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Journal of Orthopaedic Science :... Dec 2023Extracorporeal shock wave therapy (ESWT) is an effective treatment for musculoskeletal pain, tendinopathy, and fasciitis with an anti-inflammatory effect. ESWT can be...
BACKGROUND
Extracorporeal shock wave therapy (ESWT) is an effective treatment for musculoskeletal pain, tendinopathy, and fasciitis with an anti-inflammatory effect. ESWT can be categorized into two groups: radial pressure wave (RPW) and focused shock wave (FSW). Although there have been several studies on the inflammation and pain-improvement mechanisms of FSW, there are few studies on the pain-improvement mechanisms of RPW. This study aimed to elucidate the efficacy of RPW in a rat model of adjuvant arthritis.
METHODS
Ninety-six rats were randomly categorized into three groups: RPW, control, and sham as follows: (I) RPW group, which received RPW application after complete Freund's adjuvant (CFA) injection; (II) Control group, which received only CFA injection; and (III) Sham group, which received only saline injection. All rats were evaluated at 0, 4, 7, 14, 28, and 56 days post-RPW application based on foot circumference, von Frey test, and immunohistochemistry of nerve fibers for calcitonin gene-related peptide (CGRP) and protein gene product (PGP) 9.5 in plantar skins.
RESULTS
There were no significant differences in foot circumference between the RPW and control groups at any time point. The RPW group showed significant improvements in the von Frey test results on days 7 and 14. The total CGRP-immunoreactive (ir) and PGP9.5-ir nerve fiber lengths in the RPW group decreased on day 0; however, both were increased in the control group. The CGRP-ir and PGP9.5-ir nerve fibers in the RPW group were significantly shorter than those in the control group until day 14 after RPW.
CONCLUSIONS
RPW improved the mechanical hypersensitivity between days 7 and 14 after application. Like FSW, RPW also induced the degeneration of sensory nerve fibers in the skin in the early period after irradiation, and reinnervation occurred between 14 and 28 days. Thus, our results demonstrate one of the pain relief mechanisms after RPW application.
PubMed: 38042731
DOI: 10.1016/j.jos.2023.11.008 -
Medicine Apr 2024It is essential to understand the considerable variations in bifurcation patterns of the tibial nerve (TN) and its peripheral nerves at the level of the tarsal tunnel to...
It is essential to understand the considerable variations in bifurcation patterns of the tibial nerve (TN) and its peripheral nerves at the level of the tarsal tunnel to prevent iatrogenic nerve injury during surgical nerve release or nerve block. A total of 16 ankles of 8 human cadavers were dissected to investigate the branching patterns of the TN, using 2 imaginary lines passing through the tip of the medial malleolus (MM) as reference lines. Bifurcation patterns and detailed information on the relative locations of the medial plantar, lateral plantar, medial calcaneal, and inferior calcaneal nerves to the reference lines were recorded. The most common bifurcation pattern was Type 1 in 12 ankles (75%), followed by Type 2 in 2 ankles (13%). One medial calcaneal nerve (MCN) was seen in 11 (69%) specimens and 2 MCN branches were seen in 5 (31%) specimen. 88% of the MCN branches bifurcated from the TN, whereas 6% originated from both TN and lateral plantar nerve (LPN). At the level of the tip of the MM, 2 of 7 parameters showed statistically significant difference between both sexes (P < .05). There was a statistically significant difference between left and right ankles in 2 of 7 measurements (P < .05). Further morphometric analysis of the width, distance, and angle between the TN branches and the tip of MM showed a highly variable nature of the location of the peripheral nerve branches.
Topics: Female; Male; Humans; Ankle; Ankle Joint; Tibial Nerve; Tibia; Leg
PubMed: 38608103
DOI: 10.1097/MD.0000000000037745 -
Journal of Chemical Neuroanatomy Nov 2022Transient receptor potential melastatin-7 (TRPM7) is a selective cation permeable channel which plays important roles in cellular and developmental biology such as cell...
AIMS
Transient receptor potential melastatin-7 (TRPM7) is a selective cation permeable channel which plays important roles in cellular and developmental biology such as cell proliferation, survival, differentiation and migration. This channel is also known to be necessary for transmitter release in the peripheral nervous system. In this study, immunohistochemistry for TRPM7 was conducted in the rat lumbar dorsal root ganglion (DRG).
METHODS
Triple immunofluorescence methods were used to demonstrate distribution of TRPM7 and its relationship to other TRP channels in the DRG. Retrograde tracing and double immunofluorescence methods were also performed to know peripheral targets of DRG neurons containing TRPM7 and TRP vanilloid 1 (TRPV1). In addition, transection of the sciatic nerve was conducted to demonstrate an effect of the nerve injury on TRPM7expression in the DRG.
RESULTS
TRPM7-immunoreactivity was expressed by 53.9% of sensory neurons in the 4th lumbar DRG. TRPM7-immunoreactive (-IR) DRG neurons mostly had small (<600 µm²) and medium-sized (600-1200 µm²) cell bodies. By triple and double immunofluorescence methods, approximately 70% of TRPM7-IR DRG neurons contained TRPV1-immunoreactivity. Although the number of DRG neurons co-expressing TRPM7 and TRPM8 was small in the DRG, almost all of TRPM8-IR DRG neurons co-expressed TRPM7-immunoreactivity. By combination of retrograde tracing method and immunohistochemistry, TRPM7 was expressed by half of DRG neurons innervating the plantar skin (61.9%) and gastrocnemius muscle (51.2%), and 79.6% of DRG neurons innervating the periosteum. Co-expression of TRPM7 and TRPV1 among periosteum DRG neurons (75.7%) was more abundant than among cutaneous (53.2%) and muscular (40.4%) DRG neurons. DRG neurons which co-expressed these ion channels in the periosteum had smaller cell bodies compared to the skin and muscle. In addition, the sciatic nerve transection decreased the number of TRPM7-IR neurons in the DRG (approximately 60% reduction). The RT-qPCR analysis also demonstrated reduction of TRPM7 mRNA in the injured DRG.
CONCLUSION
The present study suggests that TRPM7 is mainly located in small nociceptors in the DRG. The content of TRPM7 in DRG neurons is probably different among their peripheral targets. TRPM7 in DRG neurons may be able to respond to noxious stimulation from their peripheral tissues. The nerve injury can decrease the level of TRPM7 mRNA and protein in DRG neurons.
Topics: Rats; Animals; Ganglia, Spinal; TRPM Cation Channels; TRPV Cation Channels; Sensory Receptor Cells; RNA, Messenger
PubMed: 36122679
DOI: 10.1016/j.jchemneu.2022.102163 -
Science Robotics Oct 2023Lower limb loss is a major insult to the body's nervous and musculoskeletal systems. Despite technological advances in prosthesis design, artificial limbs are not yet...
Lower limb loss is a major insult to the body's nervous and musculoskeletal systems. Despite technological advances in prosthesis design, artificial limbs are not yet integrated into the body's physiological systems. Therefore, lower limb amputees (LLAs) experience lower balance confidence, higher fear of falls, and impaired gait compared with their able-bodied peers (ABs). Previous studies have demonstrated that restored sensations perceived as originating directly from the missing limb via neural interfaces improve balance and performance in certain ambulatory tasks; however, the effects of such evoked sensations on neural circuitries involved in the locomotor activity are not well understood. In this work, we investigated the effects of plantar sensation elicited by peripheral nerve stimulation delivered by multicontact nerve cuff electrodes on gait symmetry and stability, speed perception, and motor adaptation. We found that restored plantar sensation increased stance time and propulsive force on the prosthetic side, improved gait symmetry, and yielded an enhanced perception of prosthetic limb movement. Our results show that the locomotor adaptation among LLAs with plantar sensation became similar to that of ABs. These findings suggest that our peripheral nerve-based approach to elicit plantar sensation directly affects central nervous pathways involved in locomotion and motor adaptation during walking. Our neuroprosthesis provided a unique model to investigate the role of somatosensation in the lower limb during walking and its effects on perceptual recalibration after a locomotor adaptation task. Furthermore, we demonstrated how plantar sensation in LLAs could effectively increase mobility, improve walking dynamics, and possibly reduce fall risks.
Topics: Biomechanical Phenomena; Robotics; Gait; Walking; Perception
PubMed: 37820003
DOI: 10.1126/scirobotics.adf8997 -
Journal of Surgical Case Reports Sep 2022Every year, as many as 2 million patients worldwide present with plantar heel pain, with men and women being affected equally. This case reports reflects upon a healthy...
Every year, as many as 2 million patients worldwide present with plantar heel pain, with men and women being affected equally. This case reports reflects upon a healthy 46-year-old female who presented with a subtype of true neoplasm called as neural fibrolipoma arising from the plantar nerve. This 17 × 7 × 11-mm painful soft tissue mass was firstly detected by USS, which showed this mass extended deep to the plantar fascia and not arising from it, hence ruling out the common misconception of plantar fibromatosis. Later, as discussed in the Yorkshire Sarcoma MDT with magnetic resonance imaging images, a malignancy was ruled out. The patient eventually opted for an excision biopsy which confirmed the neural fibrolipoma followed by an excellent outcome at a 2-year review. This case report highlights the need to consider the neural fibroplipoma as a rare case of plantar/heel pain, and excision of the lesion would provide an excellent outcome.
PubMed: 36131805
DOI: 10.1093/jscr/rjac361 -
Medicina (Kaunas, Lithuania) Mar 2024This study aims to identify the precise anatomical location and therapeutic mechanisms of the KI1 acupoint (Yongquan) in relation to foot muscles and nerves, known for...
This study aims to identify the precise anatomical location and therapeutic mechanisms of the KI1 acupoint (Yongquan) in relation to foot muscles and nerves, known for treating neurological disorders and pain. Dissection of six cadavers at Chungnam National University College of Medicine examined KI1's relation to the foot's four-layer structure. The KI1 acupoint was located in the superficial and deep layers of the plantar foot, adjacent to significant nerves like the medial and lateral plantar nerves. Differences in the acupoint's exact location between genders were noted, reflecting variances in foot morphology. KI1 acupuncture was found to stimulate the muscle spindles and nerve fibers essential for balance and bipedal locomotion. This stimulation may enhance sensory feedback, potentially improving cognitive functions and balance control. This anatomical insight into KI1 acupuncture underpins its potential in neurological therapies and pain management.
Topics: Humans; Acupuncture Points; Male; Female; Foot; Cadaver; Acupuncture Therapy; Tibial Nerve; Aged
PubMed: 38674181
DOI: 10.3390/medicina60040535 -
IEEE Transactions on Biomedical... Apr 2021Plantar cutaneous feedback plays an important role in stable and efficient gait, by modulating the activity of ankle dorsi- and plantar-flexor muscles. However, central...
Plantar cutaneous feedback plays an important role in stable and efficient gait, by modulating the activity of ankle dorsi- and plantar-flexor muscles. However, central and peripheral nervous system trauma often decrease plantar cutaneous feedback and/or interneuronal excitability in processing the plantar cutaneous feedback. In this study, we tested a fully implantable neural recording and stimulation system augmenting plantar cutaneous feedback. Electromyograms were recorded from the medial gastrocnemius muscle for stance phase detection, while biphasic stimulation pulses were applied to the distal-tibial nerve during the stance phase to augment plantar cutaneous feedback. A Bluetooth low energy and a Qi-standard inductive link were adopted for wireless communication and wireless charging, respectively. To test the operation of the system, one intact rat walked on a treadmill with the electrical system implanted into its back. Leg kinematics were recorded to identify the stance phase. Stimulation was applied, with a 250-ms onset delay from stance onset and 200-ms duration, resulting in the onset at 47.58 ± 2.82% of stance phase and the offset at 83.49 ± 4.26% of stance phase (Mean ± SEM). The conduction velocity of the compound action potential (31.2 m/s and 41.6 m/s at 1·T and 2·T, respectively) suggests that the evoked action potential was characteristic of an afferent volley for cutaneous feedback. We also demonstrated successful wireless charging and system reset functions. The experimental results suggest that the presented implantable system can be a valuable neural interface tool to investigate the effect of plantar cutaneous augmentation on gait in a rat model.
Topics: Animals; Ankle Joint; Electric Stimulation; Electromyography; Gait; Muscle, Skeletal; Rats; Walking
PubMed: 33861705
DOI: 10.1109/TBCAS.2021.3072894 -
Bulletin of the Hospital For Joint... Jun 2022Painful neuromas remain a challenge for both patients and surgeons. Despite numerous described treatments, they are often unreliable with variable outcomes. This study...
BACKGROUND
Painful neuromas remain a challenge for both patients and surgeons. Despite numerous described treatments, they are often unreliable with variable outcomes. This study evaluated the use of processed nerve allografts for the treatment of painful lower extremity neuromas by either reconstruction or transposition into muscle. The null hypoth- esis was that both techniques for painful neuromas would not result in improved pain or functional outcomes.
METHODS
Retrospective review was performed of 12 pa- tients treated by a single surgeon for painful lower extremity neuromas with the utilization of processed nerve allograft either with elongation of the residual nerve stump and trans- location into muscle (n = 7) or nerve reconstruction (n = 5). Patient demographics, surgical details, and outcomes data were evaluated comparing preoperative and postoperative PROMIS (Patient Reported Outcomes Measurement Infor- mation System) scores. Patients underwent preoperative workup with imaging (ultrasound and magnetic resonance imaging). Utilizing a processed nerve allograft, reconstruc- tion was performed if the proximal and distal nerve ends were identifiable, otherwise translocation to muscle was performed to preserve proximal nerve branches.
RESULTS
Average follow-up was 15.2 months (SD: 11.4). Neuroma locations included intermetatarsal (n = 4), sural (n = 1), deep peroneal (n = 3), superficial peroneal (n = 4), and medial plantar (n = 1). Five patients failed a previous neuroma surgery, five patients had prior surgery in the zone of injury, one patient sustained a traumatic laceration, and one patient had a motor vehicle collision (MVC) requiring multiple previous surgeries. All but one patient had at least one prior surgery, with seven patients (five translocation, two reconstruction) having undergone a previous attempt to spe- cifically address neuroma pain. Preoperative injection when administered demonstrated improvement in pain and symp- toms in six of seven and two of two of the translocation and reconstruction groups, respectively. Preoperative ultrasound identified a neuroma in four of seven translocation and all four reconstruction patients. Pathology confirmed a neuroma in all 12 patients. Outcome data were available for 10 patients (six translocation, four reconstruction), which demonstrated a statistically significant improvement in PROMIS interference (p = 0.006), intensity (p = 0.011), pain behavior (p = 0.016), and NRS (p = 0.0004). Three patients underwent revision for recurrent neuroma: one translocation, two reconstruction.
CONCLUSIONS
For patients with painful cutaneous neu- romas, translocation and reconstruction using processed nerve allografts improved pain in most patients, however, 25% required revision surgery. Three patients had neuroma occurrence requiring revision surgery, prompting caution when counseling patients about outcomes and recurrence.
Topics: Allografts; Humans; Lower Extremity; Neuroma; Pain; Pain Measurement
PubMed: 35643488
DOI: No ID Found -
Toxicology Letters Apr 2021Vincristine (VCR) is commonly used to treat a variety of hematological malignancies and solid tumors in pediatric and adult patients. However, peripheral neuropathy is a...
Vincristine (VCR) is commonly used to treat a variety of hematological malignancies and solid tumors in pediatric and adult patients. However, peripheral neuropathy is a dose-limiting side effect that leaves some patients with functional disability and long-term pain. Oxytocin (OT) has demonstrated analgesic and anti-inflammatory properties, but there is no evidence regarding its effects on VCR-induced neurotoxicity. Therefore, we evaluated the potential protective effects of OT on VCR-induced neurotoxicity. In vitro, VCR (0.005 ∼ 0.1 μmol/l) and OT (10 ∼ 10 mol/l) were added into cultured primary dorsal root ganglion (DRG) neurons of mice. The length of neurites was counted by using immunofluorescence. In vivo, neurotoxicity was induced in mice by administration of VCR (0.1 mg/kg, intraperitoneal injection for 14 days) with or without pretreatment of OT (0.1 mg/kg or 1 mg/kg). Atosiban, an OT receptor (OTR) antagonist and OTR knockout (KO) mice were used for evaluating effects of OTR. Mechanical hyperalgesia was measured by using von Frey filaments. Histology of plantar skin, sciatic nerve and DRG was observed by using transmission electron microscopy (TEM) and hematoxylin-eosin (HE) staining. Results indicated that OT alleviated VCR-induced neurite damage in cultured primary DRG neurons in vitro. In vivo, OT ameliorated VCR-induced hyperalgesia. Histologically, OT attenuated the VCR-induced damages of nerve endings, myelin sheaths and Schwann cells in sciatic nerve and DRG. These effects were antagonized by atosiban. In addition, OTR knockout mice exhibited more severe hyperalgesia than wild-type mice. Globally, these results indicated that OT may have neuroprotective effects on vincristine-induced neurotoxicity in mice.
Topics: Animals; Antineoplastic Agents, Phytogenic; Hyperalgesia; Mice; Mice, Knockout; Neurotoxicity Syndromes; Oxytocics; Oxytocin; Peripheral Nervous System Diseases; Receptors, Oxytocin; Sciatic Nerve; Vasotocin; Vincristine
PubMed: 33429010
DOI: 10.1016/j.toxlet.2021.01.008