Citations
Citations
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 demonstrate the bifurcation pattern of the tibial nerve and its branches.
Eleven legs of seven fresh cadavers were dissected. The reference line for the bifurcation point of tibial nerve branches was an imaginary horizontal line passing the tip of the medial malleolus. The distances between the reference line and the bifurcation points were measured. The bifurcation branching patterns were categorized as type I, the pattern in which the medial calcaneal nerve (MCN) branched most proximally; type II, the pattern in which the three branches occurred at the same point; and type III, in which MCN branched most distally.
There were seven cases (64%) of type I, three cases (27%) of type III, and one case (9%) of type II. The median MCN branching point was 0.2 cm (range, -1 to 3 cm). The median bifurcation points of the lateral plantar nerves and inferior calcaneal nerves was -0.6 cm (range, -1.5 to 1 cm) and -2.5 cm (range, -3.5 to -1 cm), respectively.
MCN originated from the tibial nerve in most cases, and plantar nerves were bifurcated below the medial malleolus. In all cases, inferior calcaneal nerves originated from the lateral plantar nerve. These anatomical findings could be useful for performing procedures, such as nerve block or electrophysiologic studies.
Citations
The posterior tibial nerve was partially blocked with 7% phenol solutions for the relief of severe spasticity in cerebral palsy and brain injured patients. Forty patients were included in this study. Among them thirty five patients were cerebral palsy and five patients were brain injured.
A phenol injection was performed to the posterior tibial nerve at the popliteal fossa with the patients in a prone position. Total injected dose in each patient was 0.40 to 4.00 cc (average 2.06⁑0.96 cc). The dose was far below the toxic level and no significant side effects were noted except for a few cases of local paresthesia and tenderness. The range of dorsiflexion of the ankle was increased and the gait pattern improved in most of the patients one month after the injection. The H-reflex latency was prolonged after the injection compared with the pre-injection latency.
The phenol injection can greatly facilitate the rehabilitation process of the patient by reducing the need for physical therapy and bracing, increasing the patient's ambulation ability, and decreasing the development of secondary leg deformities.
In conclusion, with the easiness, simplicity, safety, low cost, and a selective reduction of spasticity in the group of muscles, the remarkable therapeutic benefits of posterior tibial nerve blocked with 7% phenol solutions warrant the more widespread use of this technique in younger cerebral palsy patients before developing fixed soft tissue contractures.
The purpose of this study was to investigate the maturation characteristics of neonates.
Ninety three neonates underwent a somatosensory evoked potentials(SEPs) testing. Twenty four point seven percent of them were neonates at risks including the neonatal asphyxia, low birth weight under 1500 g, or a suspicious CNS abnormality.
Seventy five point three percent of neonates showed normal median SEPs, and 24.7% of them showed abnormal or a flat response. The mean latency of the first cortical component(N1) was 25.3⁑5.4 msec, duration 16.3⁑5.5 msec and amplitude 1.00⁑1.27 ㄍV.
Thirty one point two percent of neonates showed normal posterior tibial SEPs, and 68.8% showed abnormal or a flat response. The mean latency of the first cortical component(P1) was 44.9⁑5.6 msec, duration 17.5⁑3.9 msec and amplitude 0.47⁑0.38 ㄍV.
This result suggests that the maturation of rostal nervous system develops earlier than the caudal system.
Linear decrease of the cortical latency with post-menstrual age reflects maturation of the central pathway and not merely maturation of the peripheral nerves. But our study showed much less frequency of recordings of the tibial nerve SEPs than the median nerve responses, which suggested that the maturation of spinal cord and lower-limb nerves would be slow, in addition to that the length of pathway was increasing. This result suggests that the maturation of the proximal shorter nervous pathway develops earlier than the distal longer pathway.
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