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Open AccessArticle

Territories of Nerve Endings of the Medial Plantar Nerve within the Abductor Hallucis Muscle: Clinical Implications for Potential Pain Management

by You-Jin Choi, Timm Joachim Filler, Michael Wolf-Vollenbröker, Ji-Hyun Lee and Hyung-Jin Lee

Diagnostics 2024, 14(16), 1716; https://doi.org/10.3390/diagnostics14161716 - 7 Aug 2024

Viewed by 2753

Abstract

This study aimed to elucidate the intramuscular distribution pattern of the medial plantar nerve and determine its motor nerve ending territories within the abductor hallucis muscle using modified Sihler’s staining and external anatomical landmarks. The study included 40 specimens of the abductor hallucis [...] Read more.

This study aimed to elucidate the intramuscular distribution pattern of the medial plantar nerve and determine its motor nerve ending territories within the abductor hallucis muscle using modified Sihler’s staining and external anatomical landmarks. The study included 40 specimens of the abductor hallucis muscle (13 men and seven women) from formalin-fixed (ten cadavers) and fresh cadavers (ten cadavers), with a mean age of 77.6 years. The entry point of the medial plantar nerve into the muscle was examined, followed by Sihler’s staining to analyze the intramuscular distribution pattern and motor nerve ending location within the abductor hallucis muscle. Ultrasound- and palpation-guided injections were performed to verify the applicability of motor nerve ending location-based injections. The areas with the highest concentrations of nerve entry points and nerve endings were identified in the central portion of the muscle. Ultrasound- and palpation-guided injections were safely positioned near the densest nerve ending region of the muscle. These detailed anatomical data and injection methods would be beneficial for proceeding with safe and effective injection treatments using various analgesic agents to alleviate abductor hallucis muscle-associated pain disorders. Full article

(This article belongs to the Special Issue Advances in Human Anatomy)

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12 pages, 6015 KB

Open AccessArticle

Ultrasound-Guided Botulinum Neurotoxin Injection for Alleviating Cricopharyngeus Muscle Spasticity: A Cadaveric Feasibility Study with Nerve Ending Analysis

by Ji-Hyun Lee, Hyung-Jin Lee and Bo Hae Kim

Toxins 2024, 16(7), 317; https://doi.org/10.3390/toxins16070317 - 12 Jul 2024

Viewed by 2424

Abstract

Botulinum neurotoxin (BNT) injection into the cricopharyngeus muscle (CPM) under ultrasound (US) guidance is a minimally invasive technique performed to relieve cricopharyngeal dysphagia by reducing CPM spasticity. This technique is basically accessible only to both lateral sides of the CPM. This cadaveric study [...] Read more.

Botulinum neurotoxin (BNT) injection into the cricopharyngeus muscle (CPM) under ultrasound (US) guidance is a minimally invasive technique performed to relieve cricopharyngeal dysphagia by reducing CPM spasticity. This technique is basically accessible only to both lateral sides of the CPM. This cadaveric study aimed to evaluate whether US-guided injection could effectively deliver BNT to abundant areas of gross nerve endings within the CPM. We utilized a newly modified Sihler’s staining method to identify regions with abundant neural endings within the CPM while preserving the three-dimensional morphology of the muscle in 10 sides of 5 fresh cadavers. A mixture of 0.2 mL dye was injected into the 16 sides of CPM under US guidance in 8 cadavers. Nerve endings were abundant in posterolateral areas of the CPM; the injected dye was identified at the posterolateral area on 12 sides (12/16 side, 75%) without diffusion into the posterior cricoarytenoid muscle. The injection failed on four sides (two sides of the prevertebral fascia and two sides of the esophagus below the CPM). These results suggest that US-guided injection could be a feasible technique as it can deliver BNT to the most abundant nerve distribution areas within the CPM in most cases. Full article

(This article belongs to the Special Issue The Botulinum Toxin and Spasticity: Exploring New Horizons)

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12 pages, 11305 KB

Open AccessArticle

Intramuscular Neural Distribution of the Gluteus Maximus Muscle: Diagnostic Electromyography and Injective Treatments

by Kyu-Ho Yi, Dong Chan Kim, Siyun Lee, Hyung-Jin Lee and Ji-Hyun Lee

Diagnostics 2024, 14(2), 140; https://doi.org/10.3390/diagnostics14020140 - 8 Jan 2024

Cited by 1 | Viewed by 3401

Abstract

Introduction: The purpose of this study was to investigate neural patterns within the gluteus maximus (Gmax) muscle to identify optimal EMG placement and injection sites for botulinum toxin and other injectable agents. Methods: This study used 10 fixed and 1 non-fixed adult Korean [...] Read more.

Introduction: The purpose of this study was to investigate neural patterns within the gluteus maximus (Gmax) muscle to identify optimal EMG placement and injection sites for botulinum toxin and other injectable agents. Methods: This study used 10 fixed and 1 non-fixed adult Korean cadavers. Intramuscular arborization patterns were confirmed in the cranial, middle, and caudal segments of 20 Gmax muscles using Sihler staining. Ultrasound images were obtained from one cadaver, and blue dye was injected using ultrasound guidance to confirm the results. Results: The intramuscular innervation pattern of the Gmax was mostly in the middle part of this muscle. The nerve endings of the Gmax are mainly located in the 40–70% range in the cranial segment, the 30–60% range in the middle segment, and the 40–70% range in the caudal segment. Discussion: Addressing the spasticity of the gluteus maximus requires precise, site-specific botulinum toxin injections. The use of EMG and other injection therapies should be guided by the findings of this study. We propose that these specific sites, which correspond to areas with the densest nerve branches, are the safest and most efficient locations for both botulinum toxin injections and EMG procedures. Full article

(This article belongs to the Special Issue Advances in Anatomy—Third Edition)

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12 pages, 13432 KB

Open AccessArticle

Ideal Injection Points for Botulinum Neurotoxin for Pectoralis Minor Syndrome: A Cadaveric Study

by Ji-Hyun Lee, Hyung-Jin Lee, Kyu-Ho Yi, Kang-Woo Lee, Young-Chun Gil and Hee-Jin Kim

Toxins 2023, 15(10), 603; https://doi.org/10.3390/toxins15100603 - 7 Oct 2023

Cited by 4 | Viewed by 6013

Abstract

Pectoralis Minor Syndrome (PMS) causes significant discomfort due to the compression of the neurovascular bundle within the retropectoralis minor space. Botulinum neurotoxin (BoNT) injections have emerged as a potential treatment method; however, their effectiveness depends on accurately locating the injection site. In this [...] Read more.

Pectoralis Minor Syndrome (PMS) causes significant discomfort due to the compression of the neurovascular bundle within the retropectoralis minor space. Botulinum neurotoxin (BoNT) injections have emerged as a potential treatment method; however, their effectiveness depends on accurately locating the injection site. In this study, we aimed to identify optimal BoNT injection sites for PMS treatment. We used twenty-nine embalmed and eight non-embalmed human cadavers to determine the origin and intramuscular arborization of the pectoralis minor muscle (Pm) via manual dissection and Sihler’s nerve staining techniques. Our findings showed the Pm’s origin near an oblique line through the suprasternal notch, with most neural arborization within the proximal three-fourths of the Pm. Blind dye injections validated these results, effectively targeting the primary neural arborized area of the Pm at the oblique line’s intersection with the second and third ribs. We propose BoNT injections at the arborized region within the Pm’s proximal three-fourths, or the C region, for PMS treatment. These findings guide clinicians towards safer, more effective BoNT injections. Full article

(This article belongs to the Special Issue Clinical Applications and Diversity of Botulinum Toxins)

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9 pages, 3979 KB

Open AccessArticle

Intramuscular Innervation of the Supraspinatus Muscle Assessed Using Sihler’s Staining: Potential Application in Myofascial Pain Syndrome

by Hyung-Jin Lee, Ji-Hyun Lee, Kyu-Ho Yi and Hee-Jin Kim

Toxins 2022, 14(5), 310; https://doi.org/10.3390/toxins14050310 - 28 Apr 2022

Cited by 15 | Viewed by 5145

Abstract

Despite the positive effects of botulinum neurotoxin (BoNT) injection into the neural arborized area, there is no anatomical evidence in the literature regarding the neural arborization of the supraspinatus muscle. The present study aimed to define the intramuscular neural arborized pattern of the [...] Read more.

Despite the positive effects of botulinum neurotoxin (BoNT) injection into the neural arborized area, there is no anatomical evidence in the literature regarding the neural arborization of the supraspinatus muscle. The present study aimed to define the intramuscular neural arborized pattern of the supraspinatus muscle using the modified Sihler’s staining method to facilitate the establishment of safe and effective injection sites in patients with myofascial pain in the supraspinatus muscle. Seventeen supraspinatus muscles from 15 embalmed cadavers were dissected. Precise suprascapular nerve entry locations were also observed. Intramuscular neural arborization was visualized by Sihler’s staining. The supraspinatus muscle was divided into four portions named A, B, C, and D. The nerve entry points were observed in 88.2% (15 of 17 cases) of section B and 76.5% (13 of 17 cases) of section C of the supraspinatus muscle, respectively. The concentration of intramuscular neural arborization was highest in section B of the supraspinatus muscle, which was the center of the supraspinatus muscle. When the clinician performs a trigger point and a BoNT injection into the supraspinatus muscle, injection within the medial 25–75% of the supraspinatus muscle will lead to optimal results when using small amounts of BoNT and prevent undesirable paralysis. Full article

(This article belongs to the Section Bacterial Toxins)

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9 pages, 1840 KB

Open AccessArticle

Intramuscular Neural Distribution of the Serratus Anterior Muscle: Regarding Botulinum Neurotoxin Injection for Treating Myofascial Pain Syndrome

by Kyu-Ho Yi, Ji-Hyun Lee and Hee-Jin Kim

Toxins 2022, 14(4), 271; https://doi.org/10.3390/toxins14040271 - 11 Apr 2022

Cited by 20 | Viewed by 6507

Abstract

The serratus anterior muscle is commonly involved in myofascial pain syndrome and is treated with many different injective methods. Currently, there is no definite injection point for the muscle. This study provides a suggestion for injection points for the serratus anterior muscle considering [...] Read more.

The serratus anterior muscle is commonly involved in myofascial pain syndrome and is treated with many different injective methods. Currently, there is no definite injection point for the muscle. This study provides a suggestion for injection points for the serratus anterior muscle considering the intramuscular neural distribution using the whole-mount staining method. A modified Sihler method was applied to the serratus anterior muscles (15 specimens). The intramuscular arborization areas were identified in terms of the anterior (100%), middle (50%), and posterior axillary line (0%), and from the first to the ninth ribs. The intramuscular neural distribution for the serratus anterior muscle had the largest arborization patterns in the fifth to the ninth rib portion of between 50% and 70%, and the first to the fourth rib portion had between 20% and 40%. These intramuscular neural distribution-based injection sites are in relation to the external anatomical line for the frequently injected muscles to facilitate the efficiency of botulinum neurotoxin injections. Lastly, the intramuscular neural distribution of serratus anterior muscle should be considered in order to practice more accurately without the harmful side effects of trigger-point injections and botulinum neurotoxin injections. Full article

(This article belongs to the Special Issue Botulinum Toxins: New Uses in the Treatment of Diseases)

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9 pages, 1122 KB

Open AccessArticle

Intramuscular Neural Arborization of the Latissimus Dorsi Muscle: Application of Botulinum Neurotoxin Injection in Flap Reconstruction

by Kyu-Ho Yi, Hyung-Jin Lee, Kyle K. Seo and Hee-Jin Kim

Toxins 2022, 14(2), 107; https://doi.org/10.3390/toxins14020107 - 30 Jan 2022

Cited by 23 | Viewed by 4731

Abstract

Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method [...] Read more.

Postoperative pain after breast reconstruction surgery with the latissimus dorsi flap is a common occurrence. Botulinum neurotoxin (BoNT) injection during surgery is effective in reducing postoperative pain. This study aimed to determine the most appropriate locations for BoNT injection. A modified Sihler’s method was performed on the latissimus dorsi muscles in 16 specimens. Intramuscular nerve arborization was noted under the landmark of the medial side surgical neck of the humerus to the line crossing the spinous process of T5 and the middle of the iliac crest. The latissimus dorsi muscles were divided into medial, middle, and lateral segments with 10 transverse divisions to give 10 sections (each 10%). Intramuscular nerve arborization of the latissimus dorsi muscle was the largest from the medial and lateral part of the muscle ranging from 40 to 60%, middle part from 30 to 60% and medial, middle and lateral part from 70 to 90%. The nerve entry points were at the medial and lateral part with 20–40% regarding the medial side of surgical neck of the humerus to the line crossing spinous process of T5 to the middle of iliac crest. These outcomes propose that an injection of BoNT into the latissimus dorsi muscles should be administered into specific zones. Full article

(This article belongs to the Special Issue Clinical Application of Botulinum Toxin)

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18 pages, 7763 KB

Open AccessArticle

Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery

by Grzegorz Wysiadecki, Maciej Radek, R. Shane Tubbs, Joe Iwanaga, Jerzy Walocha, Piotr Brzeziński and Michał Polguj

Brain Sci. 2021, 11(5), 649; https://doi.org/10.3390/brainsci11050649 - 16 May 2021

Cited by 9 | Viewed by 3945

Abstract

The present study aims to provide detailed observations on the cavernous segment of the abducens nerve (AN), emphasizing anatomical variations and the relationships between the nerve and the internal carotid plexus. A total of 60 sides underwent gross-anatomical study. Five specimens of the [...] Read more.

The present study aims to provide detailed observations on the cavernous segment of the abducens nerve (AN), emphasizing anatomical variations and the relationships between the nerve and the internal carotid plexus. A total of 60 sides underwent gross-anatomical study. Five specimens of the AN were stained using Sihler’s method. An additional five specimens were subjected to histological examination. Four types of AN course were observed: a single nerve along its entire course, duplication of the nerve, division into separate rootlets at the point of contact with the cavernous part of the internal carotid artery (ICA), and early-branching before entering the orbit. Due to the relationships between the ICA and internal carotid plexus, the cavernous segment of the AN can be subdivided into a carotid portion located at the point of contact with the posterior vertical segment of the cavernous ICA and a prefissural portion. The carotid portion of the cavernous AN segment is a place of angulation, where the nerve always directly adheres to the ICA. The prefissural portion of the AN, in turn, is the primary site of fiber exchange between the internal carotid plexus and either the AN or the lateral wall of the cavernous sinus. Full article

(This article belongs to the Special Issue Neurosurgery and Neuroanatomy)

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8 pages, 1454 KB

Open AccessArticle

Application of Botulinum Neurotoxin Injections in TRAM Flap for Breast Reconstruction: Intramuscular Neural Arborization of the Rectus Abdominis Muscle

by Kyu-Ho Yi, Hyung-Jin Lee, Ji-Hyun Lee, Kyle K. Seo and Hee-Jin Kim

Toxins 2021, 13(4), 269; https://doi.org/10.3390/toxins13040269 - 9 Apr 2021

Cited by 21 | Viewed by 2910

Abstract

Breast reconstruction after mastectomy is commonly performed using transverse rectus abdominis myocutaneous (TRAM) flap. Previous studies have demonstrated that botulinum neurotoxin injections in TRAM flap surgeries lower the risk of necrosis and allow further expansion of arterial cross-sectional diameters. The study was designed [...] Read more.

Breast reconstruction after mastectomy is commonly performed using transverse rectus abdominis myocutaneous (TRAM) flap. Previous studies have demonstrated that botulinum neurotoxin injections in TRAM flap surgeries lower the risk of necrosis and allow further expansion of arterial cross-sectional diameters. The study was designed to determine the ideal injection points for botulinum neurotoxin injection by exploring the arborization patterns of the intramuscular nerves of the rectus abdominis muscle. A modified Sihler’s method was performed on 16 rectus abdominis muscle specimens. Arborization of the intramuscular nerves was determined based on the most prominent point of the xyphoid process to the pubic crest. All 16 rectus abdominis muscle specimens were divided into four muscle bellies by the tendinous portion. The arborized portions of the muscles were located on the 5–15%, 25–35%, 45–55%, and 70–80% sections of the 1st, 2nd, 3rd, and 4th muscle bellies, respectively. The tendinous portion was located at the 15–20%, 35–40%, 55–60%, and 90–100% sections. These results suggest that botulinum neurotoxin injections into the rectus abdominis muscles should be performed in specific sections. Full article

(This article belongs to the Special Issue Botulinum Toxins in Clinical Practice)

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9 pages, 1568 KB

Open AccessArticle

Intramuscular Neural Distribution of Rhomboid Muscles: Evaluation for Botulinum Toxin Injection Using Modified Sihler’s Method

by Kyu-Ho Yi, Hyung-Jin Lee, You-Jin Choi, Ji-Hyun Lee, Kyung-Seok Hu and Hee-Jin Kim

Toxins 2020, 12(5), 289; https://doi.org/10.3390/toxins12050289 - 3 May 2020

Cited by 28 | Viewed by 6752

Abstract

This study describes the nerve entry point and intramuscular nerve branching of the rhomboid major and minor, providing essential information for improved performance of botulinum toxin injections and electromyography. A modified Sihler method was performed on the rhomboid major and minor muscles (10 [...] Read more.

This study describes the nerve entry point and intramuscular nerve branching of the rhomboid major and minor, providing essential information for improved performance of botulinum toxin injections and electromyography. A modified Sihler method was performed on the rhomboid major and minor muscles (10 specimens each). The nerve entry point and intramuscular arborization areas were identified in terms of the spinous processes and medial and lateral angles of the scapula. The nerve entry point for both the rhomboid major and minor was found in the middle muscular area between levels C7 and T1. The intramuscular neural distribution for the rhomboid minor had the largest arborization patterns in the medial and lateral sections between levels C7 and T1. The rhomboid major muscle had the largest arborization area in the middle section between levels T1 and T5. In conclusion, botulinum neurotoxin injection and electromyography should be administered in the medial and lateral sections of C7−T1 for the rhomboid minor and the middle section of T1−T7 for the rhomboid major. Injections in the middle section of C7−T1 should also be avoided to prevent mechanical injury to the nerve trunk. Clinicians can administer safe and effective treatments with botulinum toxin injections and other types of injections by following the methods in our study. Full article

(This article belongs to the Special Issue Botulinum Neurotoxin Injection)

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