch for spinal accessory nerve injury: illustrative case.

BACKGROUNDInjury to the spinal accessory nerve (Acc) results in loss of motor function of the trapezius muscle and leads to severe shoulder problems. A vast number of surgical strategies have been proposed to reinnervate (suture, grafting, and nerve transfers) or compensate (tendon and muscle transfers) the lost function of the trapezius muscle.OBSERVATIONSThe authors report a successful case of Acc reconstruction 5 months after the injury with the anterior C3 levator scapulae motor nerve branch transfer in omotrapezoid triangle of the neck.LESSONSThe advantages of the proposed technique over preexisting nerve transfers were discussed. We believe that this technique can be considered as an alternative to already existing techniques for proximal injuries to Acc.

Are the nerves supplying the anterior sacroiliac joint nociceptive?

Sacroiliac joint (SIJ) pain is often difficult to diagnose. Moreover, while its anatomical characteristics have been well studied, its innervation and the contributions of particular nerves remain controversial, especially in relation to posterior joint innervation. To our knowledge, previous studies have not investigated the presence of nociceptive fibres in the nerves innervating the anterior SIJ. Eight adult cadaveric sides underwent dissection of the anterior SIJ. Adjacent anterior rami were examined for branches to the anterior SIJ. Any branches contributing to the anterior SIJ were measured and then resected. These samples were fixed in formalin and substance P was identified immunohistologically. On all sides, 1-2 small branches (mean diameter of 0.33 mm) arose from the posterior aspect of the L4 anterior ramus (12.5%), the L5 anterior ramus (62.5%), or simultaneously from both the L4 and L5 anterior rami (25%). These branches had a mean length of 13.5 mm. All histological samples contained nerve tissue. All samples of nerve fibres traveling to the anterior SIJ were positive for diffuse substance P reactivity. There were no histological differences between sides or sex. Each of the branches identified as travelling to the SIJ exhibited similar positivity for substance P. This cadaveric study demonstrates that the anterior SIJ nerve fibres carry pain fibres. This new knowledge has application to patients with SIJ syndrome and to its various treatments including interventional approaches to SIJ pain.

Detection of a novel PAX6 variant in a Chinese family with multiple ocular abnormalities

BackgroundAniridia is a congenital, panocular disease that can affect the cornea, anterior chamber angle, iris, lens, retina and optic nerve. PAX6 loss-of-function variants are the most common cause of aniridia, and variants throughout the gene have been linked to a range of ophthalmic abnormalities. Furthermore, particular variants at a given site in PAX6 lead to distinct phenotypes. This study aimed to characterize genetic variants associated with congenital aniridia in a Chinese family.MethodsThe proband and family underwent ophthalmologic examinations. DNA was sampled from the peripheral blood of all 6 individuals, and whole-exome sequencing was performed. Sanger sequencing was used to verify the variant in this family members.ResultsA novel variant (c.114_119delinsAATTTCC: p.Pro39llefsTer17) in the PAX6 gene was identified in subjects II-1, III-1 and III-2, who exhibited complete aniridia and cataracts. The proband and the proband’s brother also had glaucoma, high myopia, and foveal hypoplasia.ConclusionsWe identified that a novel PAX6 frameshift heterozygous deletion variant is the predominant cause of aniridia in this Chinese family.Trial registrationWe did not perform any health-related interventions for the participants.

Diagnosis of ulnar nerve entrapment anterior to the medial epicondyle by ultrasound elastography and diffusion tensor imaging with fiber tractography: a case report

Ulnar/cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb. Permanent location of the ulnar nerve anterior to the medial epicondyle is extremely rare, with only five cases reported in the literature. Using ultrasound elastography and diffusion tensor imaging with fiber tractography, we diagnosed a case in which ulnar nerve entrapment was associated with anterior nerve location. Surgical release confirmed the diagnosis and the patient was symptom free 3 months after surgery.

Inter Observer Agreement Among Radiologist and Otorhinolaryngologists on Paranasal Sinus Computed Tomography Scans in Chronic Rhinosinusitis.

To evaluate inter observer agreement between Radiologist and Otorhinolaryngologists in identifying important structures and pathologies on pre operative computed tomography (CT) scans of paranasal sinus (PNS) in chronic rhinosinusitis (CRS). A retrospective review of CT scans PNS of CRS patients. Archived CT scans were evaluated by 3 observers, similarly experienced radiologist and otorhinolaryngologist and a less experienced otorhinolarygologist. The degree of intra- as well as inter observer agreement was assessed by Cohen's kappa statistics. A moderate and a fair inter observer agreement was noted among experienced radiologist and otorhinolaryngologist; & experienced experts and less experienced otorhinolaryngologist respectively. The greatest disagreements among all observers were found in superior attachment of uncinate process, optic nerve's relationship with sphenoid sinus and dehiscence of anterior ethmoid canal. The present study demonstrated a considerable inter observer variability among radiologists and otorhinolaryngologists, irrespective of their experience in the field of speciality. A few critically important structures which showed an unsatisfactory level of agreement and thus need to be sought after with more training and practice, were also identified. These included Keros type, optic nerve's location, dehiscence of anterior ethmoid artery, vidian and maxillary nerves, lamina papyracia defect, sphenoid sinus pneumatization and attachment of uncinate process. The study also emphasized the importance of inter disciplinary conferences for pre operative evaluation of sinus CT scans of CRS patients.

Two cases of anterior cutaneous nerve entrapment syndrome after abdominal surgery were successfully treated by ultrasound-guided block therapy

Two cases of anterior cutaneous nerve entrapment syndrome after abdominal surgery were successfully treated by ultrasound-guided block therapy

Primary tubes in siblings of a South Indian family with total aniridia and glaucoma

Aniridia is an uncommon hereditary bilateral panocular disorder affecting not only the iris but also the cornea, anterior chamber angle, lens, retina, and optic nerve with associated life-threatening conditions. Glaucoma is associated with aniridia in around 50% of the cases and usually develops in the first two decades of life. The treatment of glaucoma is challenging and often needs surgical intervention to achieve adequate intraocular pressure (IOP) control in cases refractory to medical treatment. Here, we report the familial nature of aniridia with secondary glaucoma and discuss the challenges in the management with a comprehensive review of the literature. The elder one, a 16-year-old girl presented with absolute glaucoma in the right eye and high IOP with advanced disk damage in the left eye for which she underwent a non-valved glaucoma drainage implantation. The younger one, a 12-year-old boy presented with a high IOP of more than 40 mmHg in both eyes (OU) for which he underwent sequential glaucoma drainage devices (GDD) implantation in OU. The intermediate-term outcomes in both of them showed a well-placed Aurolab aqueous drainage implant (AADI) tube with adequately controlled IOP.

Canalis sinuosus approximation on an impacted maxillary canine: a case report

Objectives: This case report is aimed to report the finding of canalis sinuosus on an impacted maxillary canine using cone beam computed tomography (CBCT) examination.
 Case Report: A 21-year-old male was referred from orthodontic department to radiology department UNPAD Dental Hospital for CBCT to determine the treatment of malalignment asymptomatic maxillary canine. The case revealed the presence of canalis that was identified as a canalis sinuosus, a branch of the anterior superior alveolar nerve that rarely known by a practitioner, at the apex of impacted right maxillary canine.
 Conclusion: The information of this anatomical variation is important for professionals due to damage that may be caused during treatment. The use of advanced imaging examination is recommended to acknowledge the individual anatomical variation before determining the proper treatment planning.

Comparison of ultrasound-guided femoral + anterior sciatic nerve block and genicular nerve block for postoperative pain in total knee arthroplasty

Purpose: This study aimed to compare the effectiveness of ultrasound-guided femoral and anterior sciatic (FAS) nerve blocks and genicular (G) nerve blocks as preventive analgesia methods after total knee arthroplasty.
 Materials and Methods: Fifty patients, aged 55–80 years were divided into two groups preoperatively. Patients in the FAS group (n=25) received 20 mL solutions (10 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 9 mL saline) in both femoral and sciatic blocks. Patients in the G group (n=25) received 5 mL solutions (2 mL 0.5% bupivacaine, 1 mL [4 mg] dexamethasone, and 2 mL saline) for each nerve. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesic requirement, total analgesic dose, and postoperative complications during the first 24 h were recorded.
 Results: VAS scores at postoperative 0, 1, and 6 h and the total amount of tramadol consumed 24 h were lower in the FAS group than in the G group. There was no requirement for additional analgesia in the first 24 h in the FAS group; however, 9 patients required additional analgesia in the G group. 
 Conclusion: USG FAS nerve blocks were superior to the genicular nerve blocks in TKA. Additionally, the genicular block doesn’t cause motor block. A genicular block can be considered as an alternative with this regard.

Two clinical cases of unintentionally prolonged sciatic nerve block

This study describes two clinical cases of unexpectedly long duration of motor block after anterior sciatic nerve block. In two patients who underwent total knee replacement, the motor block reversion in the area of sciatic nerve innervation did not occur at the expected time. Ultrasound examination revealed the deposition of a local anesthetic near the sciatic nerve. In these two clinical cases, unintentionally prolonged sciatic nerve blockade was caused by combined age-related factors of reduced tissue perfusion and the vasoconstrictor properties of levobupivacaine. Subsequently, the block was successfully resolved in 3638 h without any neurological consequences.

High risk histopathological factors in retinoblastoma in upfront enucleated eyes: An experience from a tertiary care centre of Pakistan.

Background & Objectives:The assessment of histopathological risk factors (HRFs) in retinoblastoma in upfront enucleated eyes is important in deciding treatment protocols. Limited data is available from the developing countries as very few studies were conducted on retinoblastoma. The study aims to report this data from Pakistan.Methods:This cross-sectional study included treatment naïve retinoblastoma patients who underwent upfront enucleation between 2017 to 2021. Various tumor characteristics i.e. laterality, size, histologic grade, anaplasia grade, growth pattern, extent and length of optic nerve invasion, pathologic staging, tumor involvement of ocular structures were assessed. High-risk factors such as involvement of anterior chamber, choroidal, scleral, extrascleral, and optic nerve were also noted.Results:A total number of 54 patients were enrolled, out of which 53.7% were females while remaining were males. Median age at presentation was 24 months. Unilateral tumor was seen in 92.6% cases. Most frequent histologic grade was G2 (64.7%) and moderate anaplasia was observed in 59.2% cases. Vitreous involvement was seen in (86.5%). Pathologic staging of most of the tumors was pT1 (39.2%). Assessment of high-risk factors revealed that optic nerve involvement (35.1%) was the most common finding with retrolaminar tumor invasion seen in 75% cases. Choroidal invasion (≤3mm) was seen in 55.6% of patients. Limited involvement of anterior chamber (3.8%), sclera (7.4%), and extrascleral (3.8%) tissue was also observed.Conclusion:The presence of high risk histopathological factors in enucleated eyes diagnosed with retinoblastoma are known to have a profound impact on the risk stratification as well as decision of future treatment plan.

Detailed morphology of tentacular apparatus and central nervous system in Owenia borealis (Annelida, Oweniidae)

The Oweniidae are marine annelids with many unusual features of organ system, development, morphology, and ultrastructure. Together with magelonids, oweniids have been placed within the Palaeoannelida, a sister group to all remaining annelids. The study of this group may increase our understanding of the early evolution of annelids (including their radiation and diversification). In the current research, the morphology and ulta-anatomy of the head region of Owenia borealis is studied by scanning electron microscopy (SEM), 3D reconstructions, transmission electron microscopy (TEM), and whole-mount immunostaining with confocal laser scanning microscopy. According to SEM, the tentacle apparatus consists of 8–14 branched arms, which are covered by monociliary cells that form a ciliary groove extending along the oral side of the arm base. Each tentacle contains a coelomic cavity with a network of blood capillaries. Monociliary myoepithelial cells of the tentacle coelomic cavity form both the longitudinal and the transverse muscles. The structure of this myoepithelium is intermediate between a simple and pseudo-stratified myoepithelium. Overall, tentacles lack prominent zonality, i.e., co-localization of ciliary zones, neurite bundles, and muscles. This organization, which indicates a non-specialized tentacle crown in O. borealis and other oweniids with tentacles, may be ancestral for annelids. TEM, light, and confocal laser scanning microscopy revealed that the head region contains the anterior nerve center comprising of outer and inner (=circumoral) nerve rings. Both nerve rings are organized as concentrated nerve plexus, which contains perikarya and neurites extending between basal projections of epithelial cells (radial glia). The outer nerve ring gives rise to several thick neurite bundles, which branch and extend along aboral side of each tentacle. Accordingly to their immunoreactivity, both rings of the anterior nerve center could be homologized with the dorsal roots of circumesophageal connectives of the typical annelids. Accordingly to its ultrastructure, the outer nerve ring of O. borealis and so-called brain of other oweniids can not be regarded as a typical brain, i.e. the most anterior ganglion, because it lacks ganglionic structure.

Ultrasound-guided abdominal wall infiltration versus freehand technique in anterior cutaneous nerve entrapment syndrome (ACNES): randomized clinical trial.

BackgroundThe optimal technique of abdominal wall infiltration for chronic abdominal wall pain due to anterior cutaneous nerve entrapment syndrome (ACNES) is unknown. The aim of this study was to compare pain reduction after an abdominal wall anaesthetic injection by use of an ultrasound-guided technique (US) or given freehand (FH).MethodsIn this multicentre non-blinded randomized trial, adult patients with ACNES were randomized (1:1) to an US or a FH injection technique. Primary outcome was the proportion of injections achieving a minimum of 50 per cent pain reduction on the Numeric Rating Scale (range 0–10) 15–20 min after abdominal wall infiltration (‘successful response’). Secondary outcomes were treatment efficacy after 6 weeks and 3 months, and the influence of the subcutaneous tissue thickness on treatment outcome.ResultsBetween January 2018 and April 2020, 391 injections (US = 192, FH = 199) were administered in 117 randomized patients (US = 55, FH = 62; 76.0 per cent female, mean age 45 years). The proportion of successful responses did not significantly differ immediately after the injection regimen (US 27.1 per cent versus FH 33.2 per cent; P = 0.19) or after 3 months (US 29.4 per cent versus FH 30.5 per cent; P = 0.90). Success was not determined by subcutaneous tissue thickness.ConclusionPain relief following abdominal wall infiltration by a US or FH technique in ACNES is similar and not influenced by subcutaneous tissue thickness.Registration numberDutch Clinical Trial Register NL8465.

The early development and physiology of Xenopus laevis tadpole lateral line system.

Xenopus laevis has a lateral line mechanosensory system throughout its full life cycle, and a previous study on prefeeding stage tadpoles revealed that it may play a role in motor responses to both water suction and water jets. Here, we investigated the physiology of the anterior lateral line system in newly hatched tadpoles and the motor outputs induced by its activation in response to brief suction stimuli. High-speed videoing showed tadpoles tended to turn and swim away when strong suction was applied close to the head. The lateral line neuromasts were revealed by using DASPEI staining, and their inactivation with neomycin eliminated tadpole motor responses to suction. In immobilized preparations, suction or electrically stimulating the anterior lateral line nerve reliably initiated swimming but the motor nerve discharges implicating turning was observed only occasionally. The same stimulation applied during ongoing fictive swimming produced a halting response. The anterior lateral line nerve showed spontaneous afferent discharges at rest and increased activity during stimulation. Efferent activities were only recorded during tadpole fictive swimming and were largely synchronous with the ipsilateral motor nerve discharges. Finally, calcium imaging identified neurons with fluorescence increase time-locked with suction stimulation in the hindbrain and midbrain. A cluster of neurons at the entry point of the anterior lateral line nerve in the dorsolateral hindbrain had the shortest latency in their responses, supporting their potential sensory interneuron identity. Future studies need to reveal how the lateral line sensory information is processed by the central circuit to determine tadpole motor behavior.NEW & NOTEWORTHY We studied Xenopus tadpole motor responses to anterior lateral line stimulation using high-speed videos, electrophysiology and calcium imaging. Activating the lateral line reliably started swimming. At high stimulation intensities, turning was observed behaviorally but suitable motor nerve discharges were seen only occasionally in immobilized tadpoles. Suction applied during swimming produced a halting response. We analyzed afferent and efferent activities of the tadpole anterior lateral line nerve and located sensory interneurons using calcium imaging.

Combined Reconstruction of the Ulnar Nerve after its wide Resection by Nerve Grafting at the Site of the Resection and Distal Transfer of the Anterior Interosseus Nerve to the deep Branch of the Ulnar Nerve.

Combined Reconstruction of the Ulnar Nerve after its wide Resection by Nerve Grafting at the Site of the Resection and Distal Transfer of the Anterior Interosseus Nerve to the deep Branch of the Ulnar Nerve.

US-guided Musculoskeletal Interventions of the Body Wall and Core with MRI and US Correlation.

Chest, abdominal, and groin pain are common patient complaints that can be due to a variety of causes. Once potentially life-threatening visceral causes of pain are excluded, the evaluation should include musculoskeletal sources of pain from the body wall and core muscles. Percutaneous musculoskeletal procedures play a key role in evaluating and managing pain, although most radiologists may be unfamiliar with applications for the body wall and core muscles. US is ideally suited to guide these less commonly performed procedures owing to its low cost, portability, lack of ionizing radiation, and real-time visualization of superficial soft-tissue anatomy. US provides the operator with added confidence that the needle will be placed at the intended location and will not penetrate visceral or vascular structures. The authors review both common and uncommon US-guided procedures targeting various portions of the chest wall, abdominal wall, and core muscles with the hope of familiarizing radiologists with these techniques. Procedures include anesthetic and corticosteroid injection as well as platelet-rich plasma injection to promote tendon healing. Specific anatomic structures discussed include the sternoclavicular joint, costochondral joint, interchondral joint, intercostal nerve, scapulothoracic bursa, anterior abdominal cutaneous nerve, ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve, pubic symphysis, common aponeurotic plate, and adductor tendon origin. Relevant US anatomy is depicted with MRI correlation, and steps to performing successful safe US-guided injections are discussed. Confidence in performing these procedures will allow radiologists to continue to play an important role in diagnosis and management of many musculoskeletal pathologic conditions. ©RSNA, 2021.

Conservative treatment for an anterior cutaneous nerve entrapment syndrome case.

Conservative treatment for an anterior cutaneous nerve entrapment syndrome case.