Motor Entry Point Research Articles

Localizing motor entry points of adductor muscles of thigh for motor point procedures in the treatment of adductor spasticity.

Spasticity which is focal or segmental such as affecting a single muscle group or limb can be treated by chemical neurolysis or surgical denervation at the neurovascular hilus. This study determines the motor entry points (MEPs) of adductor muscles of the thigh in the adult Indian population and identifies precise anatomical landmarks for the successful performance motor point procedures for the relief of muscle spasticity. A total of 10 adult lower limbs were dissected, and nerve branches to adductor muscles were carefully exposed up to their MEP. The morphometry of adductor muscles, precise locations of proximal and distal MEPs, and ideal sites for motor point procedures were identified. The median number of MEPs in adductor longus was two. Most of them were located between 40% and 50% of the muscle length i.e., in the third-fifth of the total muscle length. Adductor magnus and gracilis had a median number of one and six MEPs respectively. The ideal site of motor point procedures is in the second-fifth of the muscle length for both. This preliminary study describes the location of MEPs and ideal sites of motor point procedures in the adductor muscle of the thigh. However, further cadaveric and electromyographic studies with larger samples are necessary to investigate precise locations of MEPs aiding in the treatment of spasticity.

Motor Branching Pattern of the Radial Nerve for Hyperselective Neurectomy: From Anatomy to Clinical Translation

Predominant or isolated spasticity of the triceps following upper motor neuron injury is rare and often unmasked once the spastic elbow flexors are addressed. The purpose of this study was to delineate the motor branching pattern of the radial nerve to determine the feasibility of hyperselective neurectomies (HSN) for triceps spasticity. Dissections of the motor branch to each triceps head were performed on 11 upper-extremity specimens. The numbers of trunks, branching patterns, and muscle entry points were recorded in reference to the acromion to interepicondylar line. Based on anatomic studies, 10 patients underwent a combined fractional lengthening and HSN procedure for triceps spasticity. Patient demographics, time from diagnosis, and complications were recorded. Preoperative and postoperative Modified Ashworth Scale (MAS) and total active elbow arc of motion were compared. The first branch from the radial nerve was consistently a single trunk to the long triceps head. There were many variations in the branching pattern and number of trunks to the lateral and medial heads of the triceps with motor entry points between 31% and 95% of the acromion to interepicondylar line distance. Ten patients (six men and four women; mean age: 48.5 years) underwent the combined procedure. Mean total active elbow arc of motion improved from 78° before surgery to 111° after surgery, with a 17.5° increase in active elbow flexion. Compared with a mean preoperative triceps MAS of 2.75, nine patients had triceps MAS of 0 at a mean of 10.2 months of follow-up. There was no loss of functional elbow extension and no directly related complications. Given the variable motor entry points, HSN to each triceps head would require extensive dissection. Therefore, a combined approach consisting of fractional lengthening of the long head and lateral head with HSN of the triceps medial head is recommended to address triceps spasticity. Therapeutic V.

Intramuscular nerve distribution of the sternocleidomastoid muscle for the botulinum toxin injection.

The aim of this study is to define the intramuscular nerve distribution of the sternocleidomastoid muscle (SCM) and the innervation zones (IZ) to describe the optimal botulinum toxin injection sites. The cricoid cartilage (CC), laryngeal prominence (LP) and hyoid bone (HB) and angle of mandible (AM) were determined as landmarks. The length of the muscles were measured between the sternoclavicular joint and tip of the mastoid process. SCM was evaluated in two parts as anterior and posterior divided by the line where the length of the muscle was measured. Measurements were made to define the relationships of the SCM with common carotid artery, internal and external jugular veins. IZ were described according to these vessels. Afterwards, Modified Sihler's staining technique was applied to expose the intramuscular nerve distribution. The average length of SCM was 160,1mm. Motor entry point of the accessory nerve fibers were between the AM-HB lines, in the range of 30-40% of the muscle length, and in the posterior part of the muscles. IZ were between the HB-CC lines in the anterior and posterior part. When this interval was examined according to the vessels, the optimal injection sites were between the LP-CC lines. This study shows the position of the intramuscular nerve fibers endings of the SCM according to the chosen landmarks and the relationship of the IZ with the vessels to prevent complications. These results can be used as a guide for safe and effective botulinum toxin injections with optimal quantities.

Terminal nerve entry points' locations to muscles of the thigh for selective peripheral neurectomy in the adult population: a cadaveric study.

Spasticity is the result of a variety of lesions to the central nervous system and one of the most common causes of disability worldwide. Selective peripheral neurectomy (SPN) is a surgical procedure that permanently decreases focal spasticity. The authors' objective is to provide recommendations, in terms of probabilities, for locating terminal motor entry points to muscles of the thigh, as alternatives for proximal incision sites to SPN. The femoral, obturator, and sciatic nerves, and its corresponding motor rami, were systematically dissected on cadaveric specimens, and terminal motor entry points to each muscle of the thigh were located and carefully measured, relative to the length of the thigh. Measurement distributions were obtained and normal transformations were used when necessary. In 23 adult cadaveric specimens, 779 motor rami were dissected. Entry points' locations are presented as a percentage of the length of the thigh in means and standard deviations, which roughly corresponds to 64 and 95% probability of finding a motor entry point. Alternative incisions directly over the motor entry points, for the muscles of the thigh, may be helpful when considering SPN as treatment for focal spasticity. A prior degree of certainty of the location of the nerve to be severed may simplify surgical approach.

Targeted Muscle Reinnervation for Treatment of Postresection Interdigital Neuroma: A Cadaveric Feasibility Study.

Symptomatic postresection interdigital neuroma is a frustrating problem that causes debilitating foot pain. Implementing the concepts of targeted muscle innervation, this study offers a novel nerve transfer involving the resected third common plantar digital nerve (CPDN) to the motor nerve branch of the third dorsal interosseous muscle (DIMB) to improve postresection pain. Ten fresh feet from seven cadaveric donors were used for this study. CPDN and DIMB lengths and diameters were measured, along with nerve overlap after the transfer with ankle in neutral position and in maximal dorsiflexion. Motor entry point to the calcaneal tuberosity and to the fifth metatarsal tuberosity were measured and used to evaluate the ratio relative to foot length. Means, standard deviations, and P values were calculated for each measure and between sexes and feet (right and left). In all specimens, the nerve transfer was technically feasible, without notable size mismatch between the donor and recipient nerves. CPDN, DIMB, and important anatomical reference points were identifiable in all specimens. Average CPDN length was 30.1 ± 8.2 mm. The average DIMB length was 14.4 ± 3.9 mm. The overlap between the donor and recipient in neutral ankle position at the transfer site was 6.4 ± 1.8 mm. Given their anatomical locations, a nerve transfer between the third CPDN and third DIMB is surgically feasible. This novel technique is a viable option that can be used instead of the conventional technique of muscle implantation or more proximal re-resection for symptomatic postresection interdigital neuroma.

Proof of concept for multiple nerve transfers to a single target muscle.

Surgical nerve transfers are used to efficiently treat peripheral nerve injuries, neuromas, phantom limb pain, or improve bionic prosthetic control. Commonly, one donor nerve is transferred to one target muscle. However, the transfer of multiple nerves onto a single target muscle may increase the number of muscle signals for myoelectric prosthetic control and facilitate the treatment of multiple neuromas. Currently, no experimental models are available. This study describes a novel experimental model to investigate the neurophysiological effects of peripheral double nerve transfers to a common target muscle. In 62 male Sprague-Dawley rats, the ulnar nerve of the antebrachium alone (n=30) or together with the anterior interosseus nerve (n=32) was transferred to reinnervate the long head of the biceps brachii. Before neurotization, the motor branch to the biceps' long head was transected at the motor entry point. Twelve weeks after surgery, muscle response to neurotomy, behavioral testing, retrograde labeling, and structural analyses were performed to assess reinnervation. These analyses indicated that all nerves successfully reinnervated the target muscle. No aberrant reinnervation was observed by the originally innervating nerve. Our observations suggest a minimal burden for the animal with no signs of functional deficit in daily activities or auto-mutilation in both procedures. Furthermore, standard neurophysiological analyses for nerve and muscle regeneration were applicable. This newly developed nerve transfer model allows for the reliable and standardized investigation of neural and functional changes following the transfer of multiple donor nerves to one target muscle.

Topographic anatomical localization of the motor nerve entry points (MEPs) of the masseter muscle.

The masseteric nerve, which is a branch of the mandibular nerve, passes lateral to the mandibular notch and then spreads in the muscle to achieve motor innervation. The muscle entry points of these motor branches are the target points of minimally invasive interventions preferred in the treatment of masseter hypertrophy. The aim of this study was to reveal the areas where the motor entry points are concentrated in the muscle by dividing the muscle into topographic regions using reliable anatomic landmarks. Bilateral 20 masseter muscles (40 in total) belonging to 20 formalin-fixed cadavers (10 female and 10 male) were examined. The distribution of the nerve in the muscle and its motor entry points were demonstrated and marked on the muscle surface. The masseter muscle was divided into six areas by lines passing through reliable anatomical landmarks (Areas 1-6). The total number of MEPs was 231.The mean distance of the MEPs from the Line-1 was 27.4 ± 11mm, and the same distance from the Line-6 was 30.32 ± 7.2mm. Most of the MEPs (123/231) were located in Area-4. Area-6 was the second (82/231) and Area-5 (19/231) was the third. We suggest that interventions in Area-4 (especially in the middle part) may have less complications as a result of less relationship with surrounding anatomical structures and more effective with high MEP number.

Targeted Muscle Reinnervation in the Hand: A Technical Roadmap

Targeted muscle reinnervation (TMR) transfers cut the nerve endings to the motor nerves of the nearby muscles to reduce neuroma pain and/or enhance prosthetic function. To guide surgeons, anatomic "roadmaps" describe nerve transfer options for TMR at various locations. This study aimed to landmark and measure motor entry points (MEPs) to the hand interossei muscles in the context of TMR for digital nerve neuroma management. Ten fresh-frozen cadaveric hands were dissected to describe the innervation arising from the deep branch of the ulnar nerve to the dorsal interossei (DIs) and palmar interossei (PIs) muscles. The location of MEPs relative to the bone and soft tissue landmarks and the size of the target nerves were measured. The MEPs for the DIs and PIs were found in the central third of the metacarpal. The MEPs to the PIs averaged 23.3-24.7 mm from the median nerve. The length of nerve proximal to the MEP was limited, ranging between 6.5 ± 2.6 mm for the first PI and 10.5 ± 2.7 mm for the second PI. Similarly, minimal nerve proximal to the MEP of the DI was available for mobilization. Access to the first PI innervation required substantial release of the thenar musculature. Motor nerve diameter averaged 0.85-0.97 mm. In considering TMR for the management or prevention of digital nerve neuromas, the motor branches to the second and third PIs are the most accessible and best approached volarly, whereas motor branches to the DIs take more direct routes into the muscle, making volar exposure difficult. Nerve length proximal to the MEP is short, requiring that most of the nerve length for neurorrhaphy comes from the digital nerve. Size mismatch at the neurorrhaphy site is favorable compared to more proximal TMR. Targeted muscle reinnervation in the hand is technically feasible for a patient with a symptomatic neuroma after digital amputation.

Targeted Muscle Reinnervation in the Hand: An Anatomical Feasibility Study for Neuroma Treatment and Prevention

Targeted muscle reinnervation (TMR) has emerged as a treatment for, and prevention of, symptomatic neuromas and has been reported to be of benefit in the hand. Anatomical studies establishing landmarks for consistent identification of the motor entry points (MEPs) to the intrinsic muscles have not been performed. The purpose of this study was to provide details regarding the MEPs to the intrinsic muscles, determine which MEPs are identifiable dorsally, and develop recommended sensory to MEP nerve coaptations for prophylactic TMR at the time of ray amputation or for management of symptomatic neuromas. Motor entry points to the intrinsic hand muscles were dissected in 5 fresh latex-injected cadavers. Number of MEPs, diameter, surface of entry, and distance from dorsal (Lister tubercle) and volar (hamate hook) landmarks were recorded for each target muscle. The digital sensory nerve diameters were measured for size comparison. Motor entry points were identified to all 19 intrinsic muscles through a volar approach and 12 through a dorsal approach. For all fingers, at least 2 MEPs were consistently identified dorsally at the base of each amputation site innervating expendable muscles. Motor entry points to the thenar muscles were only reliably identified through a volar approach. Two recommended nerve coaptations for each digit amputation were identified. All had a favorable sensory-to-MEP diameter ratio less than 2:1. The intrinsic hand muscles have MEPs at consistent distances from bony landmarks both dorsally and volarly. These results can be applied clinically to assist surgeons in identifying the locations of MEPs to the intrinsic muscles when performing TMR in the hand for both neuroma treatment and prevention.

Abstract 118: Targeted Muscle Reinnervation In The Hand: An Anatomical Study For Identification Of Target Motor Entry Points

Purpose: Targeted muscle reinnervation has emerged as a treatment for and prevention of symptomatic neuromas and may be beneficial in the hand. Anatomic studies establishing feasibility in the hand or landmarks to identify the motor entry points to the intrinsic muscles have not been performed. The purpose of this study was to provide details regarding the motor entry points to the intrinsic muscles, determine which motor entry points are identifiable dorsally, and develop recommended sensory to motor entry point nerve coaptations for prophylactic TMR at the time of ray amputation or for management of symptomatic neuromas. Methods: Motor entry points to the intrinsic hand muscles were dissected in five fresh latex-injected cadavers. Number of motor entry points, diameter, surface of entry, and distance from dorsal (Lister’s tubercle) and volar (hamate hook) landmarks was recorded for each target muscle. The digital sensory nerve diameters were measured for size comparison. Results: Motor entry points were identified to all nineteen intrinsic muscles through a volar approach and twelve muscles through dorsal approach. For all fingers there were at least two motor entry points consistently identified dorsally at the base of each amputation site innervating expendable muscles. Motor entry points to the thenar muscles were only reliably identified through a volar approach. Two recommended nerve coaptations for each digit amputation were identified. All had favorable sensory:MEP diameter ratio of less than 2:1. Recommended targets for index finger amputation include transfer of the radial digital nerve to the MEP to first dorsal interossei (1.46mm average diameter, 62.69% distance from Lister’s tubercle to the metacarpophalangeal joint of amputated finger; sensory:MEP diameter ratio of 1.32) and ulnar digital nerve to first palmar interossei (0.98mm, 58.32%; 1.69). The long finger radial digital nerve is best coapted to the MEP for second dorsal interossei (1.26mm, 60.11%; 1.48) and ulnar digital nerve to third dorsal interossei (1.26mm, 57.41%; 1.24). Ring finger ideal targets include the radial digital nerve to the MEP for fourth dorsal interossei (1.22mm, 62.75%; 1.46) and ulnar digital nerve to third lumbrical (1.12mm, 81.62%; 1.5). Lastly, the ideal target for the small finger radial digital nerve is to the MEP for third palmar interossei (0.76mm, 64.11%; 1.95) and ulnar digital nerve to fourth lumbrical (0.9mm, 82.04%; 1.71). Conclusion: Targeted muscle reinnervation is feasible to be performed in the hand. The intrinsic muscles have motor entry points found at consistent distances from bony landmarks both dorsally and volarly. These results can be applied clinically to assist surgeons in identifying the locations of motor entry points to the intrinsic muscles when performing targeted muscle reinnervation in the hand for both neuroma treatment and prevention.

Motor entry point acupuncture for shoulder abduction dysfunction after stroke: A randomized controlled trial

IntroductionEvidence has suggested that shoulder abduction dysfunction after stroke can be treated with acupuncture, but it remains unclear which acupuncture approach may be more effective. This trial compared two different acupuncture interventions (Motor Entry Point acupuncture (MEPA) and Standard acupuncture (SA) for patients experiencing post-stroke shoulder abduction dysfunction. MethodsHospital in-patients with post-stroke shoulder abduction dysfunction of two weeks duration and who agreed to participate in the trial were randomized into two groups. The SA group received acupuncture treatment at LI15, LI14, LI11, LI10 and LI4 (n = 20); the MEPA group received acupuncture at the mid-third of deltoid (n = 20). Each group received acupuncture for 40 min, 6 times a week for 4 weeks. Outcomes were the range of motion (ROM) and the manual muscle test (MMT). ResultsForty in-patients (19 women, 21 men; age range: 35–75 years) were enrolled in this trial. There was significant improvement in shoulder abduction dysfunction in both groups after 4 weeks of treatment (P＜0.05). The MEPA group reported larger ROM and improved MMT compared to the SA group (P＜0.05) and the recovery of muscle strength in MEPA group was superior to the SA group (P＜0.05). ConclusionCompared to SA therapy, MEPA therapy may be more effective for treating physical functional disability in post-stroke patients.

Distinct Neuroanatomical Structures of Acupoints Kidney 1 to Kidney 8: A Cadaveric Study.

Objective: The Systematic Classic/Zhen Jiu Jia Yi Jing (ZJJYJ, ) is considered to be the first complete acupuncture manual to detail the location and meridian assignations of 349 acupuncture points. Despite numerous transcriptions and editing changes, many traditional acupuncturists adhere to the classics and rarely question their validity. However, ushering the use of acupuncture into the modern era requires examining acupuncture point locations objectively by comparing contemporary anatomical knowledge with classical texts. The aim of this research was to examine distinct neuroanatomical targets associated with acupuncture points to: (1) standardize the precise neuroanatomical target of each acupuncture point; and (2) crossreference neuroanatomical targets with classical point locations. This was done to demonstrate ancient authors' intentions when describing acupuncture points as coordinates used to stimulate the peripheral nervous system. Materials and Methods: The unique neuroanatomical targets associated with acupuncture points on the Foot Shao Yin Kidney meridian were defined. Specifically, KI 1 through KI 8 were examined by comparing classical point locations from the ZJJYJ with modern standardized textbook locations from Chinese Acupuncture and Moxibustion, current anatomical literature, the current authors' cadaver dissection research, and electrostimulation of acupuncture points in healthy volunteers. Results: KI 1-KI 8 correlated with motor entry points as well as with nerve branches and vessels derived from the posterior tibial neurovascular bundle. Conclusions: This research demonstrated a procedure to verify and standardize the distinct neuroanatomical structures of acupuncture points. Standardization of neuroanatomical targets of acupuncture points will enable researchers and clinicians to obtain reproducible results in clinical treatments and research protocols.

Targeted Muscle Reinnervation in the Lower Leg: An Anatomical Study.

Targeted muscle reinnervation reroutes the ends of cut nerves to reinnervate small motor nerves of nearby muscles, with the goal of reducing neuroma pain and/or improving prosthesis function. Anatomical roadmaps for targeted muscle reinnervation have been established in the upper extremity and thigh, but not for the lower leg. The major branch points of motor nerves and the motor entry points to muscles of the leg were dissected in five cadaver specimens. Leg length was defined as distance from the lateral femoral condyle to the lateral malleolus. The distances from the lateral femoral condyle to major branch points and motor entry points were recorded as percentages of leg length to identify targets for targeted muscle reinnervation. The tibialis anterior and extensor digitorum longus were both acceptable targets in the anterior compartment, with an average 4.4 motor entry points within 10 to 80 percent and 3.0 motor entry points within 20 to 80 percent leg length, respectively. The peroneus longus was the best target in the lateral compartment, with an average 5.8 motor entry points within 20 to 70 percent leg length. The gastrocnemius and soleus were both acceptable targets in the superficial posterior compartment, with an average 4.4 motor entry points within 0 to 40 percent and 6.2 motor entry points within 20 to 80 percent leg length, respectively for each muscle. The flexor digitorum longus was the best target in the deep posterior compartment, with an average 6.0 motor entry points within 30 to 90 percent leg length. Targeted muscle reinnervation is technically feasible in the lower leg. This cadaveric study provides a roadmap for incision placement and identification of motor nerve targets.

Motor entry point acupuncture compared with the standard acupuncture for treatment of shoulder abduction dysfunction after stroke: A randomized clinical trial

Motor entry point acupuncture compared with the standard acupuncture for treatment of shoulder abduction dysfunction after stroke: A randomized clinical trial

Determination of injection site in flexor digitorum longus for effective and safe botulinum toxin injection.

ObjectiveTo determine the optimal injection site in the flexor digitorum longus (FDL) muscle for effective botulinum toxin injection.MethodsFourteen specimens from eight adult Korean cadavers were used in this study. The most proximal medial point of the tibia plateau was defined as the proximal reference point; the most distal tip of the medial malleolus was defined as the distal reference point. The distance of a line connecting the proximal and distal reference points was defined as the reference length. The X-coordinate was the distance from the proximal reference point to the intramuscular motor endpoint (IME), or motor entry point (MEP) on the reference line, and the Y-coordinate was the distance from the nearest point from MEP on the medial border of the tibia to the MEP. IME and MEP distances from the proximal reference point were evaluated using the raw value and the X-coordinate to reference length ratio was determined as a percentage.ResultsThe majority of IMEs were located within 30%-60% of the reference length from the proximal reference point. The majority of the MEPs were located within 40%-60% of the reference length from the proximal reference point.ConclusionWe recommend the anatomical site for a botulinum toxin injection in the FDL to be within a region 30%-60% of the reference length from the proximal reference point.

Anatomical localization of the motor entry point in the thyroarytenoid muscle

The aim of this study was to localize the motor entry point (MEP) of the thyroarytenoid muscle. Eight cadaver larynges were dissected. A virtual plane was used to represent the MEP in a coordinate (X/Y/Z) system. The inferior border of the thyroid cartilage was linked to the center of the anterior arc of the cricoid cartilage (the Y-axis). The X-axis was set perpendicular to the Y-axis; the Z-axis passed through the posterior border of the thyroid lamina from the height of the insertion point. The mean X, Y, and Z coordinates were 6.2 mm, 9.1 mm, and 11.0 mm, respectively. The calculated angles of the lateral and superior deflections were 29.4° and 35.8°, respectively. The calculated insertion depth, that is, the distance from the insertion point to the MEP, was 15.6 mm. These results may help to improve the accuracy of needle insertion during diagnostic laryngeal electromyography or laryngeal electromyography-guided injections.

No. 122 Determination of Motor Entry Point and Intramuscular Motor Point of Flexor Digitorum Longus for Effective Motor Point Block

PM&RVolume 6, Issue 8S2 p. S120-S120 Poster Presentation No. 122 Determination of Motor Entry Point and Intramuscular Motor Point of Flexor Digitorum Longus for Effective Motor Point Block Namsu Park, Namsu ParkSearch for more papers by this authorJuyong Kim, Juyong KimSearch for more papers by this authorBomi Seol, Bomi SeolSearch for more papers by this authorMyeongeun Chung, Myeongeun ChungSearch for more papers by this author Namsu Park, Namsu ParkSearch for more papers by this authorJuyong Kim, Juyong KimSearch for more papers by this authorBomi Seol, Bomi SeolSearch for more papers by this authorMyeongeun Chung, Myeongeun ChungSearch for more papers by this author First published: 18 September 2014 https://doi.org/10.1016/j.pmrj.2014.08.250Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume6, Issue8S28th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM)August 2014Pages S120-S120 RelatedInformation

Anatomic localization of motor entry points and accurate regions for botulinum toxin injection in the flexor digitorum superficialis

The aim of this study was to determine the motor entry points (MEPs) and the precise intramuscular nerve distribution of the flexor digitorum superficialis (FDS) and to provide accurate injection regions for botulinum toxin. This study was performed on 46 fresh cadaveric arms with exposed intramuscular innervation of the FDS. For each main motor branch of the FDS, MEPs, where the nerve branch first pierced the muscle belly, and the proximal and distal limit points (PLPs and DLPs, respectively) of the terminal intramuscular nerve endings were located. These data were expressed as relative percentages and absolute distances in relation to the coordinate system, which defined the line between medial and lateral epicondyle of the humerus (ME and LE, respectively) as y-axis and the midpoint of ME and LE as origin. MEP distributions were analyzed using distances measured in tenths of the x and y axes. Two main branches innervated the FDS in 27 cases, the distal main branches of the FDS were classified into three types by origin. For proximal main branches, MEPs were located at x=19.7% and y=18.5%, whereas PLPs were located at x=16.4%, and DLPs were located at x=37.7%. For distal main branches, corresponding values were 31.6, 5.5, 50.9, and 73.1%. The parameters provided by this study should increase the efficacy and precision of neuromuscular botulinum toxin blockades administered to treat finger spasticity.

Anatomic localization of motor entry point of superficial peroneal nerve to peroneus longus and brevis muscles

This study examined the anatomic location of the motor entry point (MEP) and branching point at the proximal and distal points of the tendon of the peroneal muscle by visual observation. Forty-three fresh legs of 25 adult bodies which had been donated to science were investigated in this study. The mean length of the reference line between the most proximal point of the head of the fibula (PHF) and the most distal point of the malleolus of the fibula (DMF) was 33.4 ± 2.5 cm. The MEPs of the peroneus longus (PL) and peroneus brevis (PB) gathered from 20 to 40% (7.0-13.0 cm) and 40 to 60%, respectively. The branching point where the nerve was divided to innervate the PL and PB was 10% and 28% from the PHF, respectively. These anatomic results suggest appropriate areas where to inject phenol or other agents for a MEP block in the case of a spastic lower extremity as well as guidelines for an electromyography conduction test.

Location of the motor entry point and intramuscular motor point of the tibialis posterior muscle: For effective motor point block

The aim of this study was to elucidate the anatomical location of the motor entry point (MEP) and intramuscular motor point (IMP) of the tibialis posterior muscle for effective motor point block. Thirty-six fresh specimens from 20 adult Korean cadavers (11 males and 9 females) were investigated. The reference line between the most proximal-medial articular margin of the tibia (MPM) at the level of the knee joint and the most distal point of the malleolus of the tibia (MDM) on the surface were identified. The mean length of the reference line was 326.5 ± 27.1 mm. There were 82.5% of the total number of MEPs located at 10-30% and 67.9% of the total IMPs were 10-40% from the MPM. The safety zone for botulinum toxin (BTX) injections on the medial approach was 10-40% from the MPM. In addition, insertion of the needle to a depth of 3.5 cm from the surface of the skin was effective. These results may assist in determining more accurate localization of injection sites.