Insertion Of Muscle Research Articles

Quantitative Analysis of the Brachialis and Triceps Brachii Insertion Sites on the Proximal Epiphysis of the Ulna in Modern Hominid Primates and Fossil Hominins.

In several species of hominid primates with different types of locomotor behavior, we quantitatively studied the insertion sites of the brachialis and triceps brachii on the proximal epiphysis of the ulna. Our main objective was to evaluate the possibility of using the anatomical features of these insertion sites to infer the locomotor behavior of different species of fossil hominins. We measured the area of these muscle insertion sites using 3D bone meshes and obtained the value of each insertion site relative to the total size of the two insertion sites for each of the species studied. We also compared these relative values of the osteological samples with the relative mass of the brachialis and triceps brachii, which we obtained by dissecting these muscles in the same primate species. The relative values for the brachialis insertion were highest in orangutans, followed by bonobos, chimpanzees, gorillas, and humans. Fossil Australopithecus and Paranthropus had values similar to those of bonobos, while fossil Homo had values similar to those of Homo sapiens. The observed similarity in ulnar attachment sites between Australopithecus and Paranthropus and extant bonobos suggest that these hominins used arboreal locomotion to complement their bipedalism. These adaptations to arboreal locomotion were not observed in Homo.

Ultrastructure and Function of the Stalk Gland Complex of Pompholyx faciemlarva (Rotifera: Monogononta).

Many planktonic rotifers carry their oviposited eggs until hatching. In some species, the eggs are attached to the mother via secretions from her style gland, which forms a thread that extends from her cloaca. In species of Pompholyx, the mother possesses the rare ability to change the tension on the secreted thread, which alters the proximity of the egg with respect to her body. In this study, we used behavioral observations, confocal microscopy, and transmission electron microscopy to study the functional morphology of the stalk gland, which secretes a similar thread to the style gland. Our observations reveal that six longitudinal muscles insert on a stalk-gland complex, which is a combination of a two-headed gland and an epithelial duct that connects to the posterior cloaca. The gland secretes a single, long, electron-dense thread that traverses the duct and attaches to the egg surface through the cloaca. Three retractor muscles insert on the stalk gland and function to pull the entire complex anteriorly, thereby increasing tension on the thread and moving the egg close to the mother's body. A set of three (two pairs and a single dorsal) protractor muscles antagonize these actions, and their contraction pulls the gland complex close to the cloaca, thereby releasing tension on the thread and allowing the egg to distance itself from the mother. The stalk gland complex does not appear to be homologous to the style glands of other rotifers, but we hypothesize that it functions as a form of maternal protection as is the case with style glands.

The Scutulum and the Pre-Auricular Aponeurosis in Bats.

The external ear in eutherian mammals is composed of the annular, auricular (pinna), and scutellar cartilages. The latter extends between the pinnae, across the top of the head, and lies at the intersection of numerous auricular muscles and is thought to be a sesamoid element. In bats, this scutulum consists of two distinct regions, (1) a thin squama that is in contact with the underlying temporalis fascia and (2) a lateral bossed portion that is lightly tethered to the medial surface of the pinna. The planar size, shape, and proportions of the squama vary by taxa, as does the relative size and thickness of the boss. The origins, insertions, and relative functions of the auricular muscles are complicated. Here, 30 muscles were tallied as to their primary attachment to the pinnae, scutula, or a pre-auricular musculo-aponeurotic plate that is derived from the epicranius. In contrast to Yangochiroptera, the origins and insertions of many auricular muscles have shifted from the scutulum to this aponeurotic plate, in both the Rhinolophidae and Hipposideridae. We propose that this functional shift is a derived character related primarily to the rapid translations and rotations of the pinna in high-duty-cycle rhinolophid and hipposiderid bats.

Case report: Two cases of Cleft rhinoplasty

The correction of cleft lip nose deformity remains a great challenge for any cleft surgeon. The nose is a prominent part of the face, and any cleft lip repair directs the beholders’ eyes from the deformed lip to the deformed nose, Controversies exist on the timing of rhinoplasty in cleft lip patients and is categorized as primary rhinoplasty performed at the time of cleft lip repair, intermediate rhinoplasty at the age of 5–11 years and definitive rhinoplasty. This article presents two cases of unilateral nasal cleft in two adults treated by secondary rhinoplasty using an open technique. The primary deformity is an imbalance between abnormal muscle insertion and maxillary skeletal hypoplasia. The general characteristics of this deformity are a very short columella, downward rotation of the tip and diminished nasal projection, and treatment of this depressed and hypoplastic bony scaffolding is the secret to successful secondary rhinoplasty. Proponents of delayed nasal repair suggest that altering the cartilages in early nasal repair at the time of lip repair would complicate future corrective nasal surgeries if the primary repair would prove unsatisfactory. However, we know that repositioning the wing cartilage at the same time as closing the lip respects nasal growth by using a rigorous technique and control of scars The aim of cleft lip rhinoplasty is both aesthetic and functional: to obtain a normal nose with nasal breathing.

Proton Therapy in Uveal Melanoma

Background/Objectives: Uveal melanoma is the most common primary intraocular malignancy in adults. Treatment options for localized, early-stage disease include enucleation, brachytherapy, and proton beam therapy. This review aims to evaluate the role of proton therapy in the definitive management of uveal melanoma, focusing on its physics, radiobiology, treatment techniques, and associated outcomes. Methods: This narrative review synthesizes current literature on proton therapy for uveal melanoma, emphasizing case selection, treatment efficacy, and side effects. Results: Proton therapy offers significant advantages for thicker uveal melanomas (over 8 mm) due to its unique physical properties, including a rapid dose fall-off that protects critical structures like the retina and optic nerve. Proton therapy may have benefits in tumor control for ocular melanomas given its increased relative biological effectiveness relative to photon therapy for these typically more radioresistant melanomas. Proton therapy may also hold special value for uveal melanomas in close proximity to the optic nerve, as patients are at high risk of visual toxicities with brachytherapy. The review discusses the efficacy of proton therapy across small, medium, and large tumors, along with strategies for improving patient survival through combined systemic therapy. Additionally, the potential of ocular reirradiation with proton therapy is addressed. Conclusions: Proton therapy is an effective treatment for uveal melanoma. It offers advantages over brachytherapy for large tumors, tumors that are close to the optic nerve or insertion of extra-ocular muscles.

Animation of latissimus dorsi flap in breast reconstruction: a retrospective analysis based on 203 cases.

Breast animation is a common postoperative complication of breast reconstruction surgery. This study investigates the factors affecting the onset and degree of animation to suggest an ideal treatment strategy for this complication. This study included patients who underwent latissimus dorsi reconstruction at Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, between 2009 and 2020 and had an outpatient visit after July 2020. Statistical analysis was performed and the patients' background and surgical factors were examined to determine whether they affected the animation incidence rate. The animation incidence rate was 69.6%. There was no significant relationship between animation incidence and any patient background or surgical factors, except for the complete dissection of insertion into the humerus of the latissimus dorsi muscle (p = 0.0039). The rate of uncomfortable animation was 4% and recurrence of animation was observed in one of the two patients who underwent denervation. Prophylactic denervation is not considered necessary and should be offered only for persistent discomfort with animation. Instead, the muscle insertion must be dissected during flap elevation to prevent animation, and the thoracodorsal nerve must be preserved to avoid muscle atrophy.

The Gross Anatomical and Histological Features of the Humerus in African Green Monkeys (Chlorocebus sabaeus) from Saint Kitts and Nevis, West Indies

This paper presents a detailed gross description of all anatomical elements of the humerus in the African green monkey and provides comparative and differential elements on monkey osteology. The osteometric investigation adds value to the gross morphological investigation, adjoining metric data to the gross descriptive data set. An in-depth investigation of the microstructural aspects of the humeral bone tissue is provided, with qualitative and quantitative details and potential for diagnostic applications. Of the gross morphological elements described, several unique features specific to this species include the humeral head shape that presents with distinctive low convexity and caudal placement, the shape of the intertubercular groove, the less developed greater tubercle, and the disposition of the rotator cuff muscle insertion. Furthermore, the overall cranio-lateral curvature of the bone shaft was found to have a distinctive 154–155 degree of angulation of the diaphysis, and the well-developed medial epicondyle was observed with its distinctive medio-caudal retroflexion. The histological investigation was more indicative of a typical non-primate organization of the bone tissue, with laminar vascular and avascular structures combined with the presence of the secondary Haversian system involving a mixture of scattered and dense unorganized secondary osteonal structures. The histomorphometric investigation yielded metrical data for the secondary osteonal structures in terms of area (20,331 ± 5105 µm2), perimeter, and vascular canal area (64,769 ± 257 µm2).

Effectiveness of Retraction 30 over Gross Stretch For Relieving Pectoralis Minor Tightness Among College Students

Background: The Pectoralis minor muscle originates from different 3 ribs and converges into one attachment point. Pectoralis minor shortening can contribute to many syndromes and impairments, especially at the shoulder. Some of them are impingement of the soft tissues, adhesive capsulitis etc. The prevalence of pectoralis minor tightness is very high in college-going students. The gross stretch is the stretching procedure that increases the length of the pectoralis minor muscle. This shoulder position produces tension in the muscle insertion in a posterior direction in conjunction with the scapular motion that is performed at flexion and elevation in the scapular plane, thereby lengthening the muscle. Retraction 30 is stretching with scapular retraction at 30 degrees of shoulder flexion; the flexion angle at 30 degrees can lengthen the muscle along the muscle fiber direction in the coronal plane. 30 degrees of flexion is considered to be more comfortable than a higher angle of flexion, as well as the angle is closest to the line of force Objectives of the study: To compare the effectiveness of gross stretch and retraction 30 in relieving pectoralis minor muscle tightness which can be co-operated in further treatment protocols. Study Design: Comparative Study Methodology: Two group pre–test–post–test design was used with purposive sampling. Selected subjects were allocated to two groups. Fourty subjects (20 males and 20 females) who fulfilled inclusion and exclusion criteria were recruited for the study. The independent variables are gross stretch and retraction 30 whereas the dependent variables were PMI (pectoralis minor index), pectoralis minor length test and Cervical Curvature. Result: This study results imply that retraction 30 is better when compared to gross stretch for correcting pectoralis minor tightness. Hence should be included as an inevitable part of stretching treatment. Practicing clinicians should continue to use evidence-based decisions when treating pectoralis minor tightness.

A cephalometric analysis of the antegonial notch in relation to the direction of mandibular growth.

Masticatory muscle forces influence craniofacial morphology development. The antegonial notch (Notch) is a bony concavity on the inferior border of the mandible. Considering the Notch is located anteriorly to the insertion of the masseter muscle and varies among individuals, we hypothesised that these muscles influence the formation of the Notch. Therefore, this study aimed to investigate the correlation between mandible morphology and Notch formation. Sixty Japanese patients who visited the Department of Orthodontics at our university hospital were retrospectively evaluated. Morphological and morphometric analyses of the Notch and related craniofacial parameters were conducted using lateral cephalograms taken at the patients' initial visits. Standard values for the Notch area and depth were determined, and the morphology of the Notch and mandible was analysed using Spearman's rank correlation coefficient (p < 0.05). The mean Notch area and depth was 78.71 ± 36.54 mm2 and 3.11 ± 1.09mm, respectively. The Notch area was significantly correlated with ramus inclination (p = 0.044, r = 0.261) and with the Y-axis (p = 0.039, r = 0.267). This study indicated that both the masticatory muscles and mandibular growth could contribute to the Notch formation.

Complete foot drop due to atypical peroneal ganglion in a 13 ½ year old boy

IntroductionPeroneal nerve palsy due to compression by an intraneural ganglion is an uncommon entity in the pediatric setting with a need for surgical treatment. Uniquely in this case, the ganglion presented as an elongated instead of a typical round cyst, delaying diagnosis and treatment. Case presentationWe present the case of a 13 ½ year old boy with increasing peroneal nerve palsy due to an atypically shaped intraneural ganglion. An MRI of the knee revealed an elongated peroneal ganglion compressing the nerve between the lateral insertion of the gastrocnemius muscle and fibular head over a length of 10 cm. After surgical decompression and physiotherapy the peroneal nerve recovered well, achieving M 4 – 5 one year after surgery. ConclusionThe atypical shape of the present peroneal ganglion delayed diagnosis and correct treatment. Though rare in the pediatric setting, this entity must be specifically looked for during the diagnostic workup of peroneal palsy, for time to surgery determines neurological outcome.

Modified gluteus maximus transfer for hip abductor deficiency

Transfer of the gluteus maximus with refixation at the greater trochanter for treatment of abductor deficiency. Symptomatic abductor deficiency with atrophy and fatty degeneration of the gluteal muscles > 50% (grade3 by quartile) with good strength of the gluteus maximus. Low atrophy or fatty degeneration of less than 50% of the gluteal muscles, limited strength of the gluteus maximus, infection. First, the fascia lata is incised dorsally to the tensor fascia latae muscle, with the incision extending approximately 1.5 cm proximal to the iliac crest. Asecond incision divides the gluteus maximus muscle longitudinally along the muscle fibers and continues towards the fascia lata distal to the greater trochanter. These incisions result in atriangular muscle flap, which is elevated and divided into anterior and posterior portions. The posterior flap is positioned ventrally over the femoral neck and fixed to the anterior capsule and the anterior edge of the greater trochanter. The anterior flap is placed directly on the proximal femur. For this purpose, agroove is prepared in the area of the proximal femur using aspherical burr to freshen up the future footprint. The anterior flap is positioned from the tip of the greater trochanter towards the insertion of the vastus lateralis muscle. Subsequently, the anterior flap is fixed to the created groove with transosseous sutures and positioned under the elevated vastus lateralis muscle in 15° abduction of the leg. To provide additional stabilization to the tendinous part of the anterior flap, ascrew is inserted distally to the greater trochanter. The vastus lateralis muscle is attached to the distal tip of the anterior flap, and the remaining gluteus maximus muscle is sutured to the fascia lata to cover the anterior flap. Additionally, aflap of the tensor fascia latae muscle can be mobilized and adapted to the reconstruction. Layered wound closure is performed. The technique of agluteus maximus transfer represents amethod for the treatment of chronic abductor deficiencies and improves abduction function as well as the gait pattern in short-term follow-ups. Fifteen patients (mean age at time of surgery 62years) had after amean follow-up of 2.5years. The modified Harris Hip Score (mHHS) improved from 48points preoperatively to 60points at follow-up. Preoperatively, 100% had apositive Trendelenburg sign; at follow-up, this was about 50%.

Kinematic–kinetic compliant acetabular cup positioning based on preoperative motion tracking and musculoskeletal modeling for total hip arthroplasty

The invention of the surgical robot enabled accurate component implantation during total hip arthroplasty (THA). However, a preoperative surgical planning methodology is still lacking to determine the acetabular cup alignment considering the patient-specific hip functions during daily activities such as walking. To simultaneously avoid implant edgeloading and impingement, this study established a kinematic–kinetic compliant (KKC) acetabular cup positioning method based on preoperative gait kinematics measurement and musculoskeletal modeling. Computed tomography images around the hip joint and their biomechanical data during gait, including motion tracking and foot–ground reaction forces, were collected. Using the reconstructed pelvic and femur geometries, the patient-specific hip muscle insertions were located in the lower limb musculoskeletal model via point cloud registration. The designed cup orientation has to be within the patient-specific safe zone to prevent implant impingement, and the optimized value selected based on the time-dependent hip joint reaction force to minimize the risk of edgeloading. As a validation of the proposed musculoskeletal model, the predicted lower limb muscle activations for seven patients were correlated with their surface electromyographic measurements, and the computed hip contact force was also in quantitative agreement with data from the literature. However, the designed cup orientations were not always within the well-known Lewinnek safe zone, highlighting the importance of KKC surgical planning based on patient-specific biomechanical evaluations.

Agreement between intraoperative and anterior segment optical coherence tomography measurements of the extraocular muscle insertion distance in patients with previous strabismus surgery

PurposeTo evaluate the agreement between anterior segment optical coherence tomography (AS-OCT) measurement of preoperative distance from the limbus to the horizontal rectus muscles insertion and intraoperative measurement in patients who have previously undergone strabismus surgery and required reoperation. MethodsSubjects from two ophthalmological centers were included. Preoperative AS-OCT was used to measure the muscle insertion from the limbus, and intraoperative measurements were obtained using calipers. Interclass correlation coefficient and Bland-Altman agreement analysis were used. ResultsA total of 53 horizontal rectus muscles from 24 patients with previous strabismus surgery were analyzed: 27 medial rectus (MR) and 26 lateral rectus (LR) muscles, including both previously operated and previously unoperated muscles. Average AS-OCT measurements of MR was 8.54 ± 2.42 mm and intraoperatively was 9.4 ± 3.09 mm. Average AS-OCT for LR was 8.32 ± 2.25 mm and intraoperatively was 9.34 ± 3.73 mm. 63% of MR muscles and 77% of LR muscles were within 1 mm between AS-OCT and intraoperative measurement. Spearman’s correlation coefficient showed positive correlation between measures for both MR and LR muscles. The interclass correlation coefficient was 0.79 (95% CI, 0.56-0.90) for MR muscles and 0.70 (95% CI, 0.44-0.85) for LR muscles, with a good agreement. Agreement was better for muscles ≤10 mm from the limbus (which included both previously operated and unoperated muscles) than for muscles found >10 mm from the limbus. ConclusionsGood agreement was observed between the measurement of limbus-insertion distance obtained by AS-OCT and by intraoperative measurement, especially when the muscle insertion was ≤10 mm from the limbus.

Medial rectus insertion site in cases of acute acquired comitant esotropia associated with excessive digital device usage.

To compare the distance of the medial rectus muscle insertion to the limbus (DMIL) between patients with acute acquired comitant esotropia (AACE) associated with excessive digital device usage (EDDU) and exotropic patients. Retrospective study. The medical records of 72 eyes of 44 patients with EDDU were retrospectively analyzed. The DMIL was measured from the anterior part at the midpoint of the medial rectus muscle insertion into the anterior limbus using a caliper after dissecting the medial rectus muscle with two control sutures at 12 o'clock and 6 o'clock. The DMIL in the non-fixation eye was compared between 44 patients with AACE and 23 patients with exotropia. The mean daily EDDU was 6.5 ± 3.1h. The mean cycloplegic refractive errors (spherical equivalent: SE) were - 3.18 ± 2.52 diopters (D) OD and - 3.03 ± 2.42 D OS. The mean DMIL in the 72 eyes of 44 patients with AACE associated with EDDU was 4.30 ± 0.66mm. The difference in DMIL of non-fixation eyes between 44 AACE patients and 23 exotropic patients was significant (4.28 ± 0.65mm vs. 5.28 ± 0.50mm, p < 0.0001). However, the SE in 44 non-dominant eyes of AACE was - 3.08 ± 2.56 D, significantly stronger than - 1.22 ± 1.93 D in the 23 exotropic eyes (p = 0.008). DMIL in patients with AACE associated with EDDU was significantly shorter. This anatomical anomaly may be an etiology of AACE associated with EDDU.

Haptic experience to significantly motivate anatomy learning in medical students

BackgroundCurrently, multiple tools exist to teach and learn anatomy, but finding an adequate activity is challenging. However, it can be achieved through haptic experiences, where motivation is the means of a significant learning process. This study aimed to evaluate a haptic experience to determine if a tactile and painting with color marker interactive experience, established a better learning process in comparison to the traditional 2D workshop on printed paper with photographs.MethodsPlaster bone models of the scapulae, humerus and clavicle were elaborated from a computerized scan tomography. Second year undergraduate medical students were invited to participate, where subjects were randomly assigned to the traditional 2D method or the 3D plaster bone model. A third group decided not to join any workshop. Following, all three groups were evaluated on bone landmarks and view, laterality, muscle insertions and functions. 2D and 3D workshop students were asked their opinion in a focus group and answered a survey regarding the overall perception and learning experience. Evaluation grades are presented as mean ± standard deviation, and answers from the survey are presented as percentages.ResultsThe survey demonstrated the students in the 3D model graded the experience as outstanding, and in five out of the six questions, answers were very good or excellent. In contrast, for students participating in the 2D workshop the most common answers were fair or good. The exception was the answer regarding the quiz, where both groups considered it good, despite the average among all groups not being a passing grade.ConclusionsTo learn the anatomy of the shoulder, the conventional methodology was compared with a haptic experience, where plaster bone models were used, enabling students to touch and paint on them. Based on the focus group and survey this study revealed the 3D workshop was an interactive experience where, the sense of touch and painting greatly contributed to their learning process. Even though this activity was useful in terms of learning bone landmarks, view muscle insertions, and establish relations, further activities must be developed to increase their understanding regarding their function, and its relevance in a clinical setting.

Exploration of Choroidal Thinning Located Temporal to the Fovea: A Pilot Study.

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1-2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis®-OCT, the area centered by the Bruch's membrane opening-fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation.

Surgical treatment of unilateral acquired superior oblique muscle palsy in adults by inferior oblique belly transposition: a retrospective analysis.

Evaluate and analyze the efficacy of inferior oblique belly transposition (IOBT) in treating adult patients with diplopia and small-angle hypertropia caused by mild to moderate inferior oblique overaction (IOOA) secondary to acquired superior oblique palsy (SOP). Nine adult patients with diplopia and small-angle hypertropia associated with mild to moderate IOOA secondary to unilateral acquired SOP were included in the current retrospective study. All patients received the IOBT procedure between February 2019 and May 2023 at The Second People's Hospital of Jinan and were followed up for more than 6months after the surgery. During the procedure, the belly of the inferior oblique muscle was fixed to the sclera at 5mm posterior to the temporal insertion of the inferior rectus muscle. The following indicators were reviewed pre- and post-surgery: the vertical deviation (VD) in the primary position and in the Bielschowsky test, the fovea disc angle (FDA) of the affected eye, changes in IOOA, and diplopia. After IOBT, the VD in the primary position decreased from 7.22△ ± 1.72△ (range 4△-10△) to 1.22△ ± 1.30△ (range 0△-3△). The VD in the Bielschowsky test decreased from 13.00△ ± 1.80△ to 3.22△ ± 1.09△. The FDA decreased from 10.02° ± 3.34° to 6.26° ± 1.91°. The grade of IOOA was reduced from 2.00 (1.00, 2.00) to 0.00 (0.00, 1.00). All changes were statistically significant (P < 0.001 or P = 0.006). Diplopia was resolved completely for all patients. IOBT can effectively treat adults with diplopia and small-angle hypertropia caused by mild to moderate IOOA secondary to acquired SOP.

Short-term effectiveness of dry needling on pain and ankle range of motion in athletes with medial tibial stress syndrome- a randomized control trial

ABSTRACT Introduction Medial tibial stress syndrome (MTSS) is also called soleus syndrome because the resultant periostitis is localized to the medial insertion of the soleus muscle. This study explores the effectiveness of dry needling (DN) targeting soleus myofascial trigger points (MTrPs) in managing MTSS. Aim To assess the impact of DN on pain reduction and ankle range of motion (ROM) improvement in athletes with MTSS. Study Design This randomized controlled trial (RCT) included 50 university-level athletes. (DN group = 25; control group = 25) Method Outcome variables, pain, and ankle dorsiflexion ROM were measured using the Numeric Pain Rating Scale (NPRS) and universal goniometer, respectively. The trial used statistical analyses like Wilcoxon rank test for within-group comparisons and Mann-Whitney U test for between-group comparisons. The trial was registered with the Clinical Trials Registry of India; CTRI/2023/10/058837. Result There were 24 Females (Age = 21.4 ± 2.06) & 26 Males (Age = 20.5 ± 2.35). DN significantly reduced pain in the intervention group from NPRS 7 ± 1.30 to 2 ± 0.87 (p < 0.001), but in the control group, the pain increased from NPRS 7 ± 0.99 to 7 ± 1.05 (p = 0.009). There was no improvement in ankle ROM. Conclusion DN effectively alleviated MTSS-associated pain in the short-term but was not effective in improving ankle ROM.

Nerve entry points in the mimic musculature of the horse head.

Facial expressions are important in pain recognition in horses, but current observation-based pain scales remain subjective. A promising technique to quantitatively measure subtle changes in expression patterns, including changes invisible to the human eye, is surface electromyography (sEMG). To achieve high-quality and reliable sEMG signals, unilateral placement of bipolar electrodes is required in relation to the motor endplates (MEP). We aimed to localize the nerve entry points (NEPs; where the nerve branch first pierced the muscle belly) and the direction of the terminal nerve endings to estimate MEP locations of the innervating nerves in five equine facial muscles involved in pain expression. Three cadaveric Dutch Warmblood horse heads were dissected to identify the NEPs in the musculi caninus, levator anguli oculi medialis, nasolabialis, masseter and zygomaticus. These points were marked with pins and measured in relation to a reference line between two anatomical landmarks near the origin and insertion of the respective muscle. Relative distances were calculated from the most caudally situated landmark. NEPs were located at 33%-38% (caninus), 69%-86% (levator anguli oculi medialis) and 0%-18% (zygomaticus) from the caudal landmark. The nasolabialis showed two innervations zones. Its NEPs were located at 47%-72% (dorsal muscle branch) and 52%-91% (ventral branch). All terminal nerve endings were found to run in rostral direction. The masseter showed numerous NEPs diffusely spread within the muscle belly. Therefore, calculation of relative positions was not performed. These results could form the basis for feasibility studies and standardization of bipolar electrode positioning invivo to measure facial muscle activity patterns in horses.

Case Report: A male newborn with occipital horn syndrome

Occipital horn syndrome (OHS) is a rare genetic disease and copper transport disorder caused by a faulty ATP7A gene with multisystemic presentations, most originally related to musculoskeletal and connective tissue affections. In our case, a male neonate with OHS presented soon after birth with pathognomonic occipital exostosis, cutis laxa at the nape region, and widely opened skull sutures and fontanels. A skeletal survey showed occipital exostosis projecting from the line of insertion of the trapezius muscle and wide fontanels on skull X-ray films with no exostoses or deformities elsewhere. In addition to our case report being the second reported case for the condition detected early in the neonatal period, it also emphasizes the importance of investigating any sign thoroughly, as it may be an early alarming sign of a progressive disease that may affect the patient’s quality of life. In addition, it highlights the value of early diagnosis and multidisciplinary management of these patients.