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Investigative and Clinical Urology Jul 2023To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and... (Clinical Trial)
Clinical Trial
PURPOSE
To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and clinical parameters associated with incontinence in women with idiopathic overactive bladder (OAB).
MATERIALS AND METHODS
Twenty-one women were included in this study. All women received T-MPNS. Two self-adhesive surface electrodes were positioned with the negative electrode near the metatarsal-phalangeal joint of the great toe on the medial aspect of the foot and the positive electrode 2 cm inferior-posterior of the medial malleolus (in front of the medio-malleolar-calcaneal axis). T-MPNS was performed 2 days a week, 30 minutes a day, for a total of 12 sessions for 6 weeks. Women were evaluated for incontinence severity (24-h pad test), 3-day voiding diary, symptom severity (Overactive Bladder Questionnaire [OAB-V8]), QoL (Quality of Life-Incontinence Impact Questionnaire [IIQ-7]), positive response and cure-improvement rates, and treatment satisfaction at baseline and at the 6th week.
RESULTS
Statistically significant improvement was found in the severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters at the 6th week compared with baseline. Treatment satisfaction, treatment success, and cure or improvement rates were found to be high at the 6th week.
CONCLUSIONS
T-MPNS was first described in the literature as a new neuromodulation method. We conclude that T-MPNS is effective on both clinical parameters and QoL associated with incontinence in women with idiopathic OAB. Randomized controlled multicenter studies are needed to validate the effectiveness of T-MPNS.
Topics: Female; Humans; Quality of Life; Tibial Nerve; Transcutaneous Electric Nerve Stimulation; Treatment Outcome; Urinary Bladder, Overactive; Urinary Incontinence
PubMed: 37417565
DOI: 10.4111/icu.20230009 -
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 -
Journal of Rehabilitation Research and... 2016The aim of this study was to analyze the displacements of center of pressure (COP) using an in-shoe recording system (F-Scan) before and after motor nerve block and...
The aim of this study was to analyze the displacements of center of pressure (COP) using an in-shoe recording system (F-Scan) before and after motor nerve block and neurotomy of the tibial nerve in spastic equinovarus foot. Thirty-nine patients (age 45 ± 15 yr) underwent a motor nerve block; 16 (age 38 ± 15.2 yr) had tibial neurotomy, combined with tendinous surgery (n = 9). The displacement of the COP (anteroposterior [AP], lateral deviation [LD], posterior margin [PM]) was compared between paretic and nonparetic limbs before and after block and surgery. At baseline, the nonparetic limb had a higher AP (17.3 vs 12.3 cm, p < 0.001) and LD (4.0 vs 3.3 cm, p = 0.001) and a smaller PM (2.9 vs 4.7 cm, p = 0.001). For the paretic limb, a significant increase of AP was observed after block (13.5 vs 12.3 cm, p = 0.02) and after surgery (13.7 vs 12.3 cm, p = 0.03). A significant decrease of PM was observed after surgery (4.5 vs 3.3 cm, p < 0.001) with no more difference between two limbs (2.8 vs 3.3 cm; p = 0.44). This study shows that the F-Scan system can be used to quantify impairments and be useful to evaluate the effects of treatment for spastic foot. It suggests that changes in AP displacement following block may predict the effects of neurotomy.
Topics: Adult; Clubfoot; Female; Hemiplegia; Humans; Male; Middle Aged; Muscle Denervation; Nerve Block; Pressure; Tibial Nerve; Transducers, Pressure; Young Adult
PubMed: 27149284
DOI: 10.1682/JRRD.2014.11.0298 -
Annals of Indian Academy of Neurology 2022The medial plantar nerve (MP) sensory nerve action potential (SNAP) has been shown to be a sensitive indicator for detecting a length-dependent axonal peripheral...
CONTEXT
The medial plantar nerve (MP) sensory nerve action potential (SNAP) has been shown to be a sensitive indicator for detecting a length-dependent axonal peripheral neuropathy. However, literature survey shows paucity of age stratified data. This study was undertaken to obtain age stratified reference data for MP SNAP amplitude and latency.
AIM
To establish age-stratified reference data in Indian subjects for the MP SNAP.
STUDY SETTING AND DESIGN
The study was conducted in the electrodiagnostic laboratory of a tertiary city hospital and is retrospective study.
MATERIALS AND METHODS
A retrospective study was conducted using the nerve conduction study reports of 173 patients with only upper limb symptoms and findings. Patients were between the ages of 18 and 86 years, stratified into six groups, a = 18-30 years, b = 31- 40 years, c = 41-50 years, d = 51- 60 years, e = 61-70 years, f ≥70 years.
STATISTICAL METHODS
Stata 12.1 statistical program was used. Lower limit of the SNAP amplitude was obtained using mean-2SD of transformed data. Analysis of variance defined the intergroup variability, linear regression and Pearson's correlation assessed the statistical significance.
RESULTS
The lower limit of normal MP SNAP amplitude for each age group is as follows: a: 8.7uv b: 7.5uv c: 3.7 uv d: 2.9uv e: 2.0 uv f: 1.4uv. The amplitude difference between the groups b & c, c & d and e and f using analysis of variance with Bonferroni correction and Tukey post-hoc test was not significant, but the other groups showed statistically significant variance. The equation of regression for the predicted amplitude value with age was defined as Y^ = {3.5 + age (-.0233) - 2 (0.389)}.
CONCLUSION
This study provides age stratified reference data for MP SNAP. There is evidence to suggest that MP SNAP amplitude varies with age hence age stratified data should be used to define abnormality.
PubMed: 35936599
DOI: 10.4103/aian.aian_53_22 -
Pediatric Neurology Mar 2023Childhood cancer survivors (CCS) are at risk of polyneuropathy due to chemotherapy, but studies in young survivors are scarce and diagnosis is challenging. We aimed to...
BACKGROUND
Childhood cancer survivors (CCS) are at risk of polyneuropathy due to chemotherapy, but studies in young survivors are scarce and diagnosis is challenging. We aimed to study the presence of polyneuropathy and the possible effect of cumulative doses of chemotherapeutic agents in a representative group of adolescent survivors.
METHODS
CCS aged nine to 18 years and age- and sex-matched controls were recruited from the cross-sectional Physical Activity and Fitness among Childhood Cancer Survivors (PACCS) study. CCS with various cancer diagnoses who had ended cancer treatment one year or more before study were included. Polyneuropathy was evaluated clinically and with nerve conduction studies (NCSs) in three motor and five sensory nerves. We used mixed-effects linear regression models to compare CCS and controls, and investigate possible associations between cumulative chemotherapy doses and NCS amplitudes.
RESULTS
A total of 127 CCS and 87 controls were included, with 14% CCS having probable or confirmed polyneuropathy. NCS amplitudes were lower in survivors compared with controls in all nerves. The largest mean difference was 3.47 μV (95% confidence interval [CI], 2.18 to 4.75) in the tibial plantar medial sensory and 1.91 mV (95% CI, 0.78 to 3.04) in the tibial motor nerve. The cumulative dose of platinum derivatives was associated with lower tibial motor nerve amplitude (-0.20; 95% CI, -0.35 to -0.04 mV for 100 mg/m dose increase) but not in other nerves. We found no significant associations between vinca alkaloids cumulative dose and amplitudes.
CONCLUSIONS
CCS without clinical signs or symptoms of polyneuropathy may have subtle nerve affection. The clinical long-term impact of this novel observation should be evaluated in larger, longitudinal studies.
Topics: Humans; Child; Adolescent; Cancer Survivors; Cross-Sectional Studies; Neoplasms; Polyneuropathies; Exercise
PubMed: 36586183
DOI: 10.1016/j.pediatrneurol.2022.11.012 -
Journal of Ultrasonography Sep 2023To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination.
AIM OF THE STUDY
To present the anatomy of the tarsal tunnel and demonstrate the utility of high-resolution ultrasound for tarsal tunnel examination.
MATERIALS AND METHODS
Anatomical dissection was performed on a defrosted cadaveric model to demonstrate relevant anatomical structures of the tarsal tunnel, namely tendons, vessels and nerves. The tibial nerve division was demonstrated; the bifurcation of the tibial nerve into the medial and lateral plantar nerve, two medial calcaneal nerve branches were identified originating from the tibial nerve and the Baxter's nerve was identified as the first branch of the lateral plantar nerve. An ultrasound examination of the tarsal tunnel region was performed on a healthy volunteer. A linear probe was used and sonographic images were obtained at different levels of the tarsal tunnel: the proximal tarsal tunnel, the tibial nerve division into the medial and lateral plantar nerves, the distal tarsal tunnel, the Baxter's nerve branching point and the Baxter's nerve crossing between the abductor hallucis and quadratus plantae muscle.
RESULTS
Sonographic images were correlated with anatomical structures exposed during cadaveric dissection.
CONCLUSIONS
We presented the anatomic-sonographic correlation of the tarsal tunnel and showed that high-resolution ultrasound is a useful imaging modality for tarsal tunnel assessment.
PubMed: 37701055
DOI: 10.15557/jou.2023.0023 -
Journal of Applied Physiology... Nov 2020Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to... (Randomized Controlled Trial)
Randomized Controlled Trial
Tissue-directed stretching interventions can preferentially load muscular or nonmuscular structures such as peripheral nerves. How these tissues adapt mechanically to long-term stretching is poorly understood. This randomized, single-blind, controlled study used ultrasonography and dynamometry to compare the effects of 12-wk nerve-directed and muscle-directed stretching programs versus control on maximal ankle dorsiflexion range of motion (ROM) and passive torque, shear wave velocity (SWV; an index of stiffness), and architecture of triceps surae and sciatic nerve. Sixty healthy adults were randomized to receive nerve-directed stretching, muscle-directed stretching, or no intervention (control). The muscle-directed protocol was designed to primarily stretch the plantar flexor muscle group, whereas the nerve-directed intervention targeted the sciatic nerve tract. Compared with the control group [mean; 95% confidence interval (CI)], muscle-directed intervention showed increased ROM (+7.3°; 95% CI: 4.1-10.5), decreased SWV of triceps surae (varied from -0.8 to -2.3 m/s across muscles), decreased passive torque (-6.8 N·m; 95% CI: -11.9 to -1.7), and greater gastrocnemius medialis fascicle length (+0.4 cm; 95% CI: 0.1-0.8). Muscle-directed intervention did not affect the SWV and size of sciatic nerve. Participants in the nerve-directed group showed a significant increase in ROM (+9.9°; 95% CI: 6.2-13.6) and a significant decrease in sciatic nerve SWV (> -1.8 m/s across nerve regions) compared with the control group. Nerve-directed intervention had no effect on the main outcomes at muscle and joint levels. These findings provide new insights into the long-term mechanical effects of stretching interventions and have relevance to clinical conditions where change in mechanical properties has occurred. This study demonstrates that the mechanical properties of plantar flexor muscles and sciatic nerve can adapt mechanically to long-term stretching programs. Although interventions targeting muscular or nonmuscular structures are both effective at increasing maximal range of motion, the changes in tissue mechanical properties (stiffness) are specific to the structure being preferentially stretched by each program. We provide the first in vivo evidence that stiffness of peripheral nerves adapts to long-term loading stimuli using appropriate nerve-directed stretching.
Topics: Adaptation, Physiological; Adult; Ankle Joint; Biomechanical Phenomena; Humans; Muscle Stretching Exercises; Muscle, Skeletal; Range of Motion, Articular; Single-Blind Method; Torque
PubMed: 32853116
DOI: 10.1152/japplphysiol.00239.2019 -
Exercise, Sport & Movement 2023The purpose of this study was to determine the following in persons with midportion Achilles tendinopathy (AT): 1) maximal strength and power; 2) neural drive during...
INTRODUCTION/PURPOSE
The purpose of this study was to determine the following in persons with midportion Achilles tendinopathy (AT): 1) maximal strength and power; 2) neural drive during maximal contractions and contractile function during electrically evoked resting contractions; and 3) whether pain, neural drive, and contractile mechanisms contribute to differences in maximal strength.
METHODS
Twenty-eight volunteers (14 AT, 14 controls) completed isometric, concentric, and eccentric maximal voluntary contractions (MVCs) of the plantar flexors in a Biodex dynamometer. Supramaximal electrical stimulation of the tibial nerve was performed to quantify neural drive and contractile properties of the plantar flexors. Pain sensitivity was quantified as the pressure-pain thresholds of the Achilles tendon, medial gastrocnemius, and upper trapezius.
RESULTS
There were no differences in plantar flexion strength or power between AT and controls (isometric MVC: = 0.95; dynamic MVC: = 0.99; power: = 0.98), nor were there differences in neural drive and contractile function ( = 0.55 and = 0.06, respectively). However, the mechanisms predicting maximal strength differed between groups: neural drive predicted maximal strength in controls ( = 0.02) and contractile function predicted maximal strength in AT ( = 0.001). Although pain did not mediate these relationships (i.e., between maximal strength and its contributing mechanisms), pressure-pain thresholds at the upper trapezius were higher in AT ( = 0.02), despite being similar at the calf ( = 0.24) and Achilles tendon ( = 0.40).
CONCLUSIONS
There were no deficits in plantar flexion strength or power in persons with AT, whether evaluated isometrically, concentrically, or eccentrically. However, the mechanisms predicting maximal plantar flexor strength differed between groups, and systemic pain sensitivity was diminished in AT.
PubMed: 38222444
DOI: 10.1249/esm.0000000000000017 -
Arthroscopy Techniques Dec 2022Closed-wedge high tibial osteotomy (CWHTO) may be carried out to realign the knee in patients with knee osteoarthritis who do not meet the criteria for open-wedge high...
Closed-wedge high tibial osteotomy (CWHTO) may be carried out to realign the knee in patients with knee osteoarthritis who do not meet the criteria for open-wedge high tibial osteotomy or total knee arthroplasty. The procedure involves both fibular and tibial osteotomy, and care is needed to prevent peroneal nerve and vessel injury during fibular osteotomy. Notably, use of a tourniquet may mask the development of hematomas or aneurysms until after surgery. We developed a 3-step ankle-angle-adjusting (triple-A) technique to relax the muscles, allowing easy retraction of the peroneal vessels. Crucially, the procedure does not require a tourniquet, thus allowing bleeding to be detected and stopped during surgery. The process involves adjusting the ankle angle by plantar-flexion and applying varus stress to highlight the tension difference between the lateral and posterior compartments; plantar-flexion of the great toe to loosen the flexor hallucis longus muscle, thus exposing the fibular posterior aspect; and valgus stress to loosen the peroneus longus muscle. The muscles can then be retracted sufficiently to allow distal and proximal osteotomies to be performed, and any bleeding can be detected and resolved before wound closure. This technique may improve the ease and safety of fibular osteotomy in patients undergoing CWHTO.
PubMed: 36632397
DOI: 10.1016/j.eats.2022.08.018 -
The Korean Journal of Pain Jan 2022Thrombospondin-4 (TSP4) upregulates in the spinal cord following peripheral nerve injury and contributes to the development of neuropathic pain (NP). We investigated the...
BACKGROUND
Thrombospondin-4 (TSP4) upregulates in the spinal cord following peripheral nerve injury and contributes to the development of neuropathic pain (NP). We investigated the effects of cyanocobalamin alone or in combination with morphine on pain and the relationship between these effects and spinal TSP4 expression in neuropathic rats.
METHODS
NP was induced by chronic constriction injury (CCI) of the sciatic nerve. Cyanocobalamin (5 and 10 mg/kg/day) was administered 15 days before CCI and then for 4 and 14 postoperative days. Morphine (2.5 and 5 mg/kg/day) was administered only post-CCI. Combination treatment included cyanocobalamin and morphine, 10 and 5 mg/kg/day, respectively. All drugs were administered intraperitoneally. Nociceptive thresholds were detected by esthesiometer, analgesia meter, and plantar test, and TSP4 expression was assessed by western blotting and fluorescence immunohistochemistry.
RESULTS
CCI decreased nociceptive thresholds in all tests and induced TSP4 expression on the 4th postoperative day. The decrease in nociceptive thresholds persisted except for the plantar test, and the increased TSP4 expression reversed on the 14th postoperative day. Cyanocobalamin and low-dose morphine alone did not produce any antinociceptive effects. High-dose morphine improved the decreased nociceptive thresholds in the esthesiometer when administered alone but combined with cyanocobalamin in all tests. Cyanocobalamin and morphine significantly induced TSP4 expression when administered alone in both doses for 4 or 14 days. However, this increase was less when the two drugs are combined.
CONCLUSIONS
The combination of cyanocobalamin and morphine is more effective in antinociception and partially decreased the induced TSP4 expression compared to the use of either drug alone.
PubMed: 34966013
DOI: 10.3344/kjp.2022.35.1.66