To identify the anatomical motor points of the abductor hallucis muscle in cadavers.
Motor nerve branches to the abductor hallucis muscles were examined in eight Korean cadaver feet. The motor point was defined as the site where the intramuscular nerve penetrates the muscle belly. The reference line connects the metatarsal base of the hallux (H) to the medial tubercle of the calcaneus (C). The x coordinate was the horizontal distance from the motor point to the point where the perpendicular line from the navicular tuberosity crossed the reference line. The y coordinate was the perpendicular distance from the motor point to the navicular tuberosity.
Most of the medial plantar nerves to the abductor hallucis muscles divide into multiple branches before entering the muscles. One, two, and three motor branches were observed in 37.5%, 37.5%, and 25% of the feet, respectively. The ratios of the main motor point from the H with respect to the H-C line were: main motor point, 68.79%±5.69%; second motor point, 73.45%±3.25%. The mean x coordinate value from the main motor point was 0.65±0.49 cm. The mean value of the y coordinate was 1.43±0.35 cm. All of the motor points of the abductor hallucis were consistently found inferior and posterior to the navicular tuberosity.
This study identified accurate locations of anatomical motor points of the abductor hallucis muscle by means of cadaveric dissection, which can be helpful for electrophysiological studies in order to correctly diagnose the various neuropathies associated with tibial nerve components.
Citations
To localize the site of motor points within human biceps brachii muscles through surface mapping using electrophysiological method.
We recorded the compound muscle action potentials of each lattice of the biceps brachii in 40 healthy subjects. Standardized reference lines were made as the following: 1) a horizontal reference line (elbow crease) and 2) a vertical reference line connecting coracoid process and mid-point of the horizontal reference line. The Compound muscle action potentials were mapped in reference to the standardized reference lines. The locations of motor points were mapped to the skin surface, in the ratio to the length of the vertical and the half of the horizontal reference lines.
The motor point of the short head of biceps was located at 69.0±4.9% distal and 19.1±9.5% medial to the mid-point of horizontal reference line. The location of the motor point of the long head of the biceps was 67.3±4.3% distal and 21.4±8.7% lateral. The motor point of the short head of the biceps was located more medially and distally in the male subjects compared to that in the female (p<0.05).
This study showed electrophysiological motor points of the biceps brachii muscles through surface mapping. This data might improve the clinical efficacy and the feasibility of motor point targeting, when injecting botulinum neurotoxin in biceps brachii.
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Objective: To identify the relationship between the location of motor points of gastrocnemius and soleus and the skin surface landmarks.
Method: Compound muscle action potentials (CMAPs) of each lattice of gastrocnemius and soleus in 11 healthy subjects were recorded. Standardized reference lines were made as follows: 1) a horizontal reference line (popliteal crease) and 2) a vertical reference line drawn between mid-points of the horizontal reference line and inter-malleolus connection line. The CMAPs were mapped horizontally and vertically 1cm width to the standardized reference lines. Location of motor points was mapped to the skin surface in the ratio of length of the vertical and horizontal reference lines.
Results: The motor point of medial head of gastrocnemius was located at 41.0⁑6.1% distal and 54.6⁑19.2% medial to the mid-point of horizontal reference line. The location of the motor point of the lateral head of gastrocnemius was 35.7⁑5.2% distal and 48.5⁑15.1% lateral, respectively. In the soleus, the motor point was at 68.6⁑8.0% distal and 10.5⁑9.0% lateral, respectively.
Conclusion: The motor point of the lateral head of gastrocnemius was located more proximally relative to medial head, and the motor point of soleus was located at slightly lateral side of the vertical reference line. The author concluded that mapping of motor points of the gastro-soleus muscles would increase accessibility in performing phenol motor point block or botulinum toxin injection for management of spasticity or abnormal tonicity of the ankle.
Objective: To evaluate the effects of intra-articular injection of shoulder and subscapularis motor point block on painful hemiplegic shoulder.
Method: Thirty painful hemiplegic shoulder of recent onset stroke were divided randomly into three groups, i.e. group I: range of motion (ROM) exercise only, group II: intra-articular injection with ROM exercise, group III: subscapularis motor point block with ROM exercise. The intra-articular injection of shoulder was done with 20 ml of normal saline, 5 ml of 1% lidocaine, and 40 mg of triamcinolone. The subscapularis motor point block was done with 5 ml of 5% phenol under electromyographic guide. The ROM in external rotation and simple X-ray of shoulder in full abduction were checked in three groups at pre-treatment and post-treatment 3 week, and the glenohumeral abduction and scapulohumeral rhythm were obtained from the shoulder X-ray.
Results: There were significant (p＜0.05) improvements of glenohumeral abduction, external rotation, and scapulohumeral rhythm of shoulder in group II and III, but improvement of only glenohumeral abduction was significant in group I. Angular increment of glenohumeral abduction and external rotation was most significant in group III compared with other two groups.
Conclusion: These results suggest that the intra-articular injection of shoulder and subscapularis motor point block are potentially useful techniques in the prevention and management of the painful hemiplegic shoulder.
Objective: The purposes of this study are to find out the long-term effect of motor point block using phenol on spasticity and gait pattern of spastic cerebral palsy children and to examine contributing factors for success of phenol block in functional implication of cerebral palsy.
Method: We injected 5% phenol into muscles of 35 cases with spastic cerebral palsy under the electromyographic monitoring. Pre, immediate post, and follow-up evaluations for type and severity, grade of spasticity, range of motion, and gait patterns by locomotion rating scale (LRS) were analyzed.
Results: The degree of spasticity was reduced dramatically by block, but this effect returned back to the level of pre-block state on follow-up evaluation. There was much improvement in pes equinus, genu recurvatum and scissoring tendency, while little change was observed in crouch gait and hind foot instability. These effects have been sustained on follow-up evaluation. The gait speed, deviation to normal gait, and instability in walking were significantly improved after block and on follow-up. Maintenance of adequate range of motion and good standing balance were the most important contributing factors determining the success in phenol block. Initial spasticity, initial and post LRS score were not significant.
Conclusion: After phenol block, spasticity returned back to the level of pre-block state but improvement in locomotion activity was maintained over 8 months on follow-up evaluation. The maintenance of adequate range of motion and good standing balance were the most important contributing factors determining the success in motor point block for improving locomotion activity.
Objective: To identify the precise locations of the motor branches and motor points of hamstring and triceps surae muscles to the bony landmarks.
Method: Twenty-eight limbs of 14 adult cadavers were anatomically dissected. The adult cadavers were selected randomly without regard to gender and age. The cadravers which were unable to obtain a neutral position or which received a trauma to the posterior thighs or the lower legs were excluded from the study. The number and location of the motor branches and motor points from sciatic nerve to each hamstirng muscles and from tibial nerve to each triceps surae muscles were identified related to the bony landmarks. Bony landmarks were ischial tuberosity, medial and lateral epicondyles of femur, and medial and lateral malleolli of tibia. The length of femur was defined as the distance from the ischial tuberosity to the intercondylar line of femur and the length of lower leg was defined as the distance from the intercondylar line of femur to the intermalleolar line of tibia. The locations of the muscular branches and the motor points were expressed as the percentage of the length of femur and lower leg.
Results: One muscular branch from the sciatic nerve to the semimembranosus muscle and from the posterior tibial nerve to the soleus muscle, and one or two muscular branches to the biceps femoris, semitendinosus, and semimembranosus, medial gastrocnemius, lateral gastrocnemius and soleus muscle were located at 23.0⁑5.7%, 21.0⁑10.5%, 25.0⁑10.3% of the femur from the ischial tuberosity and 2.0⁑6.2%, 4.0⁑3.3% and 10.0⁑3.3% of the lower leg from the intercondylar line of femur. There were one to four motor points in the hamstring and triceps surae muscles. The motor points of biceps femoris, semitendinosus and semimembranosus were located at 33.0⁑7.8%, 28.0⁑14.5% and 48.0⁑19.0% of the femur. The motor points of the medial gastrocnemius, lateral gastrocnemius and soleus were located in 5.0⁑0.6%, 10.0⁑3.0% and 18.0⁑4.3% of the lower leg below the intercondylar line of femur.
Conclusion: The identification of the locations of muscular branches and motor points related to the bony landmarks from this study would increase the accuracy of the motor branch blocks or motor point blocks to the hamstrings and triceps surae muscles.
Purpose: The purpose of this study is to find out the immediate effect of motor point block using phenol on the degree of spasticity and the gait patterns of children with spastic cerebral palsy and then to ascertain the cases to which these findings are most beneficial.
Subjects & Methods: We injected 5% phenol into spastic muscles of 33 cases with spastic cerebral palsy under the electromyographic monitoring. The clinical evaluation for type and severity of cerebral palsy was performed before the block and then, observations on both the degree of spasticity using `modified Ashworth scale' and the range of motion were made before and after the procedures. Finally, the gait patterns before and after block were analyzed by using locomotion rating scale for gait analysis.
Results: The degree of spasticity, which was measured with modified Ashworth scale, was reduced dramatically through our phenol block - i.e. from 2.8 to 1.2 -. The limited range of motion in some cases was not increased significantly after block. The constant pes equinus state resulted in the state that heel contact is occasionally possible. There was also much improvement in genu recurvatum and scissoring tendency, while little change was observed in crouch gait and hind foot instability. The speed of gait, deviation to normal gait and instability in walking were improved significantly after block, but their locomotion state was still moderately incomplete. When comparing the different outcomes of motor point block with one another according to the severity, the cases in moderately disabled state improved most dramatically. The group with both high degree of spasticity and the full range of motion in their joints improved by far the better after motor point block.
Conclusion: The immediate effect of motor point block with phenol solution can be best described as a dramatic relief of spasticity and tip toeing. but other problems such as other abnormal gait patterns and locomotion activity or state improved little, if any. The moderately disabled children with both high degree of spasticity and the full range of motion in their joint could get the best of our findings.
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