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Regional Anesthesia and Pain Medicine Oct 2023Studies show variable spread with thoracic erector spinae plane (ESP) injections. Injection sites vary from lateral end of the transverse process (TP) to 3 cm from the...
BACKGROUND AND OBJECTIVES
Studies show variable spread with thoracic erector spinae plane (ESP) injections. Injection sites vary from lateral end of the transverse process (TP) to 3 cm from the spinous process, with many not describing the precise site of injection. This human cadaveric study examined dye spread of ultrasound-guided thoracic ESP block at two needle locations.
METHODS
Ultrasound-guided ESP blocks were performed on unembalmed cadavers. Methylene blue (20 mL, 0.1%) was injected in the ESP at the medial TP at level T5 (medial transverse process injection (MED), n=7) and the lateral end of the TP between T4 and T5 (injection between transverse processes (BTWN), n=7). The back muscles were dissected, and the cephalocaudal and medial-lateral dye spread documented.
RESULTS
Dye spread cephalocaudally from C4-T12 in the MED group and C5-T11 in the BTWN group, and laterally to the iliocostalis muscle in five MED injections and all BTWN injections. One MED injection reached serratus anterior. Dorsal rami were dyed in five MED and all BTWN injections. Dye spread to the dorsal root ganglion and dorsal root in most injections, though more extensively in the BTWN group. The ventral root was dyed in 4 MED and 6 BTWN injections. Epidural spread in BTWN injections ranged from 3 to 12 levels (median: 5 levels), with contralateral spread in two cases and intrathecal spread in five injections. Epidural spread in MED injections was less extensive (median (range): 1 (0-3) levels); two MED injections did not enter the epidural space.
CONCLUSION
An ESP injection administered between TPs exhibits more extensive spread than a medial TP injection in a human cadaveric model.
Topics: Humans; Thoracic Vertebrae; Nerve Block; Ultrasonography; Paraspinal Muscles; Cadaver; Ultrasonography, Interventional
PubMed: 36797037
DOI: 10.1136/rapm-2022-104132 -
JACC. Heart Failure Apr 2024Genetic variants in titin (TTN) are associated with dilated cardiomyopathy (DCM) and skeletal myopathy. However, the skeletal muscle phenotype in individuals carrying...
BACKGROUND
Genetic variants in titin (TTN) are associated with dilated cardiomyopathy (DCM) and skeletal myopathy. However, the skeletal muscle phenotype in individuals carrying heterozygous truncating TTN variants (TTNtv), the leading cause of DCM, is understudied.
OBJECTIVES
This study aimed to assess the skeletal muscle phenotype associated with TTNtv.
METHODS
Participants with TTNtv were included in a cross-sectional study. Skeletal muscle fat fraction was evaluated by magnetic resonance imaging (compared with healthy controls and controls with non-TTNtv DCM). Muscle strength was evaluated by dynamometry and muscle biopsy specimens were analyzed.
RESULTS
Twenty-five TTNtv participants (11 women, mean age 51 ± 15 years, left ventricular ejection fraction 45% ± 10%) were included (19 had DCM). Compared to healthy controls (n = 25), fat fraction was higher in calf (12.5% vs 9.9%, P = 0.013), thigh (12.2% vs 9.3%, P = 0.004), and paraspinal muscles (18.8% vs 13.9%, P = 0.008) of TTNtv participants. Linear mixed effects modelling found higher fat fractions in TTNtv participants compared to healthy controls (2.5%; 95% CI: 1.4-3.7; P < 0.001) and controls with non-TTNtv genetic DCM (n = 7) (1.5%; 95% CI: 0.2-2.8; P = 0.025). Muscle strength was within 1 SD of normal values. Biopsy specimens from 21 participants found myopathic features in 13 (62%), including central nuclei. Electron microscopy showed well-ordered Z-lines and T-tubuli but uneven and discontinuous M-lines and excessive glycogen depositions flanked by autophagosomes, lysosomes, and abnormal mitochondria with mitophagy.
CONCLUSIONS
Mild skeletal muscle involvement was prevalent in patients with TTNtv. The phenotype was characterized by an increased muscle fat fraction and excessive accumulation of glycogen, possibly due to reduced autophagic flux. These findings indicate an impact of TTNtv beyond the heart.
Topics: Adult; Aged; Female; Humans; Middle Aged; Cardiomyopathy, Dilated; Connectin; Cross-Sectional Studies; Glycogen; Heart Failure; Muscle, Skeletal; Stroke Volume; Ventricular Function, Left
PubMed: 37999665
DOI: 10.1016/j.jchf.2023.10.010 -
International Journal of Exercise... 2024Dry cupping is a therapeutic modality proposed to produce a negative pressure, stretching the skin and underlying tissue. This mechanism is said to promote regional...
Dry cupping is a therapeutic modality proposed to produce a negative pressure, stretching the skin and underlying tissue. This mechanism is said to promote regional blood flow of oxygenated blood and causing a physiological stretch in the tissue, allowing it to elongate and potentially changing skin temperature. The possible effects of the application to the lumbar spine paraspinal muscles, however, has not been thoroughly examined. The purpose of this pilot study was to explore the immediate effects of dry cupping the lumbar paraspinals on lumbar spine range of motion (ROM) and overlying skin temperature. 30 healthy individuals aged 18-30 years completed the study. The dry cupping was placed on the lumbar paraspinal muscles for 10-minutes. Two plastic cups were placed on the bilateral paraspinals muscles at L1 and L5. Lumbar spine flexion ROM and skin temperature were measured pre- and post-intervention. Descriptive statistics and paired sample -tests were used to analyze the data ( < .05). There was a statistically significant increase in lumbar spine flexion ROM measured with the Sit and Reach Test, (29) = 12.62 = 0.001; = 2.34, and inclinometry, (29) = 11.10, = 0.001; = 3.86, with a large effect size. There was also a statistically significant decrease in the skin temperature of the lumbar spine paraspinals, (29) = -2.23, 0.034; = 0.75, with a medium effect size, post-intervention. Dry cupping may be an effective strategy to increase lumbar spine ROM and decrease stiffness, promote recovery, and reduce functional limitations. Future research may examine the difference in effectiveness of static compared to dynamic cupping in a symptomatic population.
PubMed: 38665683
DOI: No ID Found -
Pain Practice : the Official Journal of... Feb 2024Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been...
PURPOSE
Intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles are possible causes of low back pain (LBP). Multifidus has been the most commonly blamed paraspinal muscle in the etiology of LBP. However, it contributes to 20% of the extensor moment on the lumbar spine. In the present study, we aimed to identify whether patients with LBP and asymptomatic subjects differed in terms of intervertebral discs, end-plates, and fatty infiltration in their paraspinal muscles.
METHODS
Consecutive women and men, who visited the spine outpatient clinics with chronic LBP and had lumbar spine MRI for their LBP without leg pain were included. Asymptomatic subjects without LBP/leg pain for the last year were recruited. Modic changes, IVDD, and fatty infiltration in the paraspinal muscles were evaluated on lumbar spine magnetic resonance imagings of the patients with LBP and age-, gender- and BMI-matched asymptomatic controls.
RESULTS
Low back pain was closely associated with fatty infiltration in the paraspinal muscles at all lumbar levels whereas it had association with severe IVDD and Modic changes at lower lumbar levels. Multifidus at the lower lumbar levels was the fattiest paraspinal muscle in both asymptomatic subjects and patients with LBP. Patients with LBP had severe fatty infiltration in the erector spinae at the upper lumbar levels.
CONCLUSION
Severe IVDD and Modic changes were more common at lower lumbar levels in patients with LBP. Both asymptomatic subjects and those with LBP had fatty multifidus at lower lumbar levels, whereas those with LBP had fatty infiltration in the erector spinae at upper lumbar levels. We suggest that fatty infiltration could have started in the multifidus. The erector spinae had greater contribution to the lumbar extension compared to the multifidus. Thus, LBP could develop when the quality of the erector spinae at the upper lumbar levels impairs due to fatty infiltration.
Topics: Male; Humans; Female; Low Back Pain; Paraspinal Muscles; Lumbosacral Region; Lumbar Vertebrae; Intervertebral Disc Degeneration; Magnetic Resonance Imaging
PubMed: 37830410
DOI: 10.1111/papr.13302 -
Muscle & Nerve Feb 2024Limited data exist regarding variation of electrodiagnostic (EDX) findings in amyotrophic lateral sclerosis (ALS) patients with different onset regions and specificity...
INTRODUCTION/AIMS
Limited data exist regarding variation of electrodiagnostic (EDX) findings in amyotrophic lateral sclerosis (ALS) patients with different onset regions and specificity of thoracic paraspinal muscle (TPSP) examination for confirming a diagnosis of ALS. We aimed to demonstrate the variation of EDX features and characterize the utility of TPSP muscle examination in the electrodiagnosis of ALS.
METHODS
This is a retrospective study of a large cohort of ALS patients who had a comprehensive EDX evaluation.
RESULTS
The study included 448 patients; all fulfilled the Gold Coast criteria for ALS. The average age at the time of EDX study was 64 years, and 41.1% were women. The onset region was identified as follows: bulbar (N = 149), cervical (N = 127), lumbosacral (N = 162), and other (N = 10). In contrast to limb onset, bulbar-onset patients more frequently demonstrated a pattern of normal or near normal needle electromyography (EMG) (p < .0001) and less frequently had abnormalities on EMG of TPSP (p = .002). Clinical or EDX diagnosis of sensory polyneuropathy was present in 12.6% patients, more frequently in the lumbosacral onset subgroup (p < .03). EMG showed active denervation in 9.6% and chronic denervation in 59% of craniobulbar muscles examined, without observed difference among different onset regions. TPSP showed higher frequencies of active and chronic denervation in ALS than a group of patients with non-ALS neuromuscular disorders.
DISCUSSION
EDX features may differ among ALS patients of different onset regions. TPSP EMG is highly useful in differentiating ALS from non-ALS neuromuscular disorders while the yield of craniobulbar muscles, especially for active denervation, is low.
Topics: Humans; Female; Male; Amyotrophic Lateral Sclerosis; Retrospective Studies; Paraspinal Muscles; Electromyography; Electrodiagnosis
PubMed: 38038225
DOI: 10.1002/mus.28012 -
The American Surgeon Aug 2023A 60-year-old male presented to the emergency room with complaints of back pain overlying the left lumbar area and ipsilateral thigh numbness. The left erector spinae...
A 60-year-old male presented to the emergency room with complaints of back pain overlying the left lumbar area and ipsilateral thigh numbness. The left erector spinae musculature was rigid, tense, and painful to palpation. An elevated serum creatine kinase was identified, and a computed tomography scan showed evidence of left paraspinal musculature congestion. Past medical/surgical history was significant for McArdle's disease and bilateral forearm fasciotomies. The patient underwent lumbosacral fasciotomy with no obvious myonecrosis. The patient was discharged home after skin closure and has since been seen in clinic with no residual pain or change in baseline functional status. This case may represent the first reported atraumatic exertional lumbar compartment syndrome in a patient with McArdle's disease. Prompt operative intervention was effective in this case of acute atraumatic paraspinal compartment syndrome and resulted in an excellent functional outcome.
Topics: Male; Humans; Middle Aged; Glycogen Storage Disease Type V; Lumbosacral Region; Compartment Syndromes; Fasciotomy; Paraspinal Muscles
PubMed: 36867082
DOI: 10.1177/00031348231161694 -
Journal of Sports Sciences Sep 2023Adult elite rowers are at risk of developing low back pain (LBP). However, LBP data on adolescent elite rowers is currently insufficient. Therefore, the aim of this...
Adult elite rowers are at risk of developing low back pain (LBP). However, LBP data on adolescent elite rowers is currently insufficient. Therefore, the aim of this study was to assess LBP prevalence, LBP intensity and training characteristics in male adolescent elite rowers and a healthy control group. Twenty rowers (mean age 15.8 ± 1.2 years) and a non-athletic control group matched by age and gender ( = 13) were prospectively enrolled and underwent LBP assessment with a validated questionnaire and magnetic resonance imaging (MRI) of the lumbar spine muscles, which included a T2-mapping sequence. From the quantitative image data, T2 relaxation times were calculated. The prevalence of LBP in the last 24 hours and 3 months in the rowing group was 55.0% and 85.0%, respectively, compared to 23.1% and 30.8% in the control group ( < 0.001). Rowers had significantly longer T2 relaxation times of the paraspinal muscles compared to controls ( ≤ 0.041). LBP intensity was associated with longer T2 relaxation times ( < 0.001). Adolescent rowers had a higher prevalence of LBP compared to an age-matched control group. The observed increase in T2 relaxation might be explained by muscle soreness due to strenuous exercise, which is correlated with short-term pain intensity.
Topics: Adult; Humans; Male; Adolescent; Low Back Pain; Lumbosacral Region; Water Sports; Muscles; Magnetic Resonance Imaging
PubMed: 37979193
DOI: 10.1080/02640414.2023.2283289 -
BMC Genomics Aug 2023This paper aims to explore the role of circRNA expression profiles and circRNA-associated ceRNA networks in the regulation of myogenesis in the longissimus dorsi of...
This paper aims to explore the role of circRNA expression profiles and circRNA-associated ceRNA networks in the regulation of myogenesis in the longissimus dorsi of cattle breeds surviving under subtropical conditions in southern China by RNA sequencing and bioinformatics analysis. It also aims to provide comprehensive understanding of the differences in muscle fibers in subtropical cattle breeds and to expand the knowledge of the molecular networks that regulate myogenesis. With regard to meat quality indicators, results showed that the longissimus dorsi of LQC had lower pH (P < 0.0001), lower redness (P < 0.01), lower shear force (P < 0.05), and higher brightness (P < 0.05) than the longissimus dorsi of LFC. With regard to muscle fiber characteristics, the longissimus dorsi of LQC had a smaller diameter (P < 0.0001) and higher density of muscle fibers (P < 0.05). The analysis results show that the function of many circRNA-targeted mRNAs was related to myogenesis and metabolic regulation. Furthermore, in the analysis of the function of circRNA source genes, we hypothesized that btacirc_00497 and btacirc_034497 may regulate the function and type of myofibrils by affecting the expression of MYH6, MYH7, and NEB through competitive linear splicing.
Topics: Animals; Cattle; RNA, Circular; China; Computational Biology; Meat; Paraspinal Muscles
PubMed: 37644462
DOI: 10.1186/s12864-023-09566-0 -
Journal of Sports Science & Medicine Jun 2024The purpose of this study was to examine the differences in thoracolumbar fascia (TLF) and lumbar muscle modulus in individuals with and without hamstring injury using...
The purpose of this study was to examine the differences in thoracolumbar fascia (TLF) and lumbar muscle modulus in individuals with and without hamstring injury using shear wave elastography (SWE). Thirteen male soccer players without a previous hamstring injury and eleven players with a history of hamstring injury performed passive and active (submaximal) knee flexion efforts from 0, 45 and 90 angle of knee flexion as well as an active prone trunk extension test. The elastic modulus of the TLF, the erector spinae (ES) and the multifidus (MF) was measured using ultrasound SWE simultaneously with the surface electromyography (EMG) signal of the ES and MF. The TLF SWE modulus was significantly (p < 0.05) higher in the injured group (range: 29.86 ± 8.58 to 66.57 ± 11.71 kPa) than in the uninjured group (range: 17.47 ± 9.37 to 47.03 ± 16.04 kPa). The ES and MF modulus ranged from 14.97 ± 4.10 to 66.57 ± 11.71 kPa in the injured group and it was significantly (p < .05) greater compared to the uninjured group (range: 11.65 ± 5.99 to 40.49 ± 12.35 kPa). TLF modulus was greater than ES and MF modulus (p < 0.05). Active modulus was greater during the prone trunk extension test compared to the knee flexion tests and it was greater in the knee flexion test at 0° than at 90° (p < 0.05). The muscle EMG was greater in the injured compared to the uninjured group in the passive tests only (p < 0.05). SWE modulus of the TLF and ES and MF was greater in soccer players with previous hamstring injury than uninjured players. Further research could establish whether exercises that target the paraspinal muscles and the lumbar fascia can assist in preventing individuals with a history of hamstring injury from sustaining a new injury.
Topics: Humans; Male; Soccer; Electromyography; Young Adult; Hamstring Muscles; Elasticity Imaging Techniques; Fascia; Elastic Modulus; Athletic Injuries; Adult; Lumbosacral Region; Paraspinal Muscles; Adolescent
PubMed: 38841644
DOI: 10.52082/jssm.2024.436 -
European Journal of Applied Physiology Oct 2023To investigate if the recruitment of different regions within the lumbar extensor muscles in response to unexpected perturbations depends on trunk posture.
PURPOSE
To investigate if the recruitment of different regions within the lumbar extensor muscles in response to unexpected perturbations depends on trunk posture.
METHODS
In a semi-seated posture, healthy adult participants experienced unexpected posterior-anterior trunk perturbations in three different postures: neutral, trunk flexion and left trunk rotation. High-density surface electromyography was used to identify the regional distribution of activation within the lumbar erector spinae muscles. The effect of posture and side (left vs right) on muscle activity and centroid coordinates was investigated at baseline and in response to perturbations.
RESULTS
Higher muscle activity was observed in trunk flexion compared to neutral and rotation postures at baseline (multiple p < 0.001) and in response to the perturbation (multiple p < 0.01). At baseline, the centroid of the electromyographic amplitude distribution was localized more medially in trunk flexion compared to trunk neutral posture (p = 0.003), while activation was localized more laterally in response to the perturbation (multiple p < 0.05). When the trunk was rotated, the electromyographic amplitude distribution was localized more cranially on the left than the right side, both at baseline (p = 0.001) and in response to the perturbation (p = 0.001). Finally, a more lateral location of the centroid on the left side in rotation compared to neutral posture was observed in response to the perturbation (multiple p < 0.001).
CONCLUSIONS
Regional differences in the distribution of electromyographic amplitude indicate that different muscle regions were recruited in different trunk postures and in response to perturbations, possibly based on regional mechanical advantage of the erector spinae muscle fibers.
Topics: Adult; Humans; Muscle Contraction; Posture; Muscle, Skeletal; Electromyography; Muscles; Paraspinal Muscles
PubMed: 37247004
DOI: 10.1007/s00421-023-05223-2