Fascial Bands Research Articles

Effectiveness of thera-band exercise program and electro- physiotherapy on abductor strength of the iliotibial band in athletes with iliotibial band syndrome

Objectives: The iliotibial band (ITB) is a thick fascial band formed near the hip by merging the fascia of the gluteus maximus, gluteus medius, and tensor fasciae latae muscles. Iliotibial band syndrome (ITBS) is a common overuse injury, manifests as pain on the outer side of the knee and hip due to ITB friction with the femur. Athletes may experience reduced hip and knee mobility, potentially impacting performance. This study aims to compare the efficacy of two ITBS treatments: Thera-Band Exercise Program (TBEP) as the experimental group and Electro-Physiotherapy (EPT) as the control group.Methods: A randomized controlled trial carried out at the Teaching Hospital Karapitiya, with thirty athletes in each group. The control group received EPT, and medications, for two weeks, the experimental group received TBEP and medications for the same duration. Abductor Muscle strength assessment was conducted on Day 01 and Day 28 using handheld dynamometer (HHD)Results: The mean ages in the control and experimental groups were 24.33±6.40 years and 24.97±6.87 years, respectively. Muscle strength (N) for the control group on Day 1 and Day 28 were 99.77± 24.81 and 108.83±22.36, respectively. In the experimental group, the corresponding values were 102.50±26.71 and 147.00±29.92, respectively. The mean differences for muscle strength of two groups in D1 and D28 were 2.733(P>0.683) and 38.167(P<0.001) (RM-ANOVA). TBEP had a statistically significant effect (p=0.000), and it explained 16.8% of the variance in muscle strength. The Partial Eta Squared was 0.168.Conclusions: The Thera band program works better in improving abductor muscle strength of the athletes with ITBS compared to electro- physiotherapy.

Stretching of the anterior fascial tape in women after a caesarean section

Introduction. The cesarean section rate in the 21st century has significantly increased compared to the previous century. Consequences related to the existence of a scar after a cesarean section may contribute to various discomforts in the abdominal, back, or pelvic regions. Aim of the study. The research hypothesis posited that the application of stretching therapy of the anterior fascial band has an impact on and is associated with the scar texture after a cesarean section. Study materials and methodology. Eight women, 3-4 months postpartum, with an average age of 27.5 ± 4.17 years, participated in the study. The MyotonPro device was utilized to assess the biomechanical properties of the tissue around the scar. The women performed stretching exercises for 2 months, twice a week. One session per week was supervised by the researcher, and during the other session, participants performed the assigned exercises independently. Measurements with the MyotonPro device were repeated after 8 weeks. Results. A strong and positive correlation was observed between: cs_2 and cs_1 r = 0.88, cs_2 and ls_1 r = 0.96, cs_2 and rs_1 r = 0.82, ls_2 and ls_1 r = 0.97, rs_2 and rs_1 r = 0.96. Conclusions. Engaging in stretching exercises has a positive impact on improving the texture of scar tissue.

Thyroidectomy in Australia 2022: lessons from 21,000 consecutive cases.

In this article, we aim to describe our modern-day approach to total thyroidectomy, detailing the subtle refinements of our technique, as it has evolved over three decades and 21 000 cases. Since Delbridge's seminal paper in 2003, the major changes to our approach include a retrograde approach to the recurrent laryngeal nerve that allows dissection of the distal RLN from fascial bands within the ligament of Berry before medialisation of the thyroid lobe. Routine use of intraoperative nerve monitoring systems has increased our awareness of temporary neuropraxia, facilitated a reduction in the risk of bilateral RLN palsy and improved our identification and preservation of the external branch of the superior laryngeal nerve. The increasing use of advanced energy devices has been associated with a reduction in post-operative haematoma rates. We adopt a low threshold to parathyroid auto-transplantation, unless all glands are assessed to be clearly not at risk, and routinely supplement patients with Caltrate in the immediate post-operative period to minimize the risk of symptomatic hypocalcaemia. Ultimately, when we reflect on the subtle refinements that have contributed to improved outcomes, the fundamental principles of exposure and dissection that have evolved over decades remain the basis of our surgical approach and must continue to do so.

Partial plantar fasciectomy for the treatment of plantar fibromatosis

Objective: We describe a series of patients treated with resection of the affected band. We assessed functional outcome, recurrence rate, and surgical wound complications, comparing these data with the available literature. Methods: This retrospective study (level of evidence IV) included 14 patients (17 feet) diagnosed with plantar fibromatosis in the medial portion of the fascia that was refractory to conservative treatment. All operations were performed between December 2016 and November 2018. All patients were assessed for symptom improvement and major and minor complications, in addition to recurrence during the study period.Results: Our sample included 9 men and 5 women, whose mean age was 40.6 years (15-63). All of the patients underwent partial fasciectomy of the medial fascial band with margins of at least 2 cm. There was recurrence in 5 of the 17 feet (29%), but only two required further intervention. Wound dehiscence occurred in 3 patients (17%), and one of the cases was severe, requiring plastic surgery. Two feet showed signs of injury to the digital branch of the medial plantar nerve. Conclusion: Partial plantar fasciectomy is an alternative treatment for plantar fibromatosis (Ledderhose’s disease). Our results agree with the literature in terms of recurrence and postoperative complications. The moderate rate of complications must be taken into account when indicating this procedure. Level of Evidence IV; Therapeutic Studies; Case Series.

Modified Unipolar Latissimus Transfer to Restore Elbow Flexion in Musculocutaneous Nerve Palsy

Modified Unipolar Latissimus Transfer to Restore Elbow Flexion in Musculocutaneous Nerve Palsy

Peripheral Occipital Nerve Decompression Surgery in Migraine Headache.

Background:Migraine headache in the occipital region is characterized by a recurrent pain of moderate to severe intensity. However, the diagnosis can be difficult because of the multitude of symptoms overlapping with similar disorders and a pathophysiology that is not well-understood. For this reason, the medical management is often complex and ineffective.Methods:A literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted to evaluate the surgical treatment of occipital migraines. Inclusion criteria were: English language, diagnosis of migraine, occipital neuralgia, or tension headache in compliance with the classification of the International Headache Society, follow-up at minimum 3 months, and adult age. The treatment had to consist of peripheral occipital nerve surgery.Results:323 records were identified after duplicates were removed, 30 full text articles were assessed for eligibility, and 9 records were selected for inclusion. A total of 1046 patients were included in the review. General positive response after surgery (>50% reduction in occipital migraine headaches) ranged from 80.0% to 94.9%. However, many differences in the selection of patients, target of decompression surgery, and measurement outcome were described.Conclusion:Despite the decennial proven effectiveness and safeness of surgical therapy for chronic occipital migraine headaches, more significant proof is needed to definitively confirm its use as a standard therapy.

A Cadaveric Study of the Plantar Fascia for the In-Step Plantar Fasciotomy

The in-step plantar fasciotomy has remained a viable option for treatment of plantar fasciitis. The level of the in-step procedure has previously been described as 1.5 cm distal to the anterior heel fat pad. The authors are unaware of any study defining mean width and thickness of the plantar fascia at specific distances from its insertion. The authors performed a standardized cadaveric dissection of 25 fresh frozen cadaveric specimens from a local region in Pennsylvania. Each fascial band width and thickness of the plantar fascia was measured at the fascial insertion, 2 cm distal from insertion, and 3 cm distal from insertion. The mean (± standard deviation) width of the medial, central, and lateral band of the plantar fascia 3 cm from its insertion was 25.3 ± 5.3, 25 ± 3.41, and 23.3 ± 4.49 mm, respectively. At the same anatomic distance, the band thicknesses were 1.5 ± 0.82, 3.3 ± 0.85, and 1.9 ± 0.33 mm, respectively. The literature describes 2 techniques. The first is transecting between one-third to two-thirds of the plantar fascia during a fasciotomy from medial to lateral. The second is identifying, isolating, and releasing the central band. Our study allows to further quantify this, equating to 24.5 to 49 mm in total medial to lateral transection at 3 cm distal from insertion and an isolated central band equating to 25 ± 3.41 mm. With quantitative measurements of transection length, the surgeon will avoid having to estimate and potentially overtransect. This may help in preventing postoperative sequela related to overcorrection.

TL - 18148 - Partial plantar fasciotomy for the treatment of plantar fibromatosis

Introduction: Ledderhose's disease (plantar fibromatosis) is an uncommon condition that usually affecting men older than 40 years of age and causes major discomfort and disability. The low response to conservative treatment and the progression of surgical techniques have motivated some professionals to resume considering surgical resolution for this disease. Our study describes the outcomes of a series of cases treated with resection of the affected band. Methods: This is a retrospective study with 14 patients (17 feet) diagnosed with plantar fibromatosis of the medial fascia that was refractory to conservative treatment and was treated surgically from December 2016 to November 2018. All patients were evaluated for improvement in symptoms, for major and minor complications and for relapse during the study period. Results: Our sample consisted of 9 men and 5 women with a mean age of 40.6 years (15-63 years). All patients showed medial fibromatosis and underwent subtotal fasciotomy of the medial fascial band with margins of at least 2 cm. Of the 17 feet, 5 showed relapse (29%) and only 2 required reintervention. Three patients (17%) developed surgical wound dehiscence, although all patients progressed to surgical wound closure with no need for surgical intervention. Two feet showed signs of medial plantar nerve injury, although the branch of the nerve was wrapped in fibromatosis and was also resected in those cases. Conclusion: Partial plantar fasciotomy is an alternative for the treatment of Ledderhose's disease. Our series showed outcomes in line with those reported in the literature in terms of relapse and postoperative complications. The moderate relapse and reoperation rates should be considered when this procedure is indicated.

Radiologic Evaluation of Exiting Points of Supraorbital Region Neurovascular Bundles in Patients With Migraine.

To reveal the presence and nature of exiting points of supraorbital region neurovascular structures and determine the distances of those structures to midline with computed tomography images by taking into account gender and sides in patients with migraine. The study was conducted retrospectively on computed tomography images of 70 migraine and 70 control patients with a mean age of 39.5 ± 13.8 years (range: 18-80). Presence and nature (foramen or notch) of exiting points of neurovascular structures in terms of side and gender in both groups, and the distances of these structures to the midline of the face were evaluated. In migraine and control groups, the most commonly seen structure was single notch. Coexistence of foramen and notch was statistically significant in migraine and female migraine groups than control and female control groups (P < 0.05). Bilateral presence of supraorbital structure was 51.4% in migraine group and 64.3% in control group patients. In all cases, foramen-midline distance was statistically significant longer than the notch-midline distance (P < 0.05). In migraine patients, no statistically significant difference was detected regarding distances of foramen and notch to midline in terms of side and gender. Consideration of variable presence and location of the supraorbital notch and foramen, analysis of computed tomography scan might be beneficial in preoperative planning of foraminotomy and fascial band release in adult migraine patients to prevent intraoperative complications. Also, coexistence is more frequent on left side in migraine patients that might cause overlooking those structures during surgery.

Novel Investigation of the Deep Band of the Lateral Plantar Aponeurosis and Its Relationship With the Lateral Plantar Nerve.

We describe a thick fascial band arising from the medial aspect of the lateral plantar aponeurosis diving deep into the forefoot crossing over a branch of the lateral plantar nerve. Because a review of current literature resulted in limited and outdated sources, we sought to first determine the frequency of this fascial band and the location where it crosses the lateral plantar nerve and, second, discuss the clinical applications these anatomical findings could have. 50 pairs of cadaveric feet (n = 100) were dissected to investigate for presence of the fascial band and its interaction with the lateral plantar nerve. Images were taken of each foot with the fascial band. ImageJ was used to take 2 measurements assessing the relationship of the tuberosity of the base of the fifth metatarsal to where the nerve crossed deep to the fascial band. Overall, 38% of the feet possessed the fascial band. It was found unilaterally in 10 pairs and bilaterally in 14 pairs. On average, the point at which the lateral plantar nerve passed deep to the fascial band was 2.0 cm medial and 1.7 cm anterior to the tuberosity of the base of the fifth metatarsal. When present, the deep band of the lateral plantar aponeurosis (PA) was consistently found to be crossing the lateral plantar nerve. The discovery of the location where this most commonly occurs has not been previously reported and adds an interesting dimension that elevates an anatomical study to one that has clinical potential. The established target zone gives a precise location for where the relationship between the deep band of the lateral PA and the lateral plantar nerve exists when evaluating the foot. The target zone provides a potential springboard for future investigations concerning said relationship clinically.

Muscle architecture of vastus medialis obliquus and longus and its functional implications: A three‐dimensional investigation

Vastus medialis (VM) has two partitions, longus (VML), and obliquus (VMO), which have been implicated in knee pathologies. However, muscle architecture of VMO and VML has not been documented volumetrically. The aims of this study were to determine and compare the muscle architecture of VMO and VML in three-dimensional (3D) space, and to elucidate their relative functional capabilities. Twelve embalmed specimens were used in this study. Each specimen was serially dissected, digitized (Microscribe™ MX), and modeled in 3D (Autodesk Maya®). Architectural parameters: fiber bundle length (FBL), proximal (PPA)/distal (DPA) pennation angle, and physiological cross-sectional area (PCSA) were compared using descriptive statistics/t-tests. Sarcomere lengths (SLs) were measured and compared from six biopsy sites of VM. VMO and VML were found to have superficial and deep parts based on fiber bundle attachments to aponeuroses, medial patellar retinaculum, and adductor magnus tendon. The superficial part of VMO was further subdivided into superior and inferior partitions. Architecturally, VMO was found to have significantly shorter mean FBL, greater mean PPA and DPA, and smaller mean PCSA than VML. VML was found to be connected to the fascia lata by thin fascial bands, not present in VMO. SLs of VMO and VML were comparable. VMO and VML are architecturally and functionally distinct, as evidenced by marked differences in their musculoaponeurotic geometry, attachment sites, and architectural parameters. VMO likely contributes greater to medial patellar stabilization, whereas VML, with a larger relative excursion and force-generating capability, to the extension of the knee. Clin. Anat. 32:515-523, 2019. © 2019 Wiley Periodicals, Inc.

Surgical Therapy of Temporal Triggered Migraine Headache.

Background:The auriculotemporal and zygomaticotemporal nerves are the 2 primary trigger points in the temporal area of migraine headache. Different surgical approaches are described in literature, either open or endoscopic ones.Methods:We described and delineated the currently adopted strategies to treat temporal trigger points in migraine headache. Furthermore, we reported our personal experience in the field.Results:Regardless of the type of approach, outcomes observed were similar and ranged from 89% to 67% elimination / >50% reduction rates. All procedures are minimally invasive and only minor complications are reported, with an incidence ranging from 1% to 5%.Conclusions:Just like upper limb compressive neuropathies, migraine headache is believed to be caused by chronic compression of peripheral nerves (ie, the terminal branches of trigeminal nerve) caused by surrounding structures (eg, muscles, vessels, and fascial bands) the removal of which eventually results in improvement or elimination of migraine attacks. Particular attention should be paid to the close nerve/artery relationship often described in anatomical studies and clinical reports.

Modified simple decompression of ulnar nerve in the treatment of cubital tunnel syndrome: Report of a series of cases.

Ulnar compressive neuropathy is the second most common nerve compression in the upper extremity. Although numerous operative procedures have been defined for the treatment of cubital tunnel syndrome (CuTS), the best operative intervention remains controversial. The aim of this study is to discuss the efficacy of a modified simple decompression (MSD) of the ulnar nerve in the treatment of CuTS. Each patient was preoperatively examined, and the following data were recorded: initial complaint, duration of symptoms, and presence of Tinel's sign around the elbow, results of provocation by the elbow flexion test, and results of electrodiagnostic studies. Patients' preoperative clinical manifestations were determined based on Dellon's staging system and Bishop scores. Pre- and post-operative motor conduction velocity (MCV) of the ulnar nerve were also recorded. Under the regional anesthesia, 4 cm long curved skin incision, above and below the elbow, was made posterior to the medial epicondyle of the humerus and the ulnar nerve was seen. The nerve was released proximally as it passed through the medial intermuscular septum. The cubital tunnel retinaculum and flexor carpi ulnaris aponeurosis were then cut distally. Only the compressive fascial bands are released. Then, the cubital tunnel reticulum was sutured to subcutaneous tissue loosely to prevent subluxation of the ulnar nerve. A total of 15 patients were operated. Postoperative electrophysiological study assessed at 3 months following surgery in 8 patients. In 7 of these patients (86%), the mean value of MCV had improved from 38.9 ± 12.0 m/s to 48.1 ± 11.9 m/s (P < 0.05). According to Bishop scoring system, 13 patients (86.7%) were clinically graded as excellent, 1 patient (6.7%) was graded as good, and only 1 patient (6.7%) was graded as fair. MSD is a technically simple, safe, and effective method without annoying complications.

Delayed compression of the common peroneal nerve following rotational lateral gastrocnemius flap: case report

The authors present a case of delayed peroneal neuropathy following a lateral gastrocnemius rotational flap reconstruction. The patient presented 1.5 years after surgery with a new partial foot drop, which progressed over 3 years. At operation, a fascial band on the deep side of the gastrocnemius flap was compressing the common peroneal nerve proximal to the fibular head, correlating with preoperative imaging. Release of this fascial band and selective muscle resection led to immediate improvement in symptoms postoperatively.

Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation

BackgroundChronic exertional compartment syndrome (CECS) is a common cause of exertional leg pain. It is commonly treated with a surgical fasciotomy, which has a surgical complication rate of up to 16% and takes approximately 6-12 weeks to return to preprocedure activity levels. Therefore, the development of a less invasive, effective outpatient intervention to treat CECS is desirable. ObjectiveTo describe and validate an ultrasound-guided (USG) fasciotomy technique for the anterior and lateral compartments of the lower limb in an unembalmed cadaveric model. DesignProspective, cadaveric laboratory investigation. SettingAcademic institution procedural skills laboratory. SubjectsTen unembalmed cadaveric knee-ankle-foot specimens from 1 female (2 specimens) and 7 male donors aged 62-91 years (mean 78.6 years) with body mass indices of 18.9-35.3 kg/m2 (mean 27.1 kg/m2). MethodsTwo experienced operators each performed USG anterior and lateral compartment fasciotomies on 5 unembalmed cadaveric legs. A third physician subsequently dissected the legs to assess the continuity of the fasciotomies and to identify any neurovascular damage related to the procedures. Main Outcome MeasuresFasciotomy length (in centimeters) and classification by completeness (achieved target length or did not achieve target length) and continuity (continuous or discontinuous) based on predetermined criteria. Muscles, retinaculae, and neurovascular structures were assessed for damage. ResultsNo neurovascular injuries occurred in any of the 20 USG fasciotomies. The average fasciotomy length was 22.5 cm. All 20 of the fasciotomies achieved the target length. A continuous cephalocaudal fasciotomy was accomplished in 13 of 20 fasciotomies. When a fasciotomy was not continuous, the average length and number of intact fascial bands was 1.52 cm and 2.3, respectively. ConclusionsUSG fasciotomy of the anterior and lateral leg compartments can be safely performed in a cadaveric model and can achieve a fasciotomy length comparable to surgical fasciotomy. Most procedures successfully achieved a continuous cephalocaudal fasciotomy, although small areas of intact fascial bands were identified in approximately one-third of procedures. The clinical significance of this finding is indeterminate. Given the safety demonstrated with this minimally invasive USG fasciotomy in a cadaveric model, further research is warranted to develop and refine the technique for clinical application. Level of EvidenceNot applicable.

Ultrasonographic visualization and assessment of the anterolateral ligament.

Injury to the anterolateral ligament (ALL) of the knee has recently received attention as a potential risk factor for failure of anterior cruciate ligament reconstruction. However, evaluation of the anterolateral ligament is currently difficult, and radiologic data are sparse with regard to the normal appearance of this ligament. The purpose of the present study was to determine whether the ALL could be identified and visualized using ultrasonography. Ten non-paired, fresh-frozen cadaveric knees underwent ultrasound by an experienced musculoskeletal radiologist using a Siemens S2000 Acuson Ultrasound machine with a 14-MHz linear transducer. After first identifying anatomical landmarks by palpation, a thin band of tissue originating in the vicinity of the fibular collateral ligament (FCL) origin was identified and followed up distally. The tibia was held at 30° of flexion and internally rotated to verify tightening of the structure. Under ultrasound guidance, 25-gauge hypodermic needles were placed at what were sonographically determined to be the origin and insertion points of the ligament. One-tenth of a CC of aniline blue dye was injected. The specimens were then dissected to confirm the presence and location of the ALL. If an ALL was found, distances between the epicentre of the injected dye and the actual origin and insertion points were calculated. Additionally, ligament length based on dissection images and ultrasound images was calculated. Eight of ten specimens had an anterolateral structure that originated from the lateral femoral epicondyle just posterior and superior to the origin of the FCL and inserted on the lateral plateau approximately halfway between Gerdy's tubercle and the fibular head. The average length based on ultrasound was 3.8cm (±.7; range 3.1-4.7) and 4.1cm (±1.1; range 2.6-6.1) based on dissection. Length based on dissection and ultrasound had minimal agreement (ICC=.308; 95% confidence interval .257-.382, p=.265). The average width of the structure on dissection was .8cm (±.24; range .5-1.2). The mean distance from ultrasound-determined origin and insertion points to anatomical origin and insertion based on dissection was 10.9mm (±2.9, range 7.0-15.8) and 12.5mm (±5.7 range 3.2-19.3), respectively. Inter-observer reliability was excellent for all measurements based on dissection and ultrasound. Ultrasound was unable to reliably identify the anterolateral structure from its femoral to tibial attachment sites. Distinguishing it from the posterior IT band and anterolateral capsule was challenging, and it is possible that the structure is a thickened band of fascia rather than a true ligament. As a clinical diagnostic tool, ultrasound likely offers little utility in the evaluation of the ALL for injury. IV.

Fascial bundles of the infraspinatus fascia: anatomy, function, and clinical considerations.

The infraspinatus fascia is a tough sheet of connective tissue that covers the infraspinatus fossa of the scapula and the muscle within. Muscle fibers originate from the fossa and fascia and then travel laterally to insert on the greater tubercle of the humerus. Frequently the infraspinatus fascia is quickly removed to appreciate the underlying muscle, but the fascia is an interesting and complex structure in its own right. Despite having a characteristic set of fascial bundles, no contemporary anatomy texts or atlases describe the fascia in detail. The infraspinatus fascia was dissected in detail in 11 shoulders, to characterize the fascial bundles and connections that contribute to it. Thereafter, 70 shoulders were dissected to tabulate the variability of the fascial bundles and connections. Six characteristic features of the infraspinatus fascia were noted: a medial band, an inferior-lateral band, and superior-lateral band of fascia, insertion of the posterior deltoid into the infraspinatus fascia, a transverse connection from the posterior deltoid muscle to the infraspinatus fascia, and a retinacular sheet deep to the deltoid and superficial to the infraspinatus and teres minor muscles. Although other structures of the shoulder are more frequently injured, the infraspinatus fascia is involved in compartment syndromes and the fascial bundles of this structure are certain to impact the biomechanical function of the muscles of the posterior shoulder.

New Developments in the Primo Vascular System: Imaging and Functions with regard to Acupuncture.

The Primo Vascular System (PVS) is an enigma. Does it exist or not? But Richard C. Niemtzow has seen it at the Nano Primo Research Center, Advanced Institute of Convergence Technology under the Direction of Dr. Kwang-Sup Soh in Seoul, South Korea. Superficial primo-vessels, also known as Bonghan ducts and Bonghan channels, were first reported in 1962 by the North Korean scientist, Kim [1]. His work is shrouded in a cloak of mystery. Scientists are not able to reproduce all of his data, or at least for the moment without substantial difficulties. The PVS appears to be distributed throughout the entire body. Some scientists may say it is an illusion; others say it is a “new” anatomical system, while still others are convinced that these infinitesimal channels may act like optical fiber cables and transmit DNA related information continuously throughout the body using biophotons. As a comparison, we cannot see the millions of transistors on a CPU, but they are part of a manmade system that we use every day. Similarly many biological systems are indeed very minuscule. We need electronic microscopes to visualize some of their structures; otherwise, we would not know they exist. This special issue, focused on the Primo Vascular System, contains several unique articles that challenge its understanding: in the article “Primo Vascular System: An Endothelial-to-Mesenchymal Potential Transitional Tissue Involved in Gastric Cancer Metastasis,” P. An and colleagues investigate the exciting area of gastric carcinoma and the possible role of PVS vessels as precursors of blood vessels. As such they claim that PVS may facilitate the metastatic spread of gastric cancer in the endothelial to mesenchyme tissues. The association of the PVS with cancer is one of the important discoveries by modern PVS researchers that Kim did not investigate [2]. The article “Identification of Primo-Vascular System in Abdominal Subcutaneous Tissue Layer of Rats” by C. J. Lim and colleagues describes a methodology employing Hemacolor staining to identify the PVS in rat abdominal subcutaneous tissues. The authors substantiate it by providing images. Staining methods have been critical for revealing the hard-to-observe PVS. The first effective dye used to visualize the PVS was Trypan blue [3] followed by Hemacolor [4]. Additionally, the authors present a newly developed method using Hemacolor staining to identify the PVS in the subcutaneous tissue. They explain that the importance of this observation is that these skin-PVS could be the Conception Vessels in the skin of the rats. And this may provide substantial evidence that the PVS is located at acupuncture meridians. This article provides the incentive for further research into the relationship between the PVS and anatomy [5]. The article “Fascia and Primo Vascular System” by C. Yang and colleagues reviews fascia research and its relationship with acupuncture points, meridians, and PVS. The fascia bands together the tissues in the body and is receiving attention as the basis for clinical effectors. This article provides a timely review on the relationship between basic anatomy and clinical strategies. The article “Primo-Vascular System as Presented by Bong Han Kim” by V. Vodyanoy and colleagues discusses staining methods used by Kim [1] in his original work, which with the aid of a high-resolution microscope have subsequently been confirmed. This article provides valuable information on effective histological methods for investigating the PVS. The article “Comparison of Alcian Blue, Trypan Blue, and Toluidine Blue for Visualization of the Primo Vascular System Floating in Lymph Ducts” by R. Cha and colleagues describes the different characteristics of these dyes that may elucidate the mechanism of preferential PVS staining. Finally, we are evoked by the words of Konrad Lorenz, “Truth in science can be defined as the working hypothesis best suited to open the way to the next better one.”

An Anatomical Basis for Endoscopic Cubital Tunnel Release and Associated Clinical Outcomes

To study the ulnar nerve in fresh-frozen cadavers as related to endoscopic release of the cubital tunnel and to present a retrospective review of patients treated with decompression via endoscopic visualization. To further our understanding of relevant anatomy, we dissected 26 cadaver limbs. We paid special attention to fascial membranes as potential sites of constriction as well as the position of nerves, vessels, and aberrant anatomy. These findings facilitated our understanding of the extent of release in 80 patients (92 cases) with endoscopic cubital tunnel simple decompression. Outcome measures included Disabilities of the Arm, Shoulder, and Hand score, Gabel and Amadio score, and grip and pinch strengths. We noted fascial bands proximal to the medial epicondyle in 12 of 26 cadaver specimens, 2 of which could be the so-called arcade of Struthers. We observed a high degree of variability in the anatomy of the flexor pronator aponeurosis distal to the medial epicondyle. Where present (n= 10), medial antebrachial cutaneous nerve branches crossed the ulnar nerve at an average distance of 2.9 cm from the medial epicondyle (range, 1.0-4.5 cm). Aberrant structures were noted in 8 of the 26 specimens, including an anconeus epitrochlearis muscle in 2 specimens, a basilic vein crossing the ulnar nerve in 4 specimens, and an accessory origin of the medial head of the triceps from the medial intermuscular septum in 2specimens. In the clinical portion of this study, the average Disabilities of the Arm, Shoulder, and Hand score before surgery was 49 (n= 34) and after surgery was 25 (n= 56). The Gabel and Amadio outcome scores were 24 excellent, 40 good, 25 fair, and 3 poor (n=92). Average follow-up was 8.2 months (range, 0.1-35 mo). Cadaveric dissections shed light on vulnerable anatomical structures during release, including branches of the medial antebrachial cutaneous nerve, ulnar nerve, brachial artery, fascial bands, and basilic vein. The high degree of anatomical variability in this study highlights the advantage of endoscopic visualization in allowing surgeons to minimize surgical trauma. Therapeutic IV.

A Fascial Band Implicated in Wartenberg Syndrome

A Fascial Band Implicated in Wartenberg Syndrome