Muscle Belly Research Articles

Effects of experimental pain on elbow flexor muscles performance after eight weeks of strength training: a pilot study

INTRODUCTION: Strength training has been recommended in clinical rehabilitation, as well as in the physical conditioning of athletes. It is not uncommon, in both cases, the presence of pain during practice; however, to date, there is no consensual information about the effects of acute muscle pain on strength training adaptations. OBJECTIVE: The aim of this pilot study was to evaluate the effects of experimentally induced pain on muscle strength adaptation after an 8-week training period. METHOD: The study included five untrained, healthy male volunteers. Participants were submitted to a strength training protocol (3x/week for 8 weeks) for the elbow flexor muscles. Acute muscle pain was induced at the beginning of each training session through an intramuscular infusion of 2.5 ml of hypertonic saline (6%) into the biceps brachii muscle belly. Maximal dynamic strength (1RM) and maximal voluntary isometric contraction (MVIC) were measured at pre- and after four and eight weeks of training. RESULTS: Maximal dynamic strength increased, on average, 37.3% and 78.4% after four and eight weeks, respectively. However, little, if any, difference was found in MVIC (-1.7% and – 3.0% after four and eight weeks, respectively). CONCLUSION: After 24 strength training sessions, with acute muscle pain induced every session, healthy volunteers increased their ability to produce maximal dynamic strength by more than 75%; however, isometric strength presented only small negative changes.

Muscle Belly Repair: Biomechanical Assessment of the Anchor Suture and the Modified Kessler Techniques.

Background: Treatment of muscle belly lacerations remains a problem for surgeons. Inadequate repair of lacerations can cause functional disability. To date, there is no consensus on the method of repair for these injuries. We have previously described a technique of repairing mid-substance muscle belly lacerations. The aim of this study was to determine the ultimate strength of an intact muscle belly and to compare the anchor suture (AS) technique with the modified Kessler (MK) technique. Methods: Fifteen fresh frozen hind-legs from adolescent pigs were divided into three groups and used for the testing. Each group consisted of five specimens. Group one was the intact control group, group two was repaired with the MK technique and group three was repaired with the AS technique. Following repair, the muscles were secured in a custom-made fixation apparatus and underwent linear tensioning at a rate of 25 mm/min, generating a load-displacement curve for each specimen. The data regarding ultimate strength, modes of failure and number of intact suture/anchor constructs (for groups 2 and 3) was calculated. Results: The ultimate strength of the intact muscle group of was found to be 608.1 ± 107.9 N. This was significantly (p < 0.05) higher than the pull-out strength of the MK and AS groups. The pull-out strength of the AS group was 143.1 ± 36.7 N, nearly twice that of the MK group 69.8 ± 16.4 N (p = 0.11). Suture pull-out was the most common mode of failure. Conclusions: The AS technique was found to have both higher strain and nearly twice the ultimate pull-out strength compared to the MK repair group. We suggest the AS technique as a viable technique for mid-substance muscle belly repairs.

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.

Shear wave elastography evaluation of passive muscle stiffness in vivo

Shear wave elastography is emerging as a viable method for diagnosing changes in the stiffness of tissues and can be applied to many aspects of the musculoskeletal system to allow the detection of muscle properties that have previously been unseen. It can be used to evaluate the change in stiffness caused by injury, inflammation, pathology or surgery, as well as the response to interventions. Determining the appropriate protocols and interpretation of results is the current major hurdle, limiting radiology clinics from adopting the technology. To overcome this, our research involved multiple phases of data collection to determine the anatomical variation and factors that influence passive muscle stiffness, measured on multiple machine vendors and varying patient positions. Measurements were performed on healthy volunteers in vivo. This research has investigated the variability of shear wave velocities along the length of the biceps brachii, as well as confirming the decrease in velocities with elbow joint flexion. The intersession variability of machines was excellent. Most notably, we demonstrated that separate bellies of the same muscle can differ in stiffness suggesting the need for a strong morphological and biomechanical understanding of muscles before development of evaluation protocols.

Outcomes following Peroneal Tendoscopy for Peroneal Tendon Disorders: A Systematic Review

Category: Other; Ankle Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. Methods: During October 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following peroneal tendoscopy for the treatment of peroneal tendon disorders. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. Results: Nine studies were included. In total, 264 patients (269 tendons) underwent peroneal tendoscopy for the treatment of peroneal tendon disorders at a weighted mean follow-up of 30.5±11.4 months. The peroneal tendon disorders included: peroneal tendon tear (89 patients), peroneal tenosynovitis (85 patients), low lying muscle belly (54 patients) and peroneal tendon subluxation (17 patients). The weighted mean AOFAS score improved from a pre-operative score of 76.0 to a weighted mean post-operative score of 96.0. The complication rate was 3.8%, the most common of which was persistent lateral ankle pain (1.1%). Two failures (0.007%) were reported, both of which underwent repeat peroneal tendoscopy, tenosynovectomy and low lying muscle belly resection. Conclusion: This systematic review demonstrated improvement in subjective clinical outcomes together with a low complication rate and low failure rate at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. However, the level of evidence was low and the quality of evidence was poor. In addition, there was significant heterogeneity between the included studies. Further higher quality studies are warranted to determine the optimal role of peroneal tendoscopy for the management of peroneal tendon disorders.

The Effect of Focused Vibration on Tibialis Anterior Function in Normal Subjects

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Foot drop is a debilitating condition which may be caused by peripheral nerve pathology. Focused vibration therapy (FVT) is a novel treatment in this setting which aims to improve the response of muscle motor units to nervous stimuli, improving muscle function and rehabilitation potential. This study investigates the effect of FVT on tibialis anterior (TA) function in normal subjects to determine the optimal timing of application. Methods: Fifteen normal subjects with mean age 25.47±3.27 years and BMI of 21.93±1.54kg/m2 were recruited. Using surface electromyography (EMG), a rotary potentiometer, video analysis (KINOVEA software), and force gauges, the activity of TA, ankle range of movement (ROM), and force at maximal isometric voluntary contraction (MVC) in dorsiflexion were measured. Baseline TA strength was recorded, and participants then performed a series of dorsiflexion exercises to induce fatigue. Strength measurements were repeated after a 5-minute rest period (control). This process was repeated with FVT applied before exercise (FVBE) and after exercise (during the rest period, FVAE). FVT was delivered over the TA muscle belly at 75Hz / 0.4mm amplitude. Data was analysed using ANOVA. Results: There was no significant change in EMG readings or dorsiflexion ROM between baseline, control and FVBE/FVAE measurements. Compared to baseline, MVC increased by 10.87N (6.6%) after FVBE (p=0.034) and 13.87N (8.4%) after FVAE (p=0.034). Compared to control, MVC did not increase significantly with FVBE, but did increase by 7.70N (4.3%) following FVAE (p=0.049). Conclusion: FVT improved the MVC of TA - this was most pronounced when FVT was applied during the recovery phase, after exercise. The lack of EMG / ROM improvement is expected in normal subjects. Our results suggest that FVT is more effective than passive rest and may enhance muscle strength recovery. Further work will investigate the optimal dose of FVT and response in patients with pathology.

Difference in the Electromyographic Behavior of the Masticatory and Swallowing Muscles During Cued Versus Spontaneous Swallowing

The risk of dysphagia and/or aspiration is determined using screening tests, such as the repeated saliva swallowing test and modified water swallowing test, which evaluate cued swallowing. However, humans masticate and swallow foods with various consistencies, forms, and amounts, without conscious awareness. Therefore, this study aimed to examine the difference in the behavior of masticatory and swallowing muscles during spontaneous versus cued swallowing through a series of mastication and swallowing processes by evaluating surface electromyogram (sEMG) signals. The effect of the consistency and amount of food on the behavior of these muscles was also investigated. The sEMG recordings of the masseter muscles and anterior belly of the digastric muscle for 12 subjects, and genioglossus muscle for 5 subjects were obtained. The genioglossus activity was recorded using custom-made ball electrodes. The test foods were cookies and tofu, in amounts of 2 g and 4 g. The normalized muscle activity (integrated EMG), duration of the muscle activity, initial activation timepoint of each muscle, and total duration of swallowing were compared among four conditions. The activity of each muscle was significantly higher during the swallowing of cookies than tofu, for 4 g vs 2 g, and for cued versus spontaneous swallowing. The duration of each muscle activity, initial activation timepoint, and total duration of swallowing were significantly longer for cookies versus tofu, for 4 g vs 2 g, and for spontaneous versus cued swallowing. These results suggest that the behavior of the masticatory and swallowing muscles is affected by cued swallowing and by the consistency and amount of food.

Comparison of concentric and eccentric resistance training in terms of changes in the muscle contractile properties

The habitual use of resistance exercises involving concentric and eccentric contractions can increase muscle strength, speed and endurance. However, current knowledge has limited potential to fully understand the application of such resistance training and the muscle changes that occur to differentiate these two types of training. The aim of this study was to compare the effects of concentric contraction (CON) and eccentric contraction (ECC) during an acute bout of resistance training on the hamstring contractile properties. A group of 20 female recreational athletes were divided into two equal groups, CON training and ECC training. The contractile properties of the muscles on both sides of the body were assessed using tensiomyography (TMG): biceps femoris (BF) and semitendinosus (ST). The muscles were assessed twice, before and after 10 maximal repetitions of either concentric or eccentric isotonic contractions. The results indicate a greater change in TMG parameters with ECC training, with p < 0.001 (Td and Tc). An acute bout of resistance training induces changes in the muscle hamstrings contractile properties in both CON and ECC training. Eccentric training causes greater changes than concentric training, shortening contraction time (Td, Tc), increase radial displacement velocity (Vrd) and affecting changes in muscle belly displacement (Dm), so may be more effective in training.

Impairments in muscle shape changes affect metabolic demands during in-vivo contractions.

The uncoupling behaviour between muscle belly and fascicle shortening velocity (i.e. belly gearing), affects mechanical output by allowing the muscle to circumvent the limits imposed by the fascicles' force-velocity relationship. However, little is known about the 'metabolic effect' of a decrease/increase in belly gearing. In this study, we manipulated the plantar flexor muscles' capacity to change in shape (and hence belly gearing) by using compressive multidirectional loads. Metabolic, kinetic, electromyography activity and ultrasound data (in soleus and gastrocnemius medialis) were recorded during cyclic fixed-end contractions of the plantar flexor muscles in three different conditions: no load, +5 kg and +10 kg of compression. No differences were observed in mechanical power and electrophysiological variables as a function of compression intensity, whereas metabolic power increased as a function of it. At each compression intensity, differences in efficiency were observed when calculated based on fascicle or muscle behaviour and significant positive correlations (R2 range: 0.7-0.8 and p > 0.001) were observed between delta efficiency (ΔEff: Effmus-Efffas) and belly gearing (Vmus/Vfas) or ΔV (Vmus-Vfas). Thus, changes in the muscles' capacity to change in shape (e.g. in muscle stiffness or owing to compressive garments) affect the metabolic demands and the efficiency of muscle contraction.

Variations in the extensor indicis proprius muscle in the Burmese population: implications for hand reconstructive surgery

BackgroundThe use of extensor indicis proprius (EIP) muscle tendon for tendon grafting and transplantation in the management of hand injuries is common. Anatomical variations of the EIP tendons have been reported with variable prevalence and presentation in different populations worldwide. Knowledge of possible variation patterns is crucial in reconstructive surgery. The current study aims to describe the prevalence of anatomical variations of the EIP in the Burmese population. MethodsA total of 50 cadavers (39 males, and 11 females) were dissected. Both upper limbs of each cadaver were observed. The presence of the EIP, the number of tendons, the origin and insertion of the muscle and its relation with the extensor digitorum communis (EDC) were recorded and variations reported. ResultsOf the 100 limbs studied in the 50 cadavers, only 1/100 limb was reported to have an absent EIP muscle and tendon. Of the remaining 99/100 limbs examined, one of them consists of a double tendon, that is, EIP and extensor indicis et medii communis (EIMC) were inserted separately onto the index finger and middle finger respectively on the dorsum of the left hand. Further to this, there is one case in which an extra muscle belly was observed in the EIP tendon, this muscle is commonly known as the extensor digitorum brevis manus muscle. All the EIP variations were observed in the male cadavers only. ConclusionOf the 50 cadavers studied, 3/100 limbs exhibited EIP variations in the current studied population. Population-specific studies on these variations may aid in a better understanding of the different anatomical patterns of the muscles in the dorsum of the hand. This may lead to improved diagnosis and surgical management of injuries to the dorsum of the hand and for the use of the EIP tendon in surgical grafts and transplantations.

What differences exist between the lead and trail wrist in extensor carpi ulnaris activity and golf swing joint kinematics in sub-elite golfers?

ABSTRACT This study assessed the lead and trail arm peak and average extensor carpi ulnaris (ECU) muscle activity in association with tri-planar angular velocities of the lead and trail wrists during the golf swing. Fifteen sub-elite, male right-handed golfers (M age = 34.7 years ±13.3, M handicap = 1.5 ± 2.2) were recruited to execute five shots each with their pitching wedge, 7-iron and driver clubs in an indoor golf simulator. Surface electromyography (EMG) sensors were placed over the ECU muscle belly and inertial measurement unit sensors were placed bi-laterally on the distal forearm and dorsum of the hand. There was a statistically greater recruitment of the trail ECU muscle during the downswing (p < 0.001) for all clubs. The lead ECU muscle was recruited more during the backswing (p < 0.001) and follow through (p < 0.024) phases. There were statistically different tri-planar movement patterns between the lead and trail wrist throughout all three phases of the golf swing. No significant relationships were found between downswing EMG data and clubhead kinematics at impact. In conclusion, differing wrist kinematics and associated muscle activity may contribute to the asymmetrical injury pattern seen clinically.

Use of NIRS to explore skeletal muscle oxygenation during different training sessions in professional boxing

PurposeThe physiological examination of boxing has been limited to systemic response in amateur athletes. The demands of professional boxing have been overlooked, despite the different competition format. We sought to determine the physiological demands placed on skeletal muscle in professional boxing.MethodsTen male professional boxers (age 26 ± 5 years, height 177 ± 4 cm, weight 71 ± 6 kg) were recruited for this observational study. On different days, the athletes completed 6 × 3 min rounds of pad, bag or spar-based training with 1 min recovery between each round. Prior to each session, participants put on a heart rate monitor and near-infrared spectroscopy attached to the belly of the rectus femoris muscle to record heart rate and muscle oxygenation.ResultsThere were significantly less punches thrown in sparring compared to other training modalities (p < 0.001). Skeletal muscle oxygenation across training modalities consisted of a delay, fast desaturation and steady state. Across rounds there was a significant increase in time delay for desaturation (p = 0.016), rate of fast desaturation (p < 0.001) and duration of fast desaturation (p = 0.019). There was a significant difference in sparring for the heart rate where skeletal muscle oxygenation changes occurred compared to pads or bag sessions (p < 0.001).ConclusionThe findings highlight differences in the skeletal muscle response to the different training modalities. Practitioners need to be aware of the muscular demands of each session to allow optimal adaptation across a training camp. Training needs to allow the skeletal muscle to achieve a new oxygenation steady state rapidly to promote efficient performance across rounds.

181 Lessons Learned from Complex Abdominal Wall Reconstruction for the Management of Giant Paraoesophageal Hernia - a Case Analysis

Abstract Aim In this case report, we present a new method in the management of a giant hiatus hernia: the use of crural relaxing incisions. This new method in combination with previously known strategies including botox and preoperative optimisation for surgery with weight loss and prehabiliation can result in a more effective surgical hiatus hernia repair and subsequently lead to a reduced risk of hiatus hernia recurrence. Case Presentation 71yo man admitted to hospital with a one-week history of generalised abdominal pain, nausea, vomiting and chest pain. He had a background of a known large hiatus hernia for the last 10 years. An abdominal CT showed a large type IV hiatus hernia containing the stomach, transverse colon, pancreatic body, and pancreatic neck. CT guided botulinum toxin A injections were given by interventional radiology during which the muscle bellies of the transversus abdominus, internal and external obliques were targeted. The patient was placed on a meal replacement (Optifast) diet. A laparoscopic thoraco-abdominal hiatus repair was performed finding a giant hiatus hernia containing the entire stomach, first part of the duodenum, left lobe of liver, transverse colon, small bowel and distal pancreas. Due to the size of the hiatus hernia and the potential tension likely to result from a repair, both right and left crural relaxing incisions were made to facilitate closure. Crural closure was reinforced with a Bio A mesh secured in a C configuration covering the right crural relaxing incision. The patient recovered well postoperatively. Follow up imaging did now show recurrence.

Muscle morphology and architecture of the medial gastrocnemius between typically developing children with different ancestral background.

Muscle ultrasonography is frequently used to improve the understanding of musculoskeletal impairments in children with spastic cerebral palsy (SCP). So far, most studies on muscle morphology and architecture have included typically developing children and children with SCP with similar ancestry, being mainly Caucasian. Less is known about differences in muscle morphology between children with different ancestral backgrounds. Therefore, the aim of this study was to compare muscle morphology and architecture of the medial gastrocnemius in typically developing children with African, South Asian and Southeast Asian descent from Suriname. This explorative cohort study identified children as Maroon (Ghana, African descent), Hindustani (India, South Asian) or Javanese (Indonesia, Southeast Asian), aged 5-10 years. Using 3D freehand ultrasound with the subject prone, the following medial gastrocnemius parameters were defined: muscle tendon unit (MTU) length, muscle belly length, tendon length, muscle volume, muscle thickness, anatomical cross-sectional area (ACSA), fascicle length, pennation angle, and physiological cross-sectional area (PCSA). In addition, differences between ancestral groups were assessed for the length of the MTU, muscle, tendon and fascicles in two passive stretch conditions corresponding to an externally applied joint torque of 1Nm and 4Nm. One-way ANOVA with post hoc t-tests were used to investigate differences between the ancestral groups. In total, 100 Hindustani (n = 34), Javanese (n = 34) and Maroon (n = 32) children were included. For statistical analyses, we matched the children by age, which resulted in groups of 25 children per ancestral group (n = 75). There were no differences found in MTU length, muscle belly length, ACSA, PCSA and muscle volume. Tendon length, fascicle length and pennation angle were different between ancestral groups. Compared to Javanese children, tendon length was longer (p = 0.001) and pennation angle (p = 0.001) was larger in Maroon children and fascicle length was shorter in both Maroon and Hindustani children (p < 0.001). While there was a difference found in MTU length at different conditions of passive stretch between ancestries, no differences were found in the muscle, tendon and fascicles. This is the first study that investigated macroscopic morphological and architectural parameters for the medial gastrocnemius in one extended cohort of typically developing children, stratified in three ancestral subgroups. The current results imply that ancestry-specific reference data for children are needed, especially for tendon length, fascicle length and pennation angle when investigating altered muscle morphology in neurological or neuromuscular pathologies, such as SCP. Future studies should report the ancestral background when describing muscle morphology and architecture of children and ancestral specifications should be included in normative databases.

Morphological study of the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers.

Cases of variations in anterior belly of the digastric muscle must be carefully identified to avoid misinterpretations and assist in the correct surgical or aesthetic procedure and help in the teaching of anatomy. The aim of this study was to describe the anatomical variations of anterior belly of digastric muscle in Brazilian cadavers. Thirty-one human heads were selected, from adult cadavers (18-80 years, 29 males and 2 females). The morphology of the anterior belly of the digastric muscle was observed, identifying the possible anatomical variations that were characterised and classified according to the amount of muscle bellies, fibre direction and place of origin and insertion. The morphometric measurements were performed using a digital calliper. To analyse the data obtained, photographic documentation, anatomical description and individual morphometric description of each muscle belly were performed. The incidence of anatomical variation was obtained in percentage (%). The anatomical variation of the anterior belly of the digastric muscle was present in 6 cadavers (19.31%; 1 female and 5 male). All anatomical variations presented an accessory belly to the anterior belly. However, these accessory bellies were configured differently in the location, direction of muscle fibres and in their dimensions (length and width). The gross anatomy of the anterior belly of the digastric muscle and their variations is important to assist in surgical procedures, pathological or diagnostic function. In addition, asymmetrical variations in the submental region must be carefully identified to avoid misinterpretations.

Duplicated superficial branch of the radial nerve and brachioradialis muscle belly: prevalence and significance.

The superficial branch of the radial nerve (SBRN) is a sensory nerve innervating the dorsoradial part of the hand. It originates in the cubital fossa, runs under the belly of the brachioradialis muscle (BM), emerges from underneath in the distal third of the forearm and continues in the subcutaneous tissue towards the hand. There exist several anatomical variations of its branching and course, including a rare variation of its duplication combined with a duplication of the brachioradialis muscle belly. The aim of this study was to find out the prevalence of this variation on a sample of cadaveric human bodies which has not been reported yet. We have carefully dissected 208 cadaveric upper limbs (Central European population). All cases of limbs containing the variation of a double SBRN and/or a double BM belly were measured and documented. We have identified 2 cases of a double SBRN combined with a double BM belly (0.96%). Both were present in the right forearm of a male donor and in both cases the nerve was impinged by muscle bundles connecting the 2 muscle bellies together. Moreover, we have encountered 1 case of a double SBRN without a double BM belly (0.48%), i.e. the total prevalence of a double SBRN was 1.44%. The duplicated SBRN with the duplicated BM is a relatively rare anatomical variation that might cause complications while performing various surgical procedures in the forearm, moreover it might be a rare cause of Wartenberg's syndrome.

Variations and thicknesses of anterior belly of the digastric muscle: an ultrasonographic study.

This study aims to evaluate the anatomy and anatomical variations of the anterior belly of the digastric muscle. Hundred and fifty one ultrasonographic images of the digastric muscle pairs were evaluated in Near East University Faculty of Dentistry Department of Dentomaxillofacial Radiology. Morphological variations were recorded using the classification of the digastric muscle into 12 types by Kim et al. For the analysis, the Mann-Whitney U test and Chi-square test were used, and for the correlational analysis, Spearman's rho test was applied. P < 0.05 was considered statistically significant in all tests. Seventy female and 81 male patients aged 19-60years were evaluated. Type 1 digastric muscle was observed in 145 of 151 patients, Type 2 in 3 patients, and Type 7 in 3 patients. The thicknesses of the right and left digastric muscles were measured, and a statistically significant difference was observed between the groups when the genders were compared. It was observed that both right and left digastric muscle thicknesses were higher in males than females. There was a statistically significant positive high correlation between right and left digastric muscle thicknesses (p = 0.000; r = 0.736). No statistically significant difference was found between genders (p = 0.596) in terms of anatomical variations. Considering that the variations of the digastric muscle may have a clinical significance role, the normal anatomy and variations of this muscle should be well known by maxillofacial surgeons and radiologists.

A unique variation of a four-bellied digastric muscle named "real quadrigastric muscle": a case report and literature review.

From a topographical standpoint, the digastric muscle is key to the formation of several triangles of the neck, which are of the utmost clinical significance. Herein, we present a previously unrecognised variation of the digastric muscle: a quadrigastric muscle with two accessory bellies originating from the body and angle of the mandible and inserting to the intermediate tendon. Three new triangles are demarcated between the four bellies of the aberrant muscle. Detailed knowledge of variations of the digastric muscle, changing the borders and relationships of the topographic triangles, is paramount for radiologists and surgeons operating on the anterior region of the neck.

Effects of Additional Radial Shock Wave Therapy on Spasticity of Upper Extremity Muscle

Background: Spasticity is one of the most common problems and greatly interferes with the functional capacity of chronic stroke patients. The most commonly used treatments are infrared therapy and stretching exercises, but they have not reduced spasticity effectively. The addition of Radial Shock Wave Therapy (RSWT) was expected to be more effective in reducing spasticity in chronic stroke patients. Aim: The purpose of this study is to prove that the addition of RSWT is more effective reducing spasticity of chronic stroke patients. Material and methods: This study was a simple randomized controlled pre- and post-experimental design. The total sample of 30 chronic spastic stroke patients with the Modified Asworth Scale 2-3 was divided into 2 groups: the study group and the control group. RSWT was provided once a week to the muscle belly of the flexor wist muscle on the ventral aspect of the forearm, the intrinsic muscle of the hand, and flexor digitorum tendon. They were added to infrared therapy and stretching exercises in the upper extremities which are provided three times a week for six weeks consecutively. The level of spasticity was measured by the Tardieu Scale, which measures quality and angle of resistance at the beginning and end of the study. Results: A significantly greater reduction was obtained (p&lt;0.05) from the level of spasticity measured by the Tardieu Scale, both on the quality and angle of resistance, in the study group. Conclusion: The addition of RSWT has been shown to have a greater reduction in spasticity in upper extremity muscle in chronic stroke patients.

Cadaver investigation of the usefulness of the transstyloid diaphragm approach for high-position plaque carotid endarterectomy

ObjectivesPatients sometimes present with high cervical internal carotid artery (ICA) stenosis. This study demonstrates the usefulness of the transstyloid approach to expose the distal ICA by dissection of the styloid diaphragm covering the distal cervical ICA for carotid endarterectomy (CEA). In particular, the possible exposure length achieved by this approach was investigated using cadaveric heads. MethodsThe procedure of the transstyloid diaphragm approach was confirmed in 10 cadaveric heads (20 sides). After the carotid triangle was opened, both the posterior belly of the digastric muscle (PBDM) and the stylohyoid muscle could be divided. Then, the carotid sheath was dissected, and the glossopharyngeal nerve was identified crossing over the distal ICA. The revealed length of the ICA was measured with or without dissection of both the PBDM and the stylohyoid muscle. The specimens were dissected under the surgical microscope. ResultsThe transstyloid diaphragm approach was achieved successfully in all specimens. The revealed lengths of the ICA with and without dissection of the styloid diaphragm were 53.7 ± 5.9 mm and 38.8 ± 2.9 mm (mean ± standard deviation), respectively. Therefore, the revealed length of the distal ICA was 14.9 ± 4.5 mm greater using the transstyloid diaphragm approach compared to the regular CEA approach. ConclusionsMore of the ICA can be revealed by dissection of both the PBDM and the stylohyoid muscle. The transstyloid diaphragm approach might be helpful to reveal the distal ICA in cases of high cervical ICA stenosis.