Search Results (12)

To date, radiographically identifying the bony landmarks relevant to diagnosing the complete C6 aplasia of the caudal lamina ventralis (C6 aCLV4) has not been described. Furthermore, a gross study has identified C6 aCLV4 as the main correlation between transposition of the CLV from C6 to C7, where coinciding neck pain was commonly reported. This study aimed to identify C6 aCLV4 in radiographs, where the outcome might benefit equine practitioners in isolating neck pain. Initially, the relevant bony landmarks were radiographically determined from a normal C6 by applying a lateral 30° dorsal–ventral oblique view. From here, the caudal border of the transverse process (TP) projecting from the vertebral body became the defining point of reference due to the image clearly demarcating the adjacent CLV. In C6 aCLV4 cases, the CLV is completely aplastic caudal to the TP. Twenty mixed-breed horses (13 males/7 females) aged 3–22 years radiographically demonstrated a C6 aCLV4, which was confirmed by their corresponding gross morphology. During this process three anomalous variations became apparent—in the longus colli muscle, C7 foramen transversarium, and vertebral artery. Therefore, this study demonstrates effective techniques for identifying C6 aCLV4 in horses, where the results might assist veterinarians in diagnosing neck pain while providing anatomical clarity. Full article

Background: Objective, reproducible assessment of deep cervical muscle mechanics is clinically relevant, yet the reliability of shear-wave elastography (SWE) for the longus colli (LC) has not been established. Therefore, the aim of this study was to determine intra- and inter-examiner reliability of LC stiffness measured by SWE under a tightly standardized protocol in patients with mechanical neck pain. Methods: A longitudinal reliability study was conducted. Adults suffering from neck pain for ≥6 months were recruited. Two examiners (with different levels of experience) acquired bilateral LC images using fixed presets. The SWE region of interest covered the full muscle thickness (excluding fascia) to measure the LC shear-wave speed and Young’s modulus. Intraclass correlation coefficients (ICCs), standard error of measurement and minimal detectable changes were computed. Results: Nineteen participants with neck pain completed imaging (left and right sides analyzed). Inter-examiner agreement was good to excellent for single measurements (ICC_3,2 > 0.818) and improved when averaging two acquisitions (ICC_3,2 > 0.866). Intra-examiner repeatability was good to excellent for the novel examiner (ICC_3,1 > 0.891) and excellent for the experienced examiner (ICC_3,1 > 0.973). No meaningful stiffness differences by sex or side were observed in this sample (p > 0.05). Conclusions: A standardized SWE workflow yields reproducible LC stiffness measurements in mechanical neck pain. For longitudinal use, keep a single operator when feasible; in multi-examiner settings, average at least two acquisitions per side to enhance sensitivity to true change. Full article

Background/Objectives: The stellate ganglion (SG), formed by the fusion of the inferior cervical and first thoracic sympathetic ganglia in approximately 80% of individuals, plays crucial roles in cardiac innervation, pain management, and autonomic regulation. This review examines the anatomical variations, histological structure, clinical applications, and therapeutic implications of the SG and stellate ganglion block (SGB), presenting original high-resolution magnetic resonance imaging (MRI) evidence of SG visualization, an underutilized approach in autonomic nervous system research. Methods: We conducted a comprehensive literature review of anatomical, physiological, and clinical studies on the SG, incorporating original anatomical dissections and high-resolution MRI. Contemporary research on SGB applications, complications, and mechanisms of action was analysed and correlated with imaging characteristics. Results: The SG demonstrates significant anatomical variability, including the presence of intermediate ganglia, accessory nerve pathways, and variable relationships with surrounding vascular structures. Our original MRI imaging consistently identified the SG at the thoracic inlet, anterior to the neck of the first rib, lateral to the longus colli muscle, and posterior to the vertebral artery, demonstrating that advanced imaging can reliably visualize this critical autonomic structure and its anatomical variants. Histologically, it contains typical sympathetic architecture, comprising postganglionic neurons, satellite glial cells, and specialized SIF cells that modulate ganglionic transmission. SGB shows therapeutic efficacy across diverse conditions, including cardiac arrhythmias, chronic pain syndromes, post-traumatic stress disorder, sleep disorders, and immune dysfunction. The procedure’s mechanisms involve both direct sympathetic blockade and complex neuroimmune pathways that affect central autonomic centers and lymphoid organs. Complications include vascular injury, pneumothorax, and nerve blocks affecting the recurrent laryngeal and phrenic nerves. Conclusions: The SG represents a critical autonomic structure with expanding clinical applications. This work advances the field by demonstrating that high-resolution MRI can consistently and non-invasively visualize the SG and its anatomical variations, knowledge previously mostly limited to cadaveric studies. Understanding these imaging-defined anatomical variations is essential for optimizing therapeutic interventions. Advanced imaging guidance integrated with comprehensive anatomical knowledge is crucial for maximizing efficacy while minimizing complications in stellate ganglion block procedures. Full article

Background: The reliable assessment of cervical muscle morphology is essential for both clinical and research use. However, evidence on the reliability of ultrasound measurements remains limited. Objective: To investigate the intra-rater and test–retest reliability of morphological measurements of the Longus Colli, Sternocleidomastoid, Multifidus Cervicis, and Semispinalis Capitis muscles using musculoskeletal ultrasound. Methods: Cross-sectional area, anteroposterior, and lateral dimensions were assessed using B-mode ultrasound. Anterior neck muscles were scanned in the supine position, while posterior neck muscles were scanned in the prone position. Each muscle was measured three times (to assess intra-rater reliability), which was repeated after 30 min (to assess test–retest reliability). Measurements were also normalized according to BMI and neck circumference. Results: Intra-rater reliability was found to be good to excellent for the Longus Colli (ICC = 0.77–0.92), excellent for the Sternocleidomastoid (ICC = 0.93–0.99), good to excellent for the Semispinalis Capitis (ICC = 0.89–0.97), and moderate to excellent for the Multifidus Cervicis (ICC = 0.69–0.92). Test–retest reliability was found to be moderate to good for the Longus Colli (ICC = 0.73–0.87), good to excellent for the Sternocleidomastoid (ICC = 0.84–0.98), good to excellent for the Semispinalis Capitis (ICC = 0.78–0.95), and good to excellent for the Multifidus Cervicis (ICC = 0.80–0.92). Conclusions: Musculoskeletal ultrasound demonstrates strong reliability for cervical muscle assessment, supporting its clinical use. Full article

The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior–posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject’s condition. The results revealed no group ×side significant differences among the groups (p > 0. 00625). However, group effects were found for APD and MEI of the CM (p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability (p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations. Full article

Objective: The aim of this investigation was to compare the thickness of the deep local muscles in the neck region, as well as local and widespread sensitivity and functionality, between individuals with migraine and healthy control subjects. Methods: An observational study was carried out in accordance with the STROBE statements. The flexor longus colli and multifidus, two neck-stabilizing muscles, were measured using B-mode ultrasound imaging. The upper trapezius, masseter, temporalis, anterior tibialis, and median nerve all underwent bilateral pressure-pain threshold (PPT) assessments. The statistical program SPSS 29.0 was used to implement the Mann–Whitney U test and Chi-squared test. Spearman Rho was utilized to establish the correlations between the variables. Results: Sixty participants were enrolled in the study. The subjects, who were matched in terms of age, gender, and body mass index (BMI), were equally divided into migraine and control groups. No significant differences between the groups were found in the multifidus CSA regarding both sides at rest (right: p = 0.625; left: p = 0.203). However, in contraction, the multifidus CSA showed a significant decrease on the left side in the patients with migraine compared to the controls (p = 0.032), but no significant differences were found in the right multifidus CSA in contraction between the two groups (p = 0.270). In comparison to the healthy volunteers, the migraine sufferers showed a substantial reduction in CSA in the longus colli muscle on both the left side (p = 0.001) and the right side at rest (p = 0.003), as well as in the CSA of the left longus colli in contraction (p < 0.001). Furthermore, the migraine patients showed significantly lower PPT compared to the healthy subjects in local and widespread areas bilaterally. All the parameters revealed higher sensitization in the migraine group in the following areas: the right and left temporal regions (p < 0.001), the right and left upper trapezius (p < 0.001 and p < 0.01, respectively), the right and left masseter muscles (p < 0.01), the right and left median nerves (p < 0.001 and p < 0.01, respectively), and the right and left anterior tibialis muscles (p < 0.001). In terms of the craniocervical flexion test (CCFT), the migraine patients demonstrated significantly lower values than the healthy subjects (p < 0.001). A moderate positive correlation was noted between the PPT in the right temporalis muscle and that in the left longus colli and the right multifidus in contraction. The PPT in the right temporalis muscle also exhibited a positive correlation with the CCFT, although this correlation was low. Between the PPT values, the upper trapezius on both sides showed a moderate positive correlation with the median nerve bilaterally. Conclusions: This research suggests that individuals with migraine may experience local and widespread pain sensitization. A decrease in functionality due to the low muscle endurance of the deep cervical muscles is also accompanied by low values of muscle thickness in contraction. These findings may help to select more accurate treatment approaches for patients with migraine. Full article

This study examined the anomalous variations of the ventral process of C6 in modern E. ferus caballus. The aim was to provide an incremental grading protocol measuring the absence of the caudal ventral tubercle (CVT) in this ventral process. The findings revealed the most prevalent absent CVT (aCVT) was left unilateral (n = 35), with bilateral (n = 29) and right unilateral (n = 12). Grading was determined in equal increments of absence 1/4, 2/4, 3/4, with 4/4 representing a complete aCVT in 56/76, with a significance of p = 0.0013. This also applied to bilateral specimens. In those C6 osseous specimens displaying a 4/4 grade aCVT, 41/56 had a partial absence of the caudal aspect of the cranial ventral tubercle (CrVT). Here, grading absent CrVTs (aCrVT) followed similarly to aCVTs, though 4/4 was not observed. The significance between 4/4 grade aCVTs and the presentation of an aCrVT was left p = 0.00001 and right p = 0.00018. In bilateral specimens, C6 morphologically resembled C5, implying a homeotic transformation that limited the attachment sites for the cranial and thoracal longus colli muscle. This potentially diminishes function and caudal cervical stability. Therefore, it is recommended that further studies examine the morphological extent of this equine complex vertebral malformation (ECVM) as well as its interrelationships and genetic code/blueprint. Full article

In this study, we examined the ventral process of C6 in extinct and extant Equus (sister taxa to Equus ferus caballus only) with the purpose of describing normal morphology and identifying anomalous variations relevant to recent studies describing a congenital malformation in E. ferus caballus. Overall, 83 specimens from 9 museums and 3 research/educational facilities were examined, totalling 71 extinct specimens from 12 species and 12 extant specimens from 5 species. The lateral view revealed that a large convexity exists in the ventral process between the cranial ventral tubercle (CrVT) and the caudal ventral tubercle (CVT) in the earliest ancestor, Hyracotherium grangeri, from 55 mya, which receded throughout the millennia to become a smaller convexity in E. ferus caballus and the sister taxa. The CrVT is visibly shorter and narrower than the CVT, with a constricted section directly ventral to the transverse process, essentially demarcating the CrVT and CVT. No congenital malformations were evident. As the ventral process of C6 is an integral component for muscle attachment in supporting the head/neck during posture and locomotion, this would indicate that the caudal module in the cervical column might be compromised when a partial or complete absence of the CVT is detected via radiographs in modern E. ferus caballus. Full article

Background: Chronic non-specific neck pain (CINP) is common, but the etiology remains unclear. This study aimed to examine the relationship between cervical muscle composition (cervical multifidus and longus capitis/longus colli), morphometry, range of movement, muscle function, and disability severity (Neck Disability Index) in patients with CINP. Methods: From September 2020 to July 2021, subjects underwent cervical MRI and clinical tests (cervical range of motion, cranio-cervical flexion test, neck flexor, and extensor muscle endurance). MRI analysis comprised muscle cross-sectional area, volume, and fat infiltration of multifidus and longus colli between C4 and C7 levels. Results: Twenty-five participants were included. Multiple linear regression analysis indicated that NDI was positively correlated with the volume percentage of fat infiltration of the multifidus (B = 0.496), negatively correlated with fat-free muscle volume of the multifidus normalized by subject height (B = −0.230), and accounted for 32% of the variance. There was no relationship between neck disability and longus capitis/longus colli morphology. We also found no relationship between neck disability scores, neck flexor or extensor muscle endurance, or the outcome motor control test of craniocervical flexion (p > 0.05). Conclusions: Neck disability was moderately correlated with the percentage of fat volume in the multifidus muscle and fat-free volume of the multifidus. There was no relationship between NDI scores and muscle function test outcomes or any fat or volume measures pertaining to the longus colli muscle. Full article

Recent literature has demonstrated that high-resolution ultrasonographic anatomy of the canine carpus is possible; however, only the structures of the dorsal face were described. The aims of this prospective study were: (1) to describe the normal ultrasonographic appearance of the carpal tendons in sporting Border Collies; (2) to measure the height, length, and thickness of the tendon at the radial ulnar notch level in order to create a baseline reference for the breed, and (3) to describe a standardised protocol to ultrasonographically evaluate the carpal faces and visible tendinous structures. A pilot study based on ten cadaveric front limbs was used to identify the structures. A subsequent clinical phase of the study using twenty-six Border Collies was recorded. The tendons of the Extensor Carpi Radialis, Extensor Digitorum Communis, and Extensor Digitorum Lateralis were identified and followed from the tenomuscular junction to the distal insertion on the dorsal face of the digits. On the lateral face, the tendon of the Extensor Carpi Ulnaris was recognised and followed. On the palmar face, the two heads of the Flexor Carpi Ulnaris tendon ending on the accessory carpal bone, the adjacent Flexor Digitorum Superficialis tendon, and the deep and medially located Flexor Digitorum Profundus tendon were seen and followed. The Flexor Carpi Radialis and the Abductor Pollicis Longus tendons were seen in the medial carpal face. The ulnar notch of the radius was used as the measurement and starting point of the ultrasonography. These data could be used as a standard reference in the case of chronic overuse and trauma-induced changes in the canine carpus. Full article

Cerebral amyloid angiopathy (CAA) is one form of disease of the small vessels of the brain and can cause frequent cerebral hemorrhages as well as other types of stroke. The aim of the study was to analyze the static and dynamic balance of the body and changes in the tension of selected muscles of the cervical spine in patients with CAA after stroke, depending on visual control or its absence, compared to healthy volunteers. Eight stroke patients and eight healthy subjects were examined. The functional Unterberger test and the Biodex SD platform were used to test the dynamic equilibrium, on which the static equilibrium was also assessed. Muscle tension was tested with the Luna EMG device. In static tests, the LC muscle (longus colli) was significantly more active with and without visual control (p = 0.016; p = 0.002), and in dynamic tests, significantly higher results for MOS (p = 0.046) were noted. The comparison of the groups led to the conclusion that the more functional deficits, the more difficult it is to keep balance, also with eye control. Full article

Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging. The longus Colli (LoCol) and longus capitis (LoCap) muscles, two deep cervical spine and head flexor muscles, frequently contribute to these patterns. Localizing and safely injecting these muscles is particularly challenging owing to their deep location and the complex regional anatomy which includes critical neurovascular and other structures. Ultrasound (US) guidance provides direct visualization of the LoCol, LoCap, other cervical muscles and adjacent structures reducing the risks and side effects while improving the clinical outcome of BoNT for these conditions. The addition of electromyography (EMG) provides confirmation of muscle activity within the target muscle. Within this manuscript, we present a technical description of a novel US guided approach (combined with EMG) for BoNT injection into the LoCol and LoCap muscles for the management of anterocollis and anterocaput in patients with CD. Full article