Compartment Of Leg Research Articles

Effect of graston technique and cupping therapy on pain and function in individuals with medial tibial stress syndrome: a research protocol

Medial tibial stress syndrome (MTSS) is Exertional leg discomfort. There are two forms of shin splints: anterior leg compartment dysfunction and posterior leg compartment dysfunction. MTSS patients are routinely offered graded jogging, strengthening, and stretching activities for the calf muscles. Instrument-assisted soft tissue mobilization (IASTM) includes stroking the skin with a bar or spurtle to apply repetitive mechanical stimulations to (tendons, muscle, and overlaying deep fascia) soft tissue. Cupping is a therapeutic technique that involves applying negative pressure to the skin over a sore location to relieve muscular spasms and discomfort. The rationale of the study is to find how effective the therapy for shin pain in recreational runners. The effectiveness of cupping therapy in MTSS and compares the efficacy of IASTM and cupping with strengthening and stretching exercises to see which can enhance function and reduce discomfort in a short duration of time in runners. These is randomized control trials. The study’s sample will be 46. The group B experimental group in which cupping therapy will be given, the control group, i.e., group A in which IASTM will be given for four weeks with the following baseline examinations- VAS, Treadmill test, step up and down test with MMT and ROM. The efficacy of the technique for both groups will be examined every week utilizing treadmill testing, VAS, step up and step down as end measures the pain assessment, the improvement in termination time of treadmill test as well as step up and down test.

Systematic Review of Innovative Diagnostic Tests for Chronic Exertional Compartment Syndrome.

The diagnosis chronic exertional compartment syndrome is traditionally linked to elevated intracompartmental pressures, although uncertainty regarding this diagnostic instrument is increasing. The aim of current review was to evaluate literature for alternative diagnostic tests. A search in line with PRISMA criteria was conducted. Studies evaluating diagnostic tests for chronic exertional compartment syndrome other than intracompartmental pressure measurements were included. Bias and quality of studies were evaluated using the Oxford Levels of Evidence and the QUADAS-2 instrument. A total of 28 studies met study criteria (MRI n=8, SPECT n=6, NIRS n=4, MRI and NIRS together n=1, miscellaneous modalities n=9). Promising results were reported for MRI (n=4), NIRS (n=4) and SPECT (n=3). These imaging techniques rely on detecting changes of signal intensity in manually selected regions of interest in the muscle compartments of the leg. Yet, diagnostic tools and protocols were diverse. Moreover, five studies explored alternative modalities serving as an adjunct, rather than replacing pressure measurements. Future research is warranted as clinical and methodological heterogeneity were present and high quality validation studies were absent. Further optimization of specific key criteria based on a patient's history, physical examination and symptom provocation may potentially render intracompartmental pressure measurement redundant.

Novel innervation of accessory slip of lateral head of gastrocnemius muscle

The two heads of the gastrocnemius muscle, as well as the plantaris and soleus muscles, forms the superficial muscular group in the posterior compartment of the leg. The incidental occurrence of accessory slip of the lateral head of the gastrocnemius muscle in the right lower limb, innervated by a twig from the common peroneal nerve, is described in this report. We identified an anomalous 8 cm long muscle in the right popliteal fossa during standard academic dissection of a male corpse at the Department of Anatomy. It was attached to the lateral side of the femur's popliteal surface proximally and joined the lateral head of the gastrocnemius distally. In the left lower limb, no similar variation was observed.

Deep Peroneal Nerve: From an Anatomical Basis to Clinical Implementation

The deep peroneal nerve (DPN) is considered one of the clinically significant nerves of the lower extremity since several clinical abnormalities can commonly be caused by its defects, either in its sensory or motor functions. Its derivatives, classified as muscular, cutaneous, and articular, mainly supply the muscles in the anterior fascial compartment of the leg and the dorsum of the foot, the 1st dorsal web space of the foot, the ankle joint, and certain joints of the foot. To improve the effectiveness of clinical practices involving the DPN, it is important to first understand its anatomical nature, including its typical characteristics and the variants (orientation, branching, and analogous structure), prior to applying such practices in clinical implementation. This review, therefore, aims to review the previously studied information of DPN on its fundamental anatomy and link it to the provided examples of current commonly used procedures, both non-invasive and invasive, e.g., nerve imaging, nerve block, neuroelectrophysiological study, and free autologous tissue transfer, thereby giving an integrated view in the translational medicine of DPN. Conclusively, the ultimate goal of this review is to help maximize the therapeutic effectiveness and to minimize the unanticipated complications of any clinical practices involving the DPN by inferring from its anatomical knowledge.

End-to-Side Nerve Transfer for the Management of Chronic Leg Compartment Ankle Dorsiflexion Weakness

Abstract Background A proximal deep peroneal nerve (DPN) injury can significantly impact the functional capacity of the leg, to include compromised motor function of the tibialis anterior (TA) muscle. Clinical examination can range from weakness in ankle dorsiflexion, to complete foot drop. Diagnostic nerve conduction velocity (NCV) testing can demonstrate abnormalities at select areas of impingement (or) entrapment (i.e., regions affected by a demyelinating compression mono-neuropathy), along the proximal course of the common peroneal nerve. Methods We retrospectively report on 17 patients with clinical weakness involving ankle dorsiflexion. All patients underwent surgical end-to-side anastomosis, transferring a muscular nerve branch from the superficial peroneal nerve (SPN) to a segment of the DPN responsible for TA muscle innervation. Outcomes were based on comparisons of preoperative and postoperative DPN motor function to the TA muscle, standardized to the British Medical Research Council Scale for Muscle Strength. Preoperative scores were generally M2 or below. Results Postoperative outcome scores of M4 to M5 were considered good (or) successful. 94.1% of patients demonstrated successful outcomes. Conclusion An end-to-side SPN motor branch anastomosis, into the motor branch of the DPN responsible for TA muscle innervation, can be a viable treatment option for weakness in ankle dorsiflexion. All reported cases involved a compromised segment of deep peroneal nerve within the proximal one-third of the leg.

Functional Status After Lower Leg Fasciotomy for Acute Compartment Syndrome: A Single-Center Review

Acute lower leg compartment syndrome can result in limb loss after emergency revascularization procedures. Although a fasciotomy can relieve intracompartmental pressure, not all patients will achieve full functional recovery. The factors that affect the outcome after emergency fasciotomy remain unclear. We reviewed the functional outcomes of a large group of patients who had undergone lower leg fasciotomies after revascularization for limb ischemia.

An unusual accessory soleus muscle with its clinical implications

Anomalous, supernumerary or accessory mus¬cles in the flexor compartment of the leg are re¬ported in the medical literature. The accessory soleus muscle is one of the variations found in this region, with the incidence ranging from 0.7- 5.5%. The presence of an accessory muscle in the posterior compartment is of clinical significance, as it can be mistaken for a tumor during the clini¬cal examination, or it can lead to the compression of surrounding neurovascular structures. During routine dissection of a cadaver, an accessory mus¬cle was found in the medial aspect of the middle portion of the posterior compartment of the left leg. It originated with two heads from the middle portion of the soleus muscle and got inserted onto the medial surface of the calcaneum. The mus¬cle was unilateral and was supplied by the tibial nerve. Evidence about these accessory muscles and their location and attachments are useful in making a proper diagnosis and management.

Fatty Gastrocnemius Muscle: A Case Report

BackgroundThe gastrocnemius muscle is a superficial two‐headed muscle located in the posterior compartment of the leg, consisting of two heads: medial head and lateral head. The gastrocnemius muscle plays a significant role in our daily activities because its function is plantar flexing the foot at the ankle joint and flexing the leg at the knee joint. We report a very rare case of fatty gastrocnemius.MethodsThe abnormal gastrocnemius muscles were encountered during the dissection of the lower limbs of a 63‐year‐old female cadaver. For histological examination, muscular samples were sectioned from the top, middle, and bottom of two heads of both legs. A total of six muscular slides, nerve slides, artery slides were all stained with Hematoxylin and Eosin (H&E) stains. Slides were analyzed using light microscopy.ResultFor anatomy analysis, the medial heads of both gastrocnemius muscles of the lower limbs are completely infiltrated by adipose tissue. But the lateral heads of gastrocnemius muscles on both sides are almost healthy. Only the bottom of the lateral head of gastrocnemius muscles shows adipose tissue, but the middle and topdo not. Additionally, the medial heads connect to the tibial nerve and arteries normally. No abnormal adipose tissue was observed in other muscles throughout the body. For histological analysis, the entire medial heads and the bottom lateral heads are replaced by adipose cells, but the middle and top of the lateral heads are healthy muscle cells. No abnormalities or pathologies were observed in the nerves or arteries.ConclusionBoth medial heads of the gastrocnemius muscle appear to have become adipose tissue. While no underlying cause was identified it appears the pathology was spreading to the medial head.

Discovery of a Bilateral Fibulocalcaneus Externum Invertus Muscle: A Novel Fibularis Quartus Variant

The fibularis (peroneus) quartus is a variant muscle found within the lateral leg compartment in ~11.5% of cadaveric specimens, though recent studies have shown a higher prevalence of ~20.9 – 21.9%. The proximal muscular attachments can originate from the fibula, fibularis brevis, fibularis longus, and/or the intermuscular septi that form the boundaries of the lateral leg compartment, but it then descends to reside posterior to the lateral malleolus of the fibula. The distal attachment of the fibularis quartus varies greatly, and fibularis quartus muscular variants are often named according to location of its distal attachment. The most common distal insertion site of a fibularis quartus muscle is the lateral surface of the calcaneus into either the fibular trochlea or the retrotrochlear eminence. Therefore, this variant of the fibularis quartus inserting into the lateral surface of the calcaneus is called the fibulocalcaneus externum. During routine cadaveric dissection of a 79‐year‐old Caucasian male, a rare and novel variation of the fibularis quartus muscle was discovered. Although this variant is seen arising from the fibula, fibularis brevis, and the posterior intermuscular septum, descending posterior to the lateral malleolus, and attaching distally to the lateral surface of the calcaneus, it is unique in that the muscle is inverted, with the tendonous part being more proximal and the muscular portion arising distally. This novel muscle was found unilaterally in the left leg via dissection initially with its distal head inserting on the fibular trochlea of the calcaneus, but ultrasonographic imaging verified its bilateral presence. The subsequent dissection of the right leg revealed a similar inverted muscle, but this variation split into two distal muscle bellies inserting into the retrotrochlear eminence posteriorly and the fibular trochlear anteriorly. Given its anatomy, we have named this rare fibularis quartus variant the fibulocalcaneus externum invertus muscle. Like most fibularis quartus variants, the fibulocalcaneus externum invertus muscle can cause ankle instability, ankle locking, chronic lateral ankle pain, and peroneal compartment syndrome, especially due to acting as a space‐occupying lesion within the superior peroneal tunnel due to its distal muscle belly/bellies. While it is unknown if this person had any clinical signs and/or symptoms, clinicians, surgeons, and/or radiologists should be aware of the fibulocalcaneus externum invertus when assessing radiological imaging or preparing for ankle surgeries in and around the lateral leg compartment.

The interosseus crural nerve: An anatomical study of a rarely described structure.

The interosseous crural nerve (IOCn) is said to arise distally from muscular branches of the tibial nerve innervating the deep muscles of the posterior compartment of the leg. Here, we present the results of a cadaveric study of the IOCn to clarify this nerve's morphology and to discuss its potential clinical relevance. On 26 sides from 13 cadaveric specimens, the IOCn was dissected. The IOCn was identified on 14 out of 26 sides (53.8%). The mean diameter and length of the IOCn were 0.46 mm (range 0.3-0.72 mm) and 20.9 mm (range 13.5-33.0 mm), respectively. The origin of the IOCn was from a branch to the popliteus muscle on all sides. The nerve was found to have vascular, muscular, and ligamentous branches. In 53.8%, the nerve reached the inferior tibiofibular joint, and in 46.2%, the nerve terminated in the interosseous membrane of the leg. At its distal part, the IOCn gave off multiple vascular branches to the fibular artery. On one side (7.1%), the nerve pierced the interosseous membrane and innervated muscles of the anterior compartment of the leg. We believe this to be the first anatomical study of the IOCn. The nerve was found to have vascular, muscular, and ligamentous branches. Surgeons operating in the deep posterior compartment of the leg and ankle and clinicians treating patients with unusual presentations or pathology of the leg and ankle should be aware of this structure.

Three-year quantitative magnetic resonance imaging and phosphorus magnetic resonance spectroscopy study in lower limb muscle in dysferlinopathy.

BackgroundNatural history studies in neuromuscular disorders are vital to understand the disease evolution and to find sensitive outcome measures. We performed a longitudinal assessment of quantitative magnetic resonance imaging (MRI) and phosphorus magnetic resonance spectroscopy (31P MRS) outcome measures and evaluated their relationship with function in lower limb skeletal muscle of dysferlinopathy patients.MethodsQuantitative MRI/31P MRS data were obtained at 3 T in two different sites in 54 patients and 12 controls, at baseline, and three annual follow‐up visits. Fat fraction (FF), contractile cross‐sectional area (cCSA), and muscle water T2 in both global leg and thigh segments and individual muscles and 31P MRS indices in the anterior leg compartment were assessed. Analysis included comparisons between patients and controls, assessments of annual changes using a linear mixed model, standardized response means (SRM), and correlations between MRI and 31P MRS markers and functional markers.ResultsPosterior muscles in thigh and leg showed the highest FF values. FF at baseline was highly heterogeneous across patients. In ambulant patients, median annual increases in global thigh and leg segment FF values were 4.1% and 3.0%, respectively (P < 0.001). After 3 years, global thigh and leg FF increases were 9.6% and 8.4%, respectively (P < 0.001). SRM values for global thigh FF were over 0.8 for all years. Vastus lateralis muscle showed the highest SRM values across all time points. cCSA decreased significantly after 3 years with median values of 11.0% and 12.8% in global thigh and global leg, respectively (P < 0.001). Water T2 values in ambulant patients were significantly increased, as compared with control values (P < 0.001). The highest water T2 values were found in the anterior part of thigh and leg. Almost all 31P MRS indices were significantly different in patients as compared with controls (P < 0.006), except for pHw, and remained, similar as to water T2, abnormal for the whole study duration. Global thigh water T2 at baseline was significantly correlated to the change in FF after 3 years (ρ = 0.52, P < 0.001). There was also a significant relationship between the change in functional score and change in FF after 3 years in ambulant patients (ρ = −0.55, P = 0.010).ConclusionsThis multi‐centre study has shown that quantitative MRI/31P MRS measurements in a heterogeneous group of dysferlinopathy patients can measure significant changes over the course of 3 years. These data can be used as reference values in view of future clinical trials in dysferlinopathy or comparisons with quantitative MRI/S data obtained in other limb‐girdle muscular dystrophy subtypes.

Musculus peroneus longus in foetal period.

The lateral compartment of the leg, due to its distal and concurrent superficial positioning, is a multiple trauma site. Detailed knowledge of compartimentum lateralis cruris (CLC) structure is crucial for physicians. Musculus peroneus longus (MPL) is located within the structures of the CLC most superficially. There is a lot of data on the morphology of the MPL but there is no publication analysing in detail its anatomy in the foetal period. The aim of the study was to determine the variability of metric and morphological parameters of MPL in a studied period of prenatal ontogenesis. The analysis included 207 human foetuses (101 males and 106 females) at calendar age from 113 to 222 days. The analysed material comes from the local anatomy collection. Foetuses were stored in typical preservation solutions. Access to the muscle was obtained on the basis of standard preparation techniques. The authors evaluated the metric parameters of the muscle showing the presence of variable dynamics of metric increments of the examined muscle in particular age classes. In the studied period of prenatal ontogenesis, MPLs of the foetuses increased by about 60% in the length and width dimension and by about 100% in the thickness dimension. The topography of the initial and final muscle attachment was also evaluated. Statistically significant dimorphic differences were found in some aspects of muscle attachment topography. The analysis of the place of the origin and insertion of MPL showed a relatively large variety of these features.

Case report of unusual insertion of the fibularis brevis muscle

The fibularis brevis and fibularis longus muscles belong to the lateral compartment of the leg. The fibularis brevis is morphologically variable, especially in the number of tendons and place of insertion. Its type of insertion is correlated with the presence of a fibularis digiti quinti, which is also anatomically variable. We present a case study based on dissection of a seventy-three-year-old female cadaver with an unusual insertion of the fibularis brevis muscle. The tendon had three bands inserting into the fifth metatarsal bone. There was a coexisting fibularis digiti quinti, which was fused with the fibularis tertius muscle. Awareness of such anatomical variation could be useful during reconstructive surgery and planning rehabilitation protocols.

Comparison of examination techniques of anterior and posterior compartments of the leg for the diagnosis of deep vein thrombosis: A new examination technique.

Several examination techniques have been described for the diagnosis of leg deep vein thrombosis. These previously described examination techniques aim to detect muscle pain that occurs secondary to increased pressure in the posterior compartment of the leg. However, to the best of our knowledge no studies investigated the frequency of muscle pain on the anterior compartment in patients with leg deep vein thrombosis the objective of this study is to investigate the prevalence of muscle pain in the anterior compartment. The patients who were diagnosed with acute deep vein thrombosis were included in this prospective cross-sectional study. Each patient was examined using the techniques that determine the pain on the posterior compartment as well as using the technique we described to detect muscle pain on the anterior compartment. Two hunderd forty three patients were enrolled in the study. Among those, both distal and proximal deep vein thrombosis was present in 128 (52.7%) patients. 75% of them had muscle pain in the anterior compartment. The results suggested that examination of muscle pain in anterior compartment of leg in patients with both proximal and distal deep vein thrombosis can be used as an additional physical examination techniques for early diagnosis.

Ultrasound-guided, minimally invasive looped thread fasciotomy for chronic exertional compartment syndrome of the lower leg: A cadaveric feasibility study

Background– Chronic exertional compartment syndrome (CECS) is an exertional pain syndrome that typically affects the lower legs of participants involved in high-intensity running or marching activities. Surgical open fasciotomy is the standard treatment for recalcitrant cases of CECS. Alternative, minimally invasive fasciotomy techniques are emerging which may reduce rates of procedural complications and expedite recovery. The standard fasciotomy procedure for CECS may be improved by looped thread release with additional image guidance. The aim of this study was to describe and evaluate a novel technique of ultrasound-guided, minimally invasive looped thread fasciotomy for release of anterior and lateral compartments of the leg in a cadaveric model. We hypothesized that a fasciotomy of this type would be effective in achieving a target fasciotomy length of 80% of the length of a muscle compartment while avoiding injury to neurovascular structures. Materials and methods– We conducted a controlled laboratory study. Two proceduralists performed anterior and lateral compartment fasciotomies on ten lightly embalmed cadaveric legs. A total of twenty compartment releases were completed, using an ultrasound-guided, percutaneous looped cutting thread technique. The specimens were evaluated for length and completeness of fasciotomy, as well as any inadvertent injury to muscle, tendon, or neurovascular structures. Completeness of fasciotomy was compared between the anterior and lateral compartments. Results– Eighteen of twenty (90%) fasciotomies were continuous. Fasciotomy length was consistently under target (72% complete). Completeness of lateral compartment release was significantly more likely to be under target compared to anterior compartment release (65% vs. 79%, p ​= ​0.014). Sixteen of twenty (80%) fasciotomies incurred no iatrogenic soft tissue injury; no injuries to nerves or vessels were observed. Discussion –Ultrasound-guided, minimally invasive looped thread fasciotomy of the anterior and lateral leg compartments is feasible and can be successfully performed in a cadaveric model with low risk to neurovascular structures. However, further investigation is needed to improve completeness of release prior to recommendation for clinical use.

Supernumerary Muscles in the Posterior Leg Compartment: a Case Report

Supernumerary Muscles in the Posterior Leg Compartment: a Case Report

FIBULARIS TERTIUS MUSCLE AMONG PRE-CLINICAL STUDENTS OF A MEDICAL COLLEGE: A DESCRIPTIVE CROSS-SECTIONAL STUDY

Background: The fibularis tertius muscle (FTM) is a variant muscle of the crural compartment of the leg that is thought to have evolved in human as a result of the development of the bipedal gait. The Fibularis tertius muscle, as an ankle dorsiflexor and foot evertor, plays an important physiological role in effective terrestrial locomotion related to midfoot biomechanical stabilization. The objective of this study is to determine the occurrence of the fibularis tertius muscle using a surface anatomical examination of the foot in medical and dental students of a medical college. Methods: This was a descriptive cross-sectional study comprising 294 pre-clinical medical and dental students of College of Medical Sciences, Chitwan, Nepal. In each student, the fibularis tertius muscle was palpated on both lower limbs for their presence or absence. The data was collected in terms of age and gender and was analyzed using the Statistical Package for Social Science version 20. Results: The prevalence of fibularis tertius muscle was 50.68%, with females accounting for 23.13% and males accounting for 27.55%. Fibularis tertius muscle was more common bilaterally (37.07%) than unilaterally (13.61%). Among unilateral fibularis tertius muscle, 24 (8.16%) were found only on the right foot and 16 (5.44%) on the left foot only. The bilateral prevalence of the fibularis tertius muscle was 17.01 % in females and 20.07 % in males, while its unilateral prevalence in females and males was 6.12 % and 7.48 %, respectively. Conclusions: The involvement of the fibularis tertius muscle in affecting midfoot stabilization and its potential role in delaying the healing process of John’s fracture cannot be ignored. Hence, understanding the theory behind foot biomechanics requires awareness of the existence of the fibularis tertius muscle.

A Case of Well Leg Compartment Syndrome After Robot-assisted Laparoscopic Prostatectomy:With Review

Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System? can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position/Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position. J. Med. Invest. 69 : 145-147, February, 2022.

CT scan in diagnosing focal myositis: a case report.

Focal myositis (FM) is an inflammatory muscle disease of unknown cause. It can simulate sural thrombophlebitis if it affects the lower limb. We report the case of a 15-year-old child with complete post-traumatic quadriplegia who developed edema of the left leg with a tense calf, slight redness and an increase in local heat. A CT angiography of the lower limbs excluded deep vein thrombosis and showed a myositis of the posterior compartment of the left leg. The patient was put on an anti-inflammatory drug with complete disappearance of the edema after seven days. In this reported case, we highlight the role of CT in the diagnosis and follow-up of FM as it’s cheaper and more accessible than MRI. The outcome is often favorable with spontaneous resolution or under anti-inflammatory treatment after a few weeks.

Distally Based Peroneus Brevis Muscle Flap for Soft Tissue Reconstruction in Lower Third of Leg: A Case Series

Covering soft tissue defects in the distal part of leg and ankle is difficult. Most of the flaps used in reconstructing these defects are bulky and aesthetically unpleasing. The peroneus brevis muscle flap is ideal for covering these defects and providing an aesthetically better outcome. Peroneus brevis is a muscle located in the lateral compartment of the leg. It can be used for covering defects over the ankle and distal part of the leg without causing loss of function. This study was done to assess the surgical technique and clinical outcomes in the use of this muscle flap. This case series presents the authors’ experience of six cases of distally based peroneus brevis muscle flap. Three of the six patients were found to have superficial flap necrosis. Two of these three was treated with debridement and Split Skin Grafting (SSG) while one was managed conservatively with daily dressings. This flap is simple, easy to rise and useful in covering small defects of 3-4 cm width in the distal part of the leg and ankle. The donor site to be closed primarily leaving behind only a thin linear scar. Overtime the flap thins down and gives good cosmetic results. Donor site morbidity is minimal as the peroneus longus muscle is preserved and thus the function of the foot (plantar flexion and foot eversion) is intact. The distally based peroneus brevis flap is a reliable flap for covering defects over the distal one third of the leg, the upper half of the medial and lateral malleoli and the posterior aspect of the heel.